¿Cuál es el manejo óptimo de la leiomiomatosis peritoneal diseminada? Un caso clínico con 15 años de seguimiento sin malignización / What is the optimal management of disseminated peritoneal leiomyomatosis? A case report with 15 years of follow-up without malignancy

Introducción: La leiomiomatosis peritoneal diseminada (LPD), se trata de una enfermedad benigna, que se define por la presencia de múltiples nódulos diseminados en el peritoneo de diferentes tamaños compuestos por haces de células de músculo liso. Se postulan varias teorías sobre su origen relacionadas con el estímulo hormonal, la susceptibilidad genética y la iatrogenia tras cirugías como las miomectomías por vía laparoscópica. Hallazgos clínicos: Las pacientes suelen presentar molestias abdominales de diversa índole, incluso puede cursar de forma asintomática siendo un hallazgo casual en pruebas de imagen. Diagnósticos principales: En el diagnóstico diferencial se suelen incluir la carcinomatosis, la endometriosis, la endosalpingiosis, los tumores del tracto gastrointestinal o el leiomiosarcoma. Intervenciones terapéuticas: No hay suficiente evidencia acerca de cuál es el mejor abordaje, algunos optan por manejo expectante o tratamientos médicos y otros abogan por un manejo quirúrgico más radical. Dentro de los tratamientos médicos, uno de los más usados son los agonistas de la GnRH, también se han utilizado con buenos resultados inhibidores de la aromatasa y los moduladores selectivos de los receptores de progesterona como el acetato de ulipristal. Resultados: En este caso presentamos una paciente con LPD con 15 años de seguimiento en nuestro hospital, sin evidencia de malignización. Conclusión: Conociendo la naturaleza generalmente benigna de esta enfermedad, es necesario optar por el abordaje menos invasivo posible. Se desconoce la evolución a largo plazo de esta enfermedad, pues la mayoría de casos publicados no tienen suficiente tiempo de seguimiento.

Introduction: Disseminated peritoneal leiomyomatosis (DPL) is a benign pathology, defined by the presence of multiple disseminated nodules in the peritoneum of different sizes composed of bundles of smooth muscle cells. Several theories are postulated about its origin related to hormonal stimulus, genetic susceptibility and iatrogenesis after surgeries such as laparocopic myomectomies. Clinical findings: Patients usually present with abdominal discomfort of various kinds, and it may even be asymptomatic, being an incidental finding on imaging tests. Main diagnoses: The differential diagnosis usually includes carcinomatosis, endometriosis, endosalpingiosis, tumours of the gastrointestinal tract or leiomyosarcoma. Therapeutic interventions: There is insufficient evidence about the best approach, with some advocating expectant management or medical treatment and others advocating more radical surgical management. Among medical treatments, one of the most widely used are GnRH agonists, aromatase inhibitors and selective progesterone receptor modulators such as ulipristal acetate have also been used with good results. Results: In this case we present a patient with LPD with 15 years of follow-up in our hospital, with no evidence of malignancy. Conclusion: Knowing the generally benign nature of this disease, it is necessary to opt for the least invasive approach possible. The long-term evolution of this disease is unknown, as most published cases do not have sufficient follow-up time.(AU)

Multiorgan dysfunction syndrome due to high-dose cantharidin poisoning: A case report.

BACKGROUND: This report delves into the diagnostic and therapeutic journey undertaken by a patient with high-dose cantharidin poisoning and multiorgan dysfunction syndrome (MODS). Particular emphasis is placed on the comprehensive elucidation of the clinical manifestations of high-dose cantharidin poisoning, the intricate path to diagnosis, and the exploration of potential underlying mechanisms. CASE SUMMARY: A patient taking 10 g of cantharidin powder orally subsequently developed MODS. The patient was treated with supportive care, fluid hydration and antibiotics, and hemoperfusion and hemofiltration therapy for 24 h and successfully recovered 8 d after hospital admission. Cantharidin poisoning can cause life-threatening MODS and is rare clinically. This case underscores the challenge in diagnosis and highlights the need for early clinical differentiation to facilitate accurate assessment and prompt intervention. CONCLUSION: This article has reported and analyzed the clinical data, diagnosis, treatment, and prognosis of a case of high-dose cantharidin poisoning resulting in MODS and reviewed the relevant literature to improve the clinical understanding of this rare condition.

