J.S.Bach Piano Concerto in D Minor D Minor BWV 1052 Polina Osetinskaya A...

Friedrich Gulda & Claudio Abbado - Mozart: Piano Concerto K488

https://worldstrokeorganization.blogspot.com/2018/06/new-icd-11-stroke-classification-will.html

http://www.world-stroke.org/

https://www.movementdisorders.org/MDS.htm

We are near to finalize the launch of our Stroke unit and first ever Alteplase ready team in Equatorial Africa.

We would invite Kenyan emergency services, radiologists, nurses, neurosurgeons, and vascular surgeon for our preliminary discussion panels, and training sessions.

The timetable of sessions will be available in this page, on my personal blog, and Coptic Hospital web-page.

Simeon ten Holt - Canto Ostinato for two pianos and two marimbas

Igor Stravinsky - Tango for Piano

Solo & Indrė. Full Album

Evidence Based Treatment of Idiopathic Intracranial Hypertension. (IIHT)

Andras Rozsa, MD PhD, Coptic Hospital, Kenya

Statement of problem:

Idiopathic Intracranial hypertension (formerly benign intracranial hypertension or pseudotumor cerebri) is a serious disorder with therapeutic uncertainties. It may affect young obese women, with body mass index around 40, and presents with headache, visual obscurations, back pain, and pulsatile tinnitus. One to four per one hundred thousand people may be affected every year. The condition endangers vision. There is a lack of uniform agreement concerning medical management with diuretics; and there is a lack of guidelines concerning the necessity and timing of surgical interventions.

 In a 2015 Cochran Review concluded that “although…..the included RCT showed modest benefits for acetazolamide for some outcomes, there is insufficient evidence to recommend or reject the efficacy of this intervention”.

Purpose of this Study:

To find any new evidence based results published since the Cochrane Database Review of IIHT released in 2015 August.

Methodology and Theoretical Orientations:

Online research of MEDLINE, Cochrane Library and CENTRAL, MEDSCAPE, PLOS, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform.

Findings:

New results of one trial were published in multiple articles: “Idiopathic Intracranial Hypertension Treatment Trial”. This was a randomized, double-masked, placebo-controlled study.

165 patients were enrolled with mild vision loss. 86 patients were randomized to acetazolamide, 79 to placebo group.

Quality of life questionnaire results reported improvement in visual field, and neck pain, pulsatile tinnitus, and dizziness/vertigo that outweighed the side effect of acetazolamide.

All 165 patients had lumbar puncture at enrollment, 85 at 6 month. There was an association between cerebro -spinal pressure (CSFp) and Frisen papilla edema grade (FPG) at baseline.  At 6 months, acetazolamide had similar effect on CSFp in subjects with high FPG and in subjects with low FPG . Only modest association was found between CSFp and FPG.

In patients with IIH and mild visual loss the use of acetazolamide with low-sodium weight -reduction diet compared with diet alone resulted in modest improvement in visual field function. The study found profound effect of weight loss on outcome.

89 (43 acetazolamide, 46 placebo) of 165 subjects meet criteria to enroll to asses papilla edema to SD-OCT (spectral domain optical coherence tomography). Acetazolamide group had significantly greater reduction of retinal nerve fiber and total retinal thickness.

Conclusions and Significance:

In the light of new publications it is still not clear the medication or weight loss resulted in positive outcomes. Only mild cases were enrolled in the cited study. There are no data regarding drug adverse affects, neither explanations of high drop-out rate. No CSF studies results provided except changes in opening pressure. Further RCTs needed to provide conclusive evidences of interventions.

References:

1.       Piper RJ, Kalyvas AV, Young AMH et al: Interventions for idiopathic intracranial hypertension (Review) Cochrane Database of Systematic Reviews 2015, Issue 8. Art No.: CD003434

2.       Effect of Acetazolamide on Visual Function in Patients With Idiopathic Intracranial Hypertension   and Mild Visual Loss. The Idiopathic Intracaranial Hypertension Treatment Trial. The NORDIC   Idiopathiac Intracranial Hypertension Study Group Writing Committee.  JAMA. 2014; 311(16): 1641-1652

3.       Kattah JC, Pula JH, Mejico LJ et al: CSF pressure, papillaedema grade, and response to acetazolamide in the Idiopathic Intracranial Hypertension Treatment Trial. Journal of Neurology. Published online 10 July 2015

4.       Mall M, Kupersmith MJ, Kieburtz KD et al: The Idiopathc Intracranial Hypertension Trial. JAMA Neurol. 2014 June; 71(6): 693-70 

