Perry syndrome: a disorder to consider in the differential diagnosis of Parkinsonism.

A patient with a mood disorder and a Parkinsonian syndrome with frontal cognitive impairment thought to resemble progressive supranuclear palsy defied precise diagnosis until the development of respiratory compromise, prompting consideration of the diagnosis of Perry syndrome. A mutation in the dynactin 1 gene confirmed the diagnosis. Few examples of this disorder, characterised by depression, Parkinsonism, and respiratory insufficiency, have been reported but it may be more commonly recognised with the availability of genetic testing. Perry syndrome needs to be considered in the differential diagnosis of Parkinsonism, particularly in autosomal dominant pedigrees. Diagnosis early in the disease course may facilitate monitoring and prompt intervention to avoid potentially fatal respiratory failure.

Pharmacotherapy for chronic heart failure.

BACKGROUND: Heart failure is a chronic and progressive disorder which results due to inability of the heart to pump adequate blood to meet up the metabolic demands of the body. Detecting patients with heart failure could be simple but rather complex of clinical decisions as presentation could be classical or non-specific with minimal symptoms and orsigns. Management is aimed at relieving symptoms, improving quality of life, preventing hospitalisation and arresting disease progression thus prolonging survival. In addition to pharmacologic measures, non-pharmacologic ones are also employed. METHOD: Relevant literature was reviewed using medical journals and also via internet. The key words employed were: Heart failure, Chronic heart failure, Diuretics, Vasodilators, Angiotensin receptor blockers (ARBS) and Angiotensin converting enzyme inhibitors (ACEI). The National Heart, Lung and Blood Institute, Canadian Cardiovascular Society, American College of Cardiology websites were also used in the course of this review. RESULTS: This review was able to support the use of betablockers, ACEI, ARBS, digitalis, diuretics, vasodilators and aldosterone antagonists in the management of chronic heart failure. CONCLUSION: The objectives of drug therapy in heart failure includes the short-term goals of stabilising the patient, improving haemodynamic function and conferring symptomatic improvement, as well as the long-term goal of limiting disease progression, decreasing hospital re-admission rates and improving survival. The cause needs to be established and aggravating factors identified (and where possible treated). Most of the drugs, if not all, are used in combination with one another to achieve maximal therapeutic goal. Use of some drugs could be entertained as an add-on therapy depending on any co-existing medical condition.

Pharmacotherapy for Chronic Heart Failure

Background : Heart failure is a chronic and progressive disorder which results due to inability of the heart to pump adequate blood to meet up the metabolic demands of the body. Detecting patients with heart failure could be simple but rather complex of clinical decisions as presentation could be classical or non-specific with minimal symptoms and or signs. Management is aimed at relieving symptoms; improving quality of life; preventing hospitalisation and arresting disease progression thus prolonging survival. In addition to pharmacologic measures; non-pharmacologic ones are also employed. Method : Relevant literature was reviewed using medical journals and also via internet. The key words employed were: Heart failure; Chronic heart failure; Diuretics; Vasodilators; Angiotensin receptor blockers (ARBS) and Angiotensin converting enzyme inhibitors (ACEI). The National Heart; Lung and Blood Institute; Canadian Cardiovascular Society; American College of Cardiology websites were also used in the course of this review. Results: This review was able to support the use of beta- blockers; ACEI; ARBS; digitalis; diuretics; vasodilators and aldosterone antagonists in the management of chronic heart failure. Conclusion : The objectives of drug therapy in heart failure includes the short-term goals of stabilising the patient; improving haemodynamic function and conferring symptomatic improvement; as well as the long-term goal of limiting disease progression; decreasing hospital re-admission rates and improving survival. The cause needs to be established and aggravating factors identified (and where possible treated). Most of the drugs; if not all; are used in combination with one another to achieve maximal therapeutic goal. Use of some drugs could be entertained as an add-on therapy depending on any co-existing medical condition.1

The central nervous effects of Mitragyna africanus (Willd) stembark extract in rats.

The acute toxicity and the central effects of Mitragyna africanus (M. africanus) stembark methanol extract were studied in rats. The extract did not produce any death in the treated rats even at the highest dose (6400 mg kg(-1)) used. It produced depressant effects on the central nervous system. The stembark extract potentiated amylobarbitone sleeping time in rats dose-dependently, induced sleep in rats and also produced significant local anaesthetic effect on rabbits, the effects being comparable to that of xylocaine. The extract protected rats treated with a convulsive dose of strychnine (2 mg kg(-1)) and increased the period of onset of convulsions and decreased the number of spasms.