Estrategias de tratamiento en la metástasis vertebral. Necesidad de comités multidisciplinarios desde la perspectiva del cirujano. Narración de la literatura / Treatment strategies in vertebral metastasis. Need for multidisciplinary committees from the perspective of the surgeon. Narration of literatura

Las mejoras en el diagnóstico y tratamiento del cáncer han mejorado la supervivencia. Secundariamente también aumenta el número de estos pacientes que presentan una metástasis vertebral y el número con alguna morbilidad en relación con estas metástasis. Fractura vertebral, compresión radicular o lesión medular causan un deterioro de su calidad de vida. El objetivo en el tratamiento de las mismas ha de ser el control del dolor, mantenimiento función neurológica y de la estabilidad vertebral, teniendo presente que en muchos casos será un tratamiento paliativo.El tratamiento de estas complicaciones presenta un enfoque multidisciplinario, radiólogos, radiólogos intervencionistas, oncólogos y radioterapeutas, cirujanos de raquis, pero también Unidad de Rehabilitación o Unidad de Dolor. Recientes trabajos muestran que un enfoque multidisciplinario de estos pacientes puede mejorar calidad de vida e incluso pronóstico.En el presente trabajo se realiza una revisión y lectura de la bibliografía sobre el manejo multidisciplinario de estos pacientes.(AU)

Improvements in cancer diagnosis and treatment have improved survival. Secondarily, the number of patients who present a vertebral metastasis and the number with some morbidity in relation to these metastases also increases. Vertebral fracture, root compression or spinal cord injury cause a deterioration of their quality of life.The objective in the treatment of the vertebral metastasis must be the control of pain, maintenance of neurological function and vertebral stability, bearing in mind that in most cases it will be a palliative treatment.The treatment of these complications needs a multidisciplinary approach, radiologists, interventional radiologists, oncologists and radiation therapists, spine surgeons, but also rehabilitation or pain units. Recent studies show that a multidisciplinary approach of these patients can improve quality of life and even prognosis.In the present article, a review and reading of the literature on the multidisciplinary management of these patients is carried out.(AU)

[Translated article] Treatment strategies in vertebral metastasis. Need for multidisciplinary committees from the perspective of the surgeon. Narration of literature / Estrategias de tratamiento en la metástasis vertebral. Necesidad de comités multidisciplinarios desde la perspectiva del cirujano. Narración de la literatura

Las mejoras en el diagnóstico y tratamiento del cáncer han mejorado la supervivencia. Secundariamente también aumenta el número de estos pacientes que presentan una metástasis vertebral y el número con alguna morbilidad en relación con estas metástasis. Fractura vertebral, compresión radicular o lesión medular causan un deterioro de su calidad de vida. El objetivo en el tratamiento de las mismas ha de ser el control del dolor, mantenimiento función neurológica y de la estabilidad vertebral, teniendo presente que en muchos casos será un tratamiento paliativo.El tratamiento de estas complicaciones presenta un enfoque multidisciplinario, radiólogos, radiólogos intervencionistas, oncólogos y radioterapeutas, cirujanos de raquis, pero también Unidad de Rehabilitación o Unidad de Dolor. Recientes trabajos muestran que un enfoque multidisciplinario de estos pacientes puede mejorar calidad de vida e incluso pronóstico.En el presente trabajo se realiza una revisión y lectura de la bibliografía sobre el manejo multidisciplinario de estos pacientes.(AU)

Improvements in cancer diagnosis and treatment have improved survival. Secondarily, the number of patients who present a vertebral metastasis and the number with some morbidity in relation to these metastases also increases. Vertebral fracture, root compression or spinal cord injury cause a deterioration of their quality of life.The objective in the treatment of the vertebral metastasis must be the control of pain, maintenance of neurological function and vertebral stability, bearing in mind that in most cases it will be a palliative treatment.The treatment of these complications needs a multidisciplinary approach, radiologists, interventional radiologists, oncologists and radiation therapists, spine surgeons, but also rehabilitation or pain units. Recent studies show that a multidisciplinary approach of these patients can improve quality of life and even prognosis.In the present article, a review and reading of the literature on the multidisciplinary management of these patients is carried out.(AU)

Buruli ulcer in Africa: Geographical distribution, ecology, risk factors, diagnosis, and indigenous plant treatment options - A comprehensive review.

