Impact of Exercise and Cognitive Stimulation Therapy on Physical Function, Cognition and Muscle Mass in Pre-Frail Older Adults in the Primary Care Setting: A Cluster Randomized Controlled Trial.

OBJECTIVES: Multicomponent exercise program have shown to improve function and cognition in older adults but studies on pre-frail older adults in the primary care setting are limited. This study aimed i) to evaluate impact of 6 months exercise (Ex) versus complementary effect of 3 months of cognitive stimulation therapy (CST) to 6 months of Ex (Ex+CST) on physical function, muscle mass and cognition versus control group at 3, 6 and 12 months ii) inflammatory biomarkers such as Interleukin-6 (IL-6) and Tumor Necrosis Factor Alpha (TNF-α). DESIGN: Cluster randomised control trial. SETTING AND INTERVENTION: Pre-frail older adults ≥ 65 years attending primary care clinic. Two intervention groups i) Ex 6 months ii) CST 3 months with Ex 6 months. MEASUREMENTS: At 0, 3, 6 and 12 months, questionnaires (on demographics, physical function, cognition, and depression) were administered and physical function assessment (gait speed, short physical performance battery (SPPB) test, handgrip strength, five times sit-to-stand (5x-STS)) was conducted. Muscle mass and its surrogates such as phase angle and body cell mass were measured using bioelectrical impedance analysis machine. Inflammatory biomarkers were measured at 0 and 3 months. RESULTS: Data from 190 participants was analysed at 3 months (111 control, 37 Ex and 41 Ex+CST). At 3 months, significant improvement in cognition was seen only in the Ex+CST group whereas improvements in depression, gait speed, SPPB and 5x-STS were seen in both the Ex and Ex+CST groups. At 6 months, the Ex+CST group improved in cognition and depression whereas improvement in frailty and muscle mass indices were seen in both the interventions groups. At 12 months, both the interventions groups had better perceived health, gait speed and less decline in muscle mass compared with control groups. Both the Ex and Ex+CST had significant association with TNF-α at 3 months (ß -2.71 (95% CI -4.80 - -0.62); p = 0.012 and ß -1.74 (95% CI -3.43 - -0.06); p = 0.043 respectively). CONCLUSION: Combined Ex+CST had significant improvement in cognition whereas the intervention groups improved in depression, physical function, muscle mass, frailty, perceived health and TNF-α levels. With growing evidence of the benefits of multicomponent interventions at primary care level, incorporating it into mainstream care with action plans on long-term sustainability and scalability should be a priority for every country.

Association of Pain and Impact of Dual-Task Exercise on Function, Cognition and Quality of Life.

PURPOSE: This study aimed to assess the factors associated with pain and evaluate the impact of dual-task exercise on pain improvement, quality of life (QOL), cognition and function in older adults. PATIENTS AND METHODS: This study is a secondary data analysis of the HAPPY (Healthy Ageing Promotion Program for You) study. At risk older adults ≥ 60 years old were enrolled in a community dual-task exercise program. Assessments for frailty, sarcopenia, falls, quality of life (QOL) and perceived health, depression, cognition and physical function were performed at baseline and 3 months. Pain intensity was derived from EQ-5D and stratified into no pain, slight pain and moderate to extreme pain. RESULTS: Out of 296 participants, 37.2% had slight pain and 11.1% had moderate to severe pain. Both slight and moderate to extreme pain compared with no pain group were significantly associated with lower perceived health (68.2,63.6 vs 76.0) and QOL index (0.70,0.59 vs 0.93); moderate to extreme pain was also significantly associated with depression, low mental vitality, frailty, sarcopenia and poorer physical performance. After 3 months of dual-task exercise, pain improved in 70.8% of the moderate to extreme pain group and 50.8% of slight pain group. Significant improvement in perceived health, QOL, physical function and cognition were also observed. CONCLUSION: Proactive efforts are required to screen for pain and manage frailty, sarcopenia and depression. Dual-task exercise proved safe and possibly effective in reducing pain and improving QOL, physical and cognitive function in older adults. Prospective randomized studies are needed to validate the effectiveness of dual-task vs single-task exercise, including impact of reversal of frailty and sarcopenia in pain management.

Tension pneumocephalus and pneumorachis secondary to subarachnoid pleural fistula.

A case of tension pneumocephalus and pneumorachis secondary to a subarachnoid pleural fistula after thoracic spinal surgery is described. This rare complication was diagnosed on CT. The imaging findings, significance and management of this unusual condition are discussed.

Anatomy and pathology of the septal region.

Comprising the septal area and the subcortical nuclei, the septal region is gray matter structures with widespread projection systems and different neurotransmitters. Although their function is poorly understood, lesions of the septal nuclei result in a syndrome of hyper-reactivity, amnesia, and hypersexuality. The pathologic processes affecting the septal region are discussed.

Gorham's syndrome with pleural effusion and colonic carcinoma.

Gorham's syndrome is a rare primary disorder characterised by spontaneous bone-resorption which usually arrests spontaneously. The presence of thoracic findings markedly worsens the prognosis. We report a case of Gorham's syndrome with thoracic as well as skeletal involvement who subsequently developed colonic carcinoma.

Computed tomographic findings of abdominal tuberculosis--report of five cases.

