American Journal of Medical and Clinical Research & Reviews

Influence of Sociodemographic Variables on Patient and Practitioner Knowledge of Pharmacological Management Options for Parkinson's Disease

Paula Abola, Kristin Lefebvre, Mitchell Wolden — Sun, 12 Jan 2025 00:00:00 +0300

Introduction: The pharmacological management of Parkinson's Disease (PD) is imperative to improve the quality of life for patients with the disease. However, the extent of knowledge among patients with PD and practitioners of pharmacological management options is unknown. Our primary aim was to investigate patient and practitioner knowledge of pharmacological management options for PD. Our secondary aim was to study the influence of sociodemographic variables on patient and practitioner knowledge of pharmacological management options for PD.

Methodology: The Knowledge Attitude Practice (KAP) model was adapted to develop a questionnaire that assesses patient and practitioner knowledge of pharmacological management options for PD. To determine the relationship between sociodemographic variables and patient and practitioner knowledge of pharmacological management options, basic frequency, likelihood-ratio chi-squared, Spearman's correlation, simple logistic regression, and multiple logistic regression analyses were performed.

Results: For patients (n = 492) and practitioners (n = 149), the most widely known pharmacological management option was Levodopa-Carbidopa immediate-release tablets, and the least-known was Procyclidine. Compared to patients, practitioners were more likely to have knowledge of most pharmacological management options (OR 1.62 - 9.38). Higher education level (OR 2.56 - 21.01), younger age (OR 0.17 - 0.32), geographical location (Europe OR 1.97 - 9.40, North America OR 0.07 - 0.44, Oceania OR 17.70 - 38.36), ethnicity (4.73 - 5.72), and employment status (OR 0.15 - 0.28) had a significant relationship with patient and practitioner knowledge of pharmacological management options.

Conclusion: Practitioners were more likely to have knowledge of most pharmacological management options for PD than patients. Sociodemographic variables such as education level, age, geographical location, ethnicity, and employment status influenced patient and practitioner knowledge of pharmacological management options.

Twin-To-Twin Transfusion Syndrome (Ttts) Associated With Single Intrauterine Fetal Death: Report Of A Clinical Case

Mónica Campos Sánchez — Tue, 31 Dec 2024 00:00:00 +0300

Approximately 20–25% of twin pregnancies are monochorionic, meaning that the twins share a single placenta.¹Out of these monochorionic twin pregnancies, about 10–15% are complicated by twin-to-twin transfusion syndrome (TTTS), which arises from unequal sharing of the placental blood supply. TTTS generally manifests during the second trimester of pregnancy, most commonly between 16 and 26 weeks. It occurs due to the net transfer of fluids and hormones from one twin to the other through vascular connections on the placenta. If left untreated, TTTS can have a very poor prognosis. While stage I of the condition may stabilize or even improve in up to 30% of cases managed with observation, there is a risk of progression, fetal demise, or previable birth.^2_12

The Quintero staging system, is widely accepted as the standard to communicate the severity of disease. However, these indicators are not always reliable for early detection, as TTTS can develop unpredictably.^2_5

Twin-to-twin transfusion syndrome (TTTS) occurring in 8-10% of cases
Selective fetal growth restriction (sFGR) in 10-15% of cases
Single intrauterine fetal death (sIUFD) at a rate of 6%
Twin anemia-polycythemia sequence (TAPS) in about 3-13% of cases
Twin reversed arterial perfusion sequence (TRAP), which occurs in approximately 1% of cases.⁹

Most of these complications are primarily due to a single shared placenta with intertwined vascular connections. A subset of monochorionic diamniotic twin (MCDA) pregnancies may exhibit advanced TTTS without earlier stage indicators, a condition known as “atypical TTTS.”