Buruli ulcer (BU), a neglected tropical disease (NTD), is an infection of the skin and subcutaneous tissue caused by Mycobacterium ulcerans. The disease has been documented in many South American, Asian, and Western Pacific countries and is widespread throughout much of Africa, especially in West and Central Africa. In rural areas with scarce medical care, BU is a devastating disease that can leave patients permanently disabled and socially stigmatized. Mycobacterium ulcerans is thought to produce a mycolactone toxin, which results in necrosis of the afflicted tissue and may be involved in the etiology of BU. Initially, patients may notice a painless nodule or plaque on their skin; as the disease progresses, however, it may spread to other parts of the body, including the muscles and bones. Clinical signs, microbial culture, and histological analysis of afflicted tissue all contribute to a diagnosis of BU. Though antibiotic treatment and surgical removal of infected tissue are necessary for BU management, plant-derived medicine could be an alternative in areas with limited access to conventional medicine. Herein we reviewed the geographical distribution, socioeconomic, risk factors, diagnosis, biology and ecology of the pathogen. Complex environmental, socioeconomic, and genetic factors that influence BU are discussed. Further, our review highlights future research areas needed to develop strategies to manage the disease through the use of indigenous African plants.

[Translated article] Treatment strategies in vertebral metastasis. Need for multidisciplinary committees from the perspective of the surgeon. Narration of literature.

Improvements in cancer diagnosis and treatment have improved survival. Secondarily, the number of patients who present a vertebral metastasis and the number with some morbidity in relation to these metastases also increase. Vertebral fracture, root compression or spinal cord injury cause a deterioration of their quality of life. The objective in the treatment of the vertebral metastasis must be the control of pain, maintenance of neurological function and vertebral stability, bearing in mind that in most cases it will be a palliative treatment. The treatment of these complications needs a multidisciplinary approach, radiologists, interventional radiologists, oncologists and radiation therapists, spine surgeons, but also rehabilitation or pain units. Recent studies show that a multidisciplinary approach of these patients can improve quality of life and even prognosis. In the present article, a review and reading of the literature on the multidisciplinary management of these patients is carried out.

Treatment strategies in vertebral metastasis. Need for multidisciplinary committees from the perspective of the surgeon. Narration of literatura. / Estrategias de tratamiento en la metástasis vertebral. Necesidad de comités multidisciplinarios desde la perspectiva del cirujano. Narración de la literatura.

Improvements in cancer diagnosis and treatment have improved survival. Secondarily, the number of patients who present a vertebral metastasis and the number with some morbidity in relation to these metastases also increases. Vertebral fracture, root compression or spinal cord injury cause a deterioration of their quality of life. The objective in the treatment of the vertebral metastasis must be the control of pain, maintenance of neurological function and vertebral stability, bearing in mind that in most cases it will be a palliative treatment. The treatment of these complications needs a multidisciplinary approach, radiologists, interventional radiologists, oncologists and radiation therapists, spine surgeons, but also rehabilitation or pain units. Recent studies show that a multidisciplinary approach of these patients can improve quality of life and even prognosis. In the present article, a review and reading of the literature on the multidisciplinary management of these patients is carried out.

Current trends in natural products for the treatment and management of dementia: Computational to clinical studies.

The number of preclinical and clinical studies evaluating natural products-based management of dementia has gradually increased, with an exponential rise in 2020 and 2021. Keeping this in mind, we examined current trends from 2016 to 2021 in order to assess the growth potential of natural products in the treatment of dementia. Publicly available literature was collected from various databases like PubMed and Google Scholar. Oxidative stress-related targets, NF-κB pathway, anti-tau aggregation, anti-AChE, and A-ß aggregation were found to be common targets and pathways. A retrospective analysis of 33 antidementia natural compounds identified 125 sustainable resources distributed among 65 families, 39 orders, and 7 classes. We found that families such as Berberidaceae, Zingiberaceae, and Fabaceae, as well as orders such as Lamiales, Sapindales, and Myrtales, appear to be important and should be researched further for antidementia compounds. Moreover, some natural products, such as quercetin, curcumin, icariside II, berberine, and resveratrol, have a wide range of applications. Clinical studies and patents support the importance of dietary supplements and natural products, which we will also discuss. Finally, we conclude with the broad scope, future challenges, and opportunities for field researchers.

Liver injury in COVID-19: Clinical features, potential mechanisms, risk factors and clinical treatments.