Five patients with proven intra-abdominal tuberculosis were examined with computed tomography (CT) over a period of one year. This revealed hepatosplenomegaly in all five cases. Macroscopic nodules were noted in the liver and spleen in three cases. All three cases showed more severe involvement of the spleen over the liver. Other features were enlarged (para-aortic, para-caval, peripancreatic and mesenteric) nodes, ascites, stellate mesentery and thickened bowel wall. Incidental extra-abdominal findings included intrathoracic nodules, pleural effusion, pericardial effusion with constrictive pericarditis, bony osteomyelitis and psoas abscess. Follow-up CT was performed on four of the five cases and showed significant resolution of the above findings. In addition, one case showed calcification within a healing splenic nodule. The presence of macroscopic nodules detected on CT, especially in the spleen, is an unusual finding in prior reports. This paper attempts to account for its high local incidence and discusses the significance of other findings in the diagnosis of abdominal tuberculosis.

Preliminary report on ultrasound guided transrectal prostatic biopsy.

Transrectal ultrasound (TRUS)-guided transrectal biopsy was performed on 15 patients. Histological findings were carcinoma in three cases (20%), prostatitis in three cases (20%) and glandular atypia in two cases (13%). All lesions were located in the peripheral zone. Hyperechoic lesions on TRUS were seen in two of the three cases of prostatic carcinoma while hypoechoic lesions were seen in all three cases of prostatitis. Directed biopsies established the diagnosis in six cases. However, random biopsies revealed that the extent of involvement was underestimated in five of these six cases. In addition, random biopsies established the diagnosis in two cases where the directed specimen was negative. Where both digital rectal examination (DRE) and TRUS were positive for nodules and the prostatic specific antigen (PSA) was elevated, the histology was positive in 100%. Where both the DRE and TRUS were negative, the histology was negative irrespective of the PSA level. Patient acceptance of the procedure was high. Complications to the procedure were haematuria, passing blood per rectum and fever.

Serum and red blood cell magnesium, copper, and zinc content in G6PD deficiency.

Sixty-nine G6PD-deficient and 67 normal non-deficient Chinese adult males were investigated for blood hemoglobin concentration and for serum and red cell content of magnesium, copper, and zinc. There was no significant difference in blood hemoglobin content. Both the serum magnesium and copper content were found to be significantly lower in the G6PD-deficient subjects compared to that in the non-deficient control. Serum zinc content and red cell content of all the three metals were not significantly altered in G6PD deficiency.

Subcortical hemorrhage: marker for radiographically occult cerebral vein thrombosis on CT.

OBJECTIVE: Cerebral vein thrombosis (CVT) is a potentially life-threatening entity with a protean clinical presentation that can lead to delays in diagnosis and treatment. Computed tomography of the brain is often the initial imaging tool in evaluation of these patients, but is frequently nondiagnostic. This study identifies subcortical hemorrhage (SCH) as an indicator of radiographically occult CVT on CT. MATERIALS AND METHODS: A retrospective analysis of all subjects (n = 24) with CVT proven by MRI over a 4 year period was performed. The CT examinations of all subjects were evaluated for the presence of SCH and signs of CVT. An evaluation of the correlation between findings on CT and MRI as well as the delay in diagnosis and treatment secondary to unrecognized CVT on CT was also performed. RESULTS: Subcortical hemorrhage was noted in 9 of 24 (38%) subjects with CVT by MRI. The CT antedated MRI in eight of these subjects as the initial evaluation for presenting neurological symptoms. Subcortical hemorrhage was noted in six of eight of these subjects as the sole CT finding. Subcortical hemorrhage as well as CVT was seen in one subject, and no abnormality was seen in the final subject. Cerebral vein thrombosis was not suggested as a diagnosis in any of the six subjects with SCH as the sole radiographic finding. In all six of these cases, a delay in diagnosis occurred pending MRI obtained subsequently secondary to clinical deterioration. CONCLUSION: Subcortical hemorrhage can be seen in association with acute CVT and can be the sole abnormality on head CT. SCH as an isolated finding on CT suggests the possibility of unrecognized CVT, warranting further investigation by MRI.

MRI of the fornix and mamillary body in temporal lobe epilepsy.

We performed MRI on 27 patients with clinically proven temporal lobe epilepsy (TLE), all with prior EEG lateralisation, and 10 volunteers, studied to evaluate disparity in size arising from biological variation (group 1). Three-dimensional spoiled GRASS (3DSPGR) sequences provided 2-mm contiguous sections of the limbic system, enabling assessment of the hippocampus (HC), fornix (FN) and mamillary body (MB). Measurements of FN and MB width were made from a workstation. Any percentage difference in size was computed. In 19 cases there was unilateral abnormality in the HC (group 2); in 18 and 19 cases respectively there was a smaller FN and MB on the same side as the abnormal HC. This percentage difference in size was significantly greater than that in group 1 in the FN and MB in 17 and 17 cases respectively. Comparison of percentage difference computations for FN and MB between groups 1 and 2 showed high statistical significance (P < 0.0002). In 5 patients with clinical TLE the HC was normal on MRI (group 3). Unequal FN and MB sizes were found in 4, significant in 2. Comparison of percentage difference computations for FN and MB showed statistical significance (P < 0.0005 and P < 0.0003 respectively). There was no case of discordance between the sides of hippocampal abnormality and the smaller FN or MB or between the sides of smaller FN and MB. The strong concordance between the changes in the HC and those in the FN and MB suggests that this combination will play an important role in the assessment of TLE and limbic system abnormality.