Additionally, the atypical TTTS may include coexisting conditions such as TAPS, sFGR, or cardiac compromise. This group also encompasses cases complicated by spontaneous septostomy( a rare complication that occurs when the dividing membrane in a multiple pregnancy ruptures, resulting in a pseudomonoamniotic environment) or TTTS in monochorionic monoamniotic twins (MCMA).⁷

Outcomes and Prognosis for Twin-to-Twin Transfusion Syndrome (TTTS): Contemporary outcome data after laser surgery suggests survival for both fetuses can be anticipated in up to 65% of cases and survival of a single fetus in up to 88% of cases. Without treatment, FFTS carries a high risk of stillbirth or disability if undetected, with up to 90% fetal loss. ^1,2

However, preterm birth remains a significant contributor to postnatal morbidity and mortality. Long term outcomes of TTTS survivors indicate that up to 11% of children may show signs of neurologic impairment.²

A 37-year-old patient came to the unit experiencing abnormal uterine bleeding, and she was subsequently diagnosed with a monochorionic-biamniotic twin pregnancy. After being denied access to tertiary-level care, she received treatment within our unit, resulting in the delivery of one healthy newborn and a papyraceous fetus that weighed 60 grams.

The Neuropsychological Consequences of Anger Suppression: A Review of Sex Differences and Clinical Implications

Benjamin Pelz — Thu, 02 Jan 2025 00:00:00 +0300

Anger suppression is a common coping mechanism used by individuals to manage anger-related emotions. However, chronic anger suppression has been linked to various negative health outcomes, including increased stress, anxiety, and cardiovascular disease. This review aims to synthesize the existing literature on the neuropsychological effects of anger suppression in men and women, with a focus on sex differences and clinical implications. A comprehensive review of existing studies reveals that both men and women exhibit altered neural activity patterns when suppressing anger, including increased activation in the anterior cingulate cortex and insula. However, sex differences emerge in the neural mechanisms underlying anger suppression, with women showing greater activation in the prefrontal cortex and reduced activity in the amygdala, and men showing increased activation in the basal ganglia and reduced activity in the prefrontal cortex. These findings suggest that men and women employ different neural strategies to regulate anger, with implications for the development of sex-specific interventions. Furthermore, chronic anger suppression has been linked to increased symptoms of anxiety and depression in both sexes, but with a greater impact on women's mental health. This review highlights the importance of considering sex differences in the neuropsychological effects of anger suppression and emphasizes the need for clinicians to develop targeted interventions that address the unique needs of men and women. By synthesizing the existing literature, this review aims to provide a comprehensive understanding of the neuropsychological consequences of anger suppression and inform the development of effective treatments for anger-related disorders.

Chimeric Antigen Receptor T-cell Therapy (CAR-T): Insights into Clinical Efficacy, Emerging Perspectives, and Future Innovations in Hematology Malignancies Treatment.

malika salhi — Tue, 31 Dec 2024 00:00:00 +0300

Chimeric antigen receptor (CAR) T-cell therapy has improved the outcome for patients with hematological malignancies. FDA-approved CAR-T-cell medications, such as tisagenlecleucel and axicabtagene ciloleucel, have significantly increased overall survival (OS) and progression-free survival (PFS) in patients with relapsed or refractory B-cell malignancies, particularly in pediatric acute lymphoblastic leukemia and diffuse large B-cell lymphoma. However, challenges remain, in particular in translating these successes to solid tumors, owing to issues such as tumor antigen heterogeneity, the immunosuppressive tumor microenvironment and antigen escape. Efforts to improve CAR-T-cell efficacy include exploring dual-target CAR constructs and combining CAR-T cells with radiotherapy, chemotherapy, or immunomodulatory agents. Additionally, the high costs of complex manufacturing processes and side effects, including cytokine release syndrome and neurotoxicity, remain significant issues. Research efforts are now focused on optimizing CAR-T-cell design, improving patient accessibility, and identifying biomarkers to predict patient outcomes. The use of real-world evidence and advanced computational modeling further highlights the important future role of CAR-T-cell therapy in cancer treatment. Overall, CAR-T-cell therapy has improved the outcomes of patients with hematologic malignancies and has potential for use in solid tumor therapy.