The coronavirus disease 2019 (COVID-19) pandemic has been a serious threat to global health for nearly 3 years. In addition to pulmonary complications, liver injury is not uncommon in patients with novel COVID-19. Although the prevalence of liver injury varies widely among COVID-19 patients, its incidence is significantly increased in severe cases. Hence, there is an urgent need to understand liver injury caused by COVID-19. Clinical features of liver injury include detectable liver function abnormalities and liver imaging changes. Liver function tests, computed tomography scans, and ultrasound can help evaluate liver injury. Risk factors for liver injury in patients with COVID-19 include male sex, preexisting liver disease including liver transplantation and chronic liver disease, diabetes, obesity, and hypertension. To date, the mechanism of COVID-19-related liver injury is not fully understood. Its pathophysiological basis can generally be explained by systemic inflammatory response, hypoxic damage, ischemia-reperfusion injury, and drug side effects. In this review, we systematically summarize the existing literature on liver injury caused by COVID-19, including clinical features, underlying mechanisms, and potential risk factors. Finally, we discuss clinical management and provide recommendations for the care of patients with liver injury.

Research Progress on Radiotherapy Combined with Immunotherapy for Associated Pneumonitis During Treatment of Non-Small Cell Lung Cancer.

Radiation pneumonitis is a common and serious complication of radiotherapy for thoracic tumours. Although radiotherapy technology is constantly improving, the incidence of radiation pneumonitis is still not low, and severe cases can be life-threatening. Once radiation pneumonitis develops into radiation fibrosis (RF), it will have irreversible consequences, so it is particularly important to prevent the occurrence and development of radiation pneumonitis. Immune checkpoint inhibitors (ICIs) have rapidly altered the treatment landscape for multiple tumour types, providing unprecedented survival in some patients, especially for the treatment of non-small cell lung cancer (NSCLC). However, in addition to its remarkable curative effect, ICls may cause immune-related adverse events. The incidence of checkpoint inhibitor pneumonitis (CIP) is 3% to 5%, and its mortality rate is 10% to 17%. In addition, the incidence of CIP in NSCLC is higher than in other tumour types, reaching 7%-13%. With the increasing use of immune checkpoint inhibitors (ICls) and thoracic radiotherapy in the treatment of patients with NSCLC, ICIs may induce delayed radiation pneumonitis in patients previously treated with radiation therapy, or radiation activation of the systemic immune system increases the toxicity of adverse reactions, which may lead to increased pulmonary toxicity and the incidence of pneumonitis. In this paper, the data about the occurrence of radiation pneumonitis, immune pneumonitis, and combined treatment and the latest related research results will be reviewed.

Cancer Patient Management during COVID-19 Pandemic: An Audit of a Single-Surgeon Unit in a COVID-Hotspot.

The report evaluates the effect of coronavirus disease (COVID-19) pandemic on breast cancer treatment and management at a single-surgeon cancer care unit in one of the hotspots of COVID-19 in India. In response to the pandemic, the adjustments were made in the clinical practice to accommodate social distancing. Patient consultations were done over phone call or in-clinic visit with prior appointment to reduce the risk of exposure to COVID-19. Total number of patients that were treated at the clinic and the essential surgeries performed during the pandemic phases are summarized in the report. The methodology adopted here for care and management of the cancer patients can serve as a guiding principle for cancer care units in the country.

Does a Behavioral Parent Training Program for Parents of ADHD Children Improve Outcomes? A Pilot Project.

Attention Deficit Hyperactivity Disorder (ADHD) is the most common chronic neurobehavioral disorder of childhood. Research suggests increased parent-child conflict exists in families with an ADHD child. The evidence indicates links between child behavior problems and parenting practices. Behavioral Parent Training (BPT) is an evidence-based intervention recommended for the treatment of ADHD. BPT is recommended as first-line treatment in ADHD children under age six and as a combination treatment approach for children older than the age six. BPT programs have demonstrated significant improvement in frequency of the problem behaviors of inattention, hyperactivity, and impulsivity associated with ADHD. Pre- and Post-BPT Parenting Scales and Vanderbilt ADHD Diagnostic Rating Scales for Parents and Teachers were used to evaluate the efficacy of the BPT program. Percent changes for each participant pre- and post-BPT were calculated. The Parenting Scale overall score and overreactivity factor score showed significant improvement post-BPT (p = .05). Participation in a BPT program can affect parenting practices and improve outcomes for ADHD children. BPT programs are effective in reducing negative parenting practices and improving outcomes for this population.

Heart failure with preserved ejection fraction: strategies for disease management and emerging therapeutic approaches.

