Neurologic comorbidity in psychiatric inpatients: evidence from neurologic consultations in a Spanish center. / Comorbilidad neurológica en pacientes psiquiátricos ingresados: evidencia sobre interconsultas de neurología en un centro español.

INTRODUCTION: The presence of psychiatric comorbidity in some neurological disorders is common. A bi-directional influence between some psychiatric and neurological disorders has been discussed, but not widely studied. There is an absence of literature on the typology and rates of neurology consultations in different types of psychiatric inpatients. MATERIALS AND METHODS: Cross-sectional study based on real world data on patients who had a neurological consultation during hospitalization on a psychiatric ward. RESULTS: The most frequent reasons for visits to neurologists in our study were cluster 'Epilepsy/other types of non-epileptic seizures' (n = 177, 36.44%), followed by cluster 'Movement disorders' (n = 77, 20.48%), 'Cognitive disorder' (n = 69, 18.35%), and finally cluster 'Neuropathy' (n = 21, 5.59%). The most frequent type of psychiatric patient who required neurologic consultation presented a psychotic disorder (n = 100, 26.60%), follow by problem behavior (n = 82, 21.81%), bipolar disorder (n = 78, 20.78%), depressive disorder (n = 42, 11.17%) and autism spectrum disorder (n = 20, 5.32%). We found a statistically significant relationship between (problem behavior and intellectual disability) and neurologic consultation for epilepsy/other types of non-epileptic seizures, and between (depressive disorder, bipolar disorder, autism spectrum disorder and intellectual disability) and neurologic consultation for movement disorders. CONCLUSIONS: This is the first study in the literature which analyzes the rates and typology of neurologic consultations in people hospitalized with psychiatric disorders. A deep knowledge of epilepsy, movement disorders and cognitive disorders should be required for health professionals to treat psychiatric inpatients appropriately. Patients with particular psychiatric disorders seem to require a higher number of neurologic consultations than others during their hospitalization.

TITLE: Comorbilidad neurológica en pacientes psiquiátricos ingresados: evidencia sobre interconsultas de neurología en un centro español.Introducción. La presencia de comorbilidad psiquiátrica en algunos trastornos neurológicos es frecuente. Se ha discutido sobre una influencia bidireccional entre algunos trastornos psiquiátricos y neurológicos, pero este hecho no se ha estudiado ampliamente. Existe escasa información en la bibliografía sobre la tipología y la prevalencia de las interconsultas de neurología en los diferentes tipos de pacientes psiquiátricos hospitalizados. Materiales y métodos. Estudio transversal basado en datos reales sobre pacientes que necesitaron una interconsulta de neurología durante su hospitalización en salud mental. Resultados. Los motivos más frecuentes que requirieron una interconsulta de neurología en nuestro estudio fueron el clúster 'Epilepsia/otros tipos de crisis no epilépticas' (n = 177; 36,44%), seguido del clúster 'Trastornos del movimiento' (n = 77; 20,48%), el clúster 'Trastorno cognitivo' (n = 69; 18,35%) y, por último, el clúster 'Neuropatía' (n = 21; 5,9%). El tipo más frecuente de paciente psiquiátrico que requirió consulta neurológica presentó un trastorno psicótico (n = 100; 26,6%), seguido de problemas de conducta (n = 82; 21,81%), trastorno bipolar (n = 78; 20,78%), trastorno depresivo (n = 42; 11,17%) y trastorno del espectro autista (n = 20; 5,32%). Se encontró una relación estadísticamente significativa entre problemas de conducta y discapacidad intelectual e interconsulta de neurología por epilepsia/otros tipos de crisis no epilépticas, y entre trastorno depresivo, trastorno bipolar, trastorno del espectro autista y discapacidad intelectual e interconsulta de neurología por trastornos del movimiento. Conclusiones. Éste es el primer estudio en la bibliografía que analiza la frecuencia y la tipología de las interconsultas de neurología en personas hospitalizadas con trastornos psiquiátricos. Debe requerirse a los profesionales que traten a pacientes de salud mental hospitalizados un conocimiento profundo en epilepsia, trastornos del movimiento y trastornos cognitivos. Algunos pacientes con determinados trastornos psiquiátricos parecen necesitar un mayor número de interconsultas de neurología que otros durante su hospitalización.

CT and MR Imaging Appearance of the Pedicled Submandibular Gland Flap: A Potential Imaging Pitfall in the Posttreatment Head and Neck.