      The OCT Sub-Study Committee and the NORDIC Idiopathic Intracranial Hypertension Study Group. Papiledema Outcomes from the OCT Substudy of the Idiopathic Intracranial Hypertension Treatment Trial. Ophtalmology. 2015 September; 122(9): 1939-1945

      Bruce BB, Digre KB, McDermott MP et al: Quality of life at 6 month in the Idiopatica Intracranial Hypertension Treatment Trial. Neurology. 2016 November; 87: 1871-1877

      Wall M, Johnson CA, Cello KE et al.; for the NORDIC Idiopathic Intracranial Hypertension Study Visual field outcomes for the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) Invest Ophtalmol Vis Sci. 2016; 57; 805-812.

driving a coach -"four at hand" - in Nairobi

Arvo Pärt Fur Alina 1976

Carey Bell - Live at the International Jazz Festival (Bern, Switzerland ...

Repose

With coach in the ‘Puszta’. The autumn in the ‘Great Hungarian Plain’

In October, from the palette of the nature, the autumn paints the ‘great Hungarian’ plain from lush green into gold, brown, yellow and amber. Lucky was I to be invited to the cottage of ’Jaszkarajeno’ by Sandor Galambos to visit the National Coach Riding competition in Hungary. The Galambos family is one of the oldest horse breeding family, and he and his son are winners of many European coach riding competitions. 

Linguistics shows that the origin of the word ‘coach’ and its equivalents in many European languages is the Hungarian word ‘kocsi’-he says. It is derived from the wagon of ‘Kocs’. The village of ‘Kocs’ in Hungary is considered to be the home of coach builders who build the first light and fast carriages.  The colorful world of carriage as part of everyday life has disappeared in inverse ratio to the rapid advance of motorization. But an increasing number of horses are kept for sport and recreation. Equestrian sports have made remarkable progress during the last few decades and their popularity has increased in our motorized world. One of the newest of the equestrian sports, carriage-driving, has recently been accorded official recognition by the International Equestrian Federation. Carriage-and-pair championships and four-in-hand World Championships has been held in every two years. Carriage-driving competitions last three days, on the first day there is presentation and dressage, on the second day the marathon, and on the third day the obstacle driving. It is very complex challenge, which requires much knowledge, attention and training.

Because it is a relatively new sport, which is a short time in horse breeding, means that we cannot even speak about individual breed especially suitable for driving competitions. The horses, other accessories such as harness, vehicle and its fitting are of vital importance. We usually use the Arab, the Lipizzaner, the Nonius and the Hungarian half-breeds, but with some refinement in breeding, Mr. Galambos explains. In selecting them, care must be taken regarding harmony, since vehicles should not only meet the demands of practicability, but also those of aesthetics. According to their usage, present day competition vehicles are divided into two groups: road carriages and cross-country carriages. As carriage-driving is a formal event, dark clothing is considered to appropriate to wear. It is very much the driver’s favour if his dress matches the colour of the covers and the grooms’ outfit. If the assistant driver wears national costume, the driver himself should be dressed in dark gray or black. The costume of the grooms and of the assistant drivers can be proper coachman’s livery or the original national costume of a particular geographic region. The assistant driver of a carriage-and-pair may be attired in a sporting style similar that of the driver. Ceremonial dress is always close fitting, the boots have seam on the side, the shafts are stiff and the counters low. The characteristic broad-brimmed hat is adorned with ostrich feathers. A fringed silk tie and brown leather gloves complete the outfit. The first day, the presentation is actually a kind of ‘beauty contest’ in which a three-member jury judges the competing teams. A very essential aspect is that horses of a team should be uniform in colour and size. The harness should be put on correctly and the team has to be fully equipped. The driver and the grooms should be dressed according to the rules. All the parts of the carriage, and accessories like shabracks, blankets, upholstery, dress, should coordinate in colour and style. Further points are awarded to the trimness of the team, i.e horses, harness, carriage, dress, boots and shoes should all be in the best condition.

During cross-country driving or marathon - which is the second day of the competition - the distance to be covered is between 20 and 30 km on very different kind of road: lose sand, gravel, loess or plain, hilly and rocky ground and sometimes even mountains.

The third day of the competition is the obstacle driving. The course of obstacle driving is either on turf or in a stadium. The obstacles to be negotiated in the sequence are: gates, U or Z-formed passages and there are sometimes water-ditches and platforms. The rather spectacular nature of obstacle driving gives it a high entertainment rating, and it usually attracts several thousand spectators. It is important to be prepared for this, as no driver is without nerves - says Mr. Galambos and instead of inviting us into a race coach, with a smile he whisked us into a ceremonial coach to enjoy the stunning autumn sunset of the ‘Puszta’. We just can not resist sharing the beauty and joy of  driving coaches.