Approximately 50% of patients with heart failure (HF) have a preserved ejection fraction (HFpEF), and the incidence of HFpEF is increasing relative to HF with reduced ejection fraction (HFrEF). Both types of HF are associated with reduced survival and increased risk for hospitalization. However, in contrast to HFrEF, there are no approved treatments specifically indicated for HFpEF, and current therapy is largely focused on management of symptoms and comorbidities. Diagnosis of HFpEF in the outpatient setting also presents unique challenges compared with HFrEF because of factors including a high burden of comorbidities in HFpEF and difficulties in distinguishing HFpEF from normal aging. Primary care providers (PCPs) play a pivotal role in the delivery of holistic, patient-centric care from diagnosis to management and palliative care. As the prevalence of HF continues to rise in an aging population, PCPs will need to play a greater role in HFpEF care. This article will review HFpEF etiology and pathophysiology, diagnostic workup, and management of symptoms and comorbidities, with a focus on the critical role of PCPs throughout the clinical course of HFpEF.

Electro-dewatering treatment of sludge: Assessment of the influence on relevant indicators for disposal in agriculture.

Waste activated sludge requires effective dewatering, high biological stability and retention of nutrients prior to disposal for agricultural application. The study was conducted to evaluate the impact of pressure-driven electro-dewatering (EDW) on improving sludge characteristics related to disposal in agriculture, including biological stability, pathogen availability, heavy metals concentrations and nutrients content. Thickened conditioned and mechanically dewatered sludge samples were collected from two wastewater treatment plants (WWTPs), characterized by different stabilization processes, and treated by a lab-scale device at 5, 15 and 25 V. EDW increased significantly the dry solid (DS) content, up to 43-45%, starting from 2 to 3% of raw sludge. The endogenous value of specific oxygen uptake rate (SOUR), monitored as indicator of biological stability, increased up to 56% and 39% after EDW tests for sludge from two WWTPs. On the other hand, the exogenous SOUR decreased, indicating a significant drop in the active bacterial population. Likewise, a 1-2 log unit reduction was observed for E. coli after EDW tests at 15 and 25 V. However, no remarkable removal of heavy metals, namely chromium, nickel, lead, copper and zinc, was achieved. Finally, the concentration of nutrients for soil, such as carbon, nitrogen, phosphorus and sulfur, was not affected by the EDW process. In conclusion, EDW exerts considerable effects on the biological characteristics of sludge, which should be considered in a proper design of sludge management to ensure safe and sustainable resource recovery.

A narrative review of the interpretation of guidelines for the treatment of infective endocarditis.

The recommendations of the current guidelines and the position papers of professional societies from the European Society of Cardiology/European Society of Cardiothoracic Surgeons (ESC), the American College of Cardiology/American Heart Association/Society of Thoracic Surgeon (ACC/AHA/STS) and American Association of Thoracic Surgeon (AATS) regarding management of patients with valvular heart endocarditis were updated over the past decade. However, some of the recommendations appear to contradict one another. Given the changing paradigms on how the disease manifests, our aim was to review the respective guidelines and highlight these differences whilst drawing attention to the subsequent studies from which they were derived. In particular, concerns regarding antibiotic prophylaxis and therapy, imaging modality for diagnosis and follow-up, cerebrovascular sequalae and timing of surgery are appraised in detail. We also identified the novel techniques used such as transcatheter therapies and advances in imaging modalities used for diagnosis and treatment of this condition. The lack of randomised control trials (RCTs) does raise several issues regarding applicability of findings in day-to-day practice. Therefore, the focus of upcoming studies should be on clearly defined multicenter RCTs to provide more robust evidence for the management and treatment of infective endocarditis as future guidelines will be based on the outcomes of these trials.

A management framework for left sided endocarditis: a narrative review.

Left sided endocarditis (LSE) can include the entirety or portion of mitral and/or aortic valve and the structures in their anatomical contiguity and represent a significant portion of emergency surgical activity. Literature and guidelines on the management of LSE relies mainly on observational studies given the difficulty in designing randomized trials in emergency settings. Heart teams (HT) are often called in to difficult decisions on the most appropriate strategy to adopted in case of LSE. Decision-making should take into account the localization and the extension of the infection, patient preoperative status and comorbidities, presence of a previous valve prosthesis and best timing for surgery. Despite evidence suggests that early surgery may improve survival in patients with complicated infective endocarditis (IE), an increased risk of recurrence and postoperative valvular dysfunctions has been reported. The most important factors associated with long-term outcomes are preoperative multiorgan failure, prosthetic mechanical valve IE, vegetation size ≥15 mm, and timing of surgical treatment. Importantly, up to one third of potential candidates do not undergo surgery and these patients experience extremely high mortality rates. Another important point regards the choice of the optimal valve substitute to be used according to the different clinical situation. The lack of RCT in this field and the difficulty to design this type of studies in the case of non-elective conditions further complicates the possibility to achieve a univocal consensus on the best strategy to be adopted in each form of LSE and further validation studies are needed. On the basis of the current evidences a decisional algorithm is proposed summarizing all the crucial aspects in the management of LSE.