Pedicled locoregional submandibular gland reconstruction flaps are increasingly used in oncologic head and neck surgery and have unique imaging characteristics that can mimic locally recurrent tumor. In this clinical report, 23 posttreatment imaging studies were evaluated in 19 patients who had undergone submandibular gland flap reconstructions after resection of a primary head and neck tumor. Submandibular gland flaps were most commonly mobilized into the parapharyngeal space or parotid bed, with others located inferior to the mandibular body and within marginal mandibulectomy defects. The original shape of the gland was typically not preserved. Identifying the submandibular gland hilum, vascular pedicle, glandular texture, and absence of submandibular gland in the orthotopic location was most useful in recognizing a flap. The interpreting radiologist must be familiar with the unique submandibular gland flap imaging characteristics to accurately differentiate normal postoperative appearance and recurrent tumor.

Predictive Value of Noncontrast Head CT with Negative Findings in the Emergency Department Setting.

BACKGROUND AND PURPOSE: Noncontrast head CTs are routinely acquired for patients with neurologic symptoms in the emergency department setting. Anecdotally, noncontrast head CTs performed in patients with prior negative findings with the same clinical indication are of low diagnostic yield. We hypothesized that the rate of acute findings in noncontrast head CTs performed in patients with a preceding study with negative findings would be lower compared with patients being imaged for the first time. MATERIALS AND METHODS: We retrospectively evaluated patients in the emergency department setting who underwent noncontrast head CTs at our institution during a 4-year period, recording whether the patient had undergone a prior noncontrast head CT, the clinical indication for the examination, and the examination outcome. Positive findings on examinations were defined as those that showed any intracranial abnormality that would necessitate a change in acute management, such as acute hemorrhage, hydrocephalus, herniation, or interval worsening of a prior finding. RESULTS: During the study period, 8160 patients in the emergency department setting underwent a total of 9593 noncontrast head CTs; 88.2% (7198/8160) had a single examination, and 11.8% (962/8160) had at least 1 repeat examination. The baseline positive rate of the "nonrepeat" group was 4.3% (308/7198). The 911 patients in the "repeat" group with negative findings on a baseline/first CT had a total of 1359 repeat noncontrast head CTs during the study period. The rate of positive findings for these repeat examinations was 1.8% (25/1359), significantly lower than the 4.3% baseline rate (P < .001). Of the repeat examinations that had positive findings, 80% (20/25) had a study indication that was discordant with that of the prior examination, compared with only 44% (593/1334) of the repeat examinations that had negative findings (P < .001). CONCLUSIONS: In a retrospective observational study based on approximately 10,000 examinations, we found that serial noncontrast head CT examinations in patients with prior negative findings with the same study indication are less likely to have positive findings compared with first-time examinations or examinations with a new indication. This finding suggests a negative predictive value of a prior noncontrast head CT examination with negative findings with the same clinical indication.

Abnormal Cerebral Perfusion Profile in Older Adults with HIV-Associated Neurocognitive Disorder: Discriminative Power of Arterial Spin-Labeling.

BACKGROUND AND PURPOSE: The aging HIV-infected (HIV+) population has increased vascular comorbidities, including stroke, and increased cognitive deficits compared with the general population. Arterial spin-labeling is a technique to measure cerebral blood flow and is more sensitive than regional volume loss in assessing neurodegenerative diseases and cognitive aging. Previous studies have found global cerebral perfusion abnormalities in the HIV+ participants. In this study, we evaluated the specific regional pattern of CBF abnormalities in older HIV+ participants using quantitative whole-brain arterial spin-labeling. MATERIALS AND METHODS: CBF data from the UCSF HIV Over 60 Cohort and the Alzheimer Disease Neuroimaging Initiative were retrospectively evaluated to identify 19 HIV+ older adults, all with plasma viral suppression (including 5 with HIV-associated neurocognitive disorder); 13 healthy, age-matched controls; and 19 participants with early mild cognitive impairment. CBF values were averaged by ROI and compared among the 3 groups using generalized linear models. RESULTS: When we accounted for age, education, sex, and vascular risk factors, the HIV+ participants demonstrated alterations in regional cerebral perfusion, including hypoperfusion of bilateral temporal, parietal, and occipital brain regions compared with both clinically healthy participants and those with mild cognitive impairment. Arterial spin-labeling showed reasonable test characteristics in distinguishing those with HIV-associated neurocognitive disorder from healthy controls and participants with mild cognitive impairment. CONCLUSIONS: This study found specific CBF patterns associated with HIV status despite viral suppression-data that should animate further investigations into the pathobiologic basis of vascular and cognitive abnormalities in HIV-associated neurocognitive disorders.