The quest for the optimal surgical management of tricuspid valve endocarditis in the current era: a narrative review.

Tricuspid valve endocarditis (TVE) is a growing concern with increasing rates and mortality burden. The currently changing etiology, the antibiotic resistance and the raise in iatrogenic causes as with implantable cardiac devices [cardiac implantable electronic device (CIED)], represent a challenge for the management of these patients. The progressively widespread use of CIEDs is adding to the more commonly known intravenous (IV) drug abuse in the list of causes. Treatment strategies include medical therapy alone or surgery. From the surgical standpoint tricuspid valve repair, replacement or the staged procedure of valvectomy as bridge to replacement are available options. Treatment of endocarditis related to implantable device is another expanding field which requires a coordinated action with microbiologists in consideration of the microorganism antibiotic resistance. This review summarizes the currently available evidences on TVE including surgical indications, timing of interventions and technical considerations. The conflicting results of the available observational evidences and the non-unanimous consensus on many aspects of TVE impede to reach a definitive conclusion regarding the best management strategy and demands for randomized studies in this field.

Evaluation of the quality and quantity of compost and leachate from household waterless toilets in France.

One of the most undesired wastes is the human excreta due to the socio-environmental pressure. Otherwise, the nutriments contained in human excreta could be used as fertilizers to enrich the soil. Familial waterless litter composting toilets (FWLCT) are an alternative for locations where a centralized sewerage network cannot be provided or where there is a lack of standard urban infrastructure including roads, electricity, and water supply. The scientific researches on the composting techniques, the methods of control of the composting processors, and the rate of produced leachate are very limited. In this research, the composting systems included a feces and urine collection device. In each passage, the litter (carbonaceous material) is added to the excreta. Regularly, the buckets were emptied into a composting device located outside the house to which an additional portion of carbonaceous materials can be added. Monitoring was carried out on five rural and one urban familial composting areas in France for 1.5 years. The physiochemical and microbiological properties of the compost and leachate have been monitored and measured in compliance with the protocols. The results show that one of the main problems of this system of human excreta treatment is that the composting process does not achieve a significant rise in temperature and does not allow reaching the optimum temperatures (> 50 °C). Otherwise, from an agronomic point of view, the obtained compost is not rich enough in nutriments to be a good compost as soil fertilizer. But it can be used as a soil conditioner. The average leachate flux from the composters is 1.79 L/day. Because of the very short stay time in the piles, the leachate is contaminated by harmful bacteria and should be treated by another sanitation system.

Managing challenging behaviours in dementia.

Dementia is a condition marked by the progressive and irreversible clinical syndrome of cognitive decline that is eventually severe enough to interfere with daily living. Management of dementia is often complex and requires a multidisciplinary approach. This article discusses the behavioural and psychological symptoms of dementia (BPSD), such as agitation, insomnia, restlessness, hallucinations, anxiety and depressed mood, for which patients and their caregivers commonly seek medical advice from their primary care clinician. These symptoms can cause significant distress to patients, their families and caregivers, and may even lead to the patient being prematurely institutionalised. Management consists of assessment of BPSD and supporting the needs of the family, especially those of the caregiver, and can be both non-pharmacological and pharmacological.

Dementia management: a brief overview for primary care clinicians.

With the increasing life expectancy and ageing population in Singapore, we are likely to see more patients with dementia seeking help from their primary care clinicians. Acetylcholinesterase inhibitors and N-Methyl-D-aspartate receptor antagonists for dementia management can be costly given their modest efficacy, and it is important to discuss the risks and benefits with patients before a shared decision is made. Non-pharmacological management such as regular structured routine, good sleep hygiene, reminiscence and other activities are also useful in improving the well-being of dementia patients. Caregivers and family members can be advised on what to watch out for to keep patients safe at home and outdoors, as dementia patients have poor safety awareness. The primary care clinician can manage depression, if present, and refer the patient to memory clinics or appropriate specialist clinics for further assessment when indicated.