Comparison of different vaccination schedules for sustaining the immune response against porcine reproductive and respiratory syndrome virus.

In order to better understand how immunization against porcine reproductive and respiratory syndrome virus (PRRSV) can be improved using commercial vaccines, different strategies of immunization were applied in the field using an inactivated vaccine (INV), a modified live vaccine (MLV) or a combination of the two and the responses compared. In experiment 1 (E1), 21 piglets were distributed in three groups. Group A was vaccinated with a commercial INV at 2.5, 3.5 and 6.5 months old; group B pigs received the INV at 1.5, 2.5, 5.5 and 6.5 months old, while pigs in group C were kept as unvaccinated controls. At 7.5 months of age all pigs were challenged with PRRSV and followed for 21 days. In experiment 2 (E2), 32 piglets were distributed evenly in four groups. Groups A, B and C were vaccinated with a commercial MLV at 1.5 months old, while group D pigs were kept as controls. At 4.5 months old, groups A and C received the INV while B received a second MLV, 1 month later group C pigs received a third INV. At 6.5 months old all pigs were challenged as in E1. In both experiments, total antibodies, neutralizing antibodies (NA) and cell-mediated immunity (CMI) were evaluated, and viraemia was determined after challenge. In E1, immunization with an INV induced high interferon-γ responses after the second and subsequent vaccinations. Development of NA after challenge was faster in INV vaccinated pigs compared to unvaccinated controls. In E2, re-vaccination with INV induced NA responses similar to re-vaccination with MLV; however, a significant increase in NA titres after challenge was only detected in group C pigs. The use of combined protocols (MLV+INV) was superior to the use of MLV alone in inducing cell mediated immunity. In conclusion, the highest immune responses against PRRSV after a single shot were achieved with MLV; after that, INV re-vaccination should be considered as the best strategy to induce significant boosters.

Validación de la versión española del Cuestionario Benign Prostatic Hyperplasia Impact Index. 'Estudio Validart' / Validation of the spanish version of the benign prostatic hyperplasia impact indez questionnaire. 'Validar study'

Introducción: La Hiperplasia Benigna de Próstata (HBP) es una enfermedad crónica que afecta la calidad de vida relacionada con la salud (CVRS). En España no hay cuestionarios específicos para evaluar la CVRS en esta enfermedad. El objetivo del presente estudio fue validar la versión española del cuestionario Benign Prostatic Hyperplasia ImpactIndex (BII). Material y métodos: Participaron hombres mayores de 49 años diagnosticados de HBP evaluados en tres visitas. Se analizaron las propiedades psicométricas del cuestionario en términos de validez, fiabilidad y sensibilidad al cambio. Resultados: Se evaluaron 1.719 hombres con edad media (DE) de 68,36 años (8,07) clasificados según gravedad de la HBP. La validez longitudinal y la validez de constructo (r>0,6) del cuestionario BII fueron moderadas-altas. La consistencia interna (α=0,91), la fiabilidad test-retest (CCI=0,8) y la sensibilidad al cambio (tamaño efecto=0,6) fueron buenas. La CVRS mejoró significativamente durante el seguimiento (p<0,01).Discusión: Hasta ahora no existían cuestionarios específicos de calidad de vida para población española con HBP. La versión española del cuestionario BII cumple las propiedades psicométricas necesarias para evaluar la CVRS en la HBP; confirmando además, el significativo impacto de la enfermedad en la calidad de vida de estos pacientes (AU)

Introduction: Benign Prostatic Hyperplasia is a chronic disease that affects Health related quality of life (HRQL). In Spain there are no specific questionnaires to assess HRQL in patients suffering from BPH. The objective of this study was to validate the Spanish version of the Benign Prostatic Hyperplasia Impact Index (BII) questionnaire. Material and methods: Study participants were men over 49 with confirmed BPH diagnosis and evaluated in three visits. Psychometric properties of the questionnaire were analyzed in terms of validity, reliability and sensitivity to change. Results: A total of 1,719 men with mean (SD) age 68.36 were evaluated and classified according to the BPH severity. Both longitudinal and construct validity (r>0.6) of the BII questionnaire were moderate-high. Internal consistency (α=0.91), test-retest reliability (CCI=0.8) and sensitivity to change (effect size=0.6) showed good results. The HRQL improved significantly during the monitoring period (p<0.01).Discussion: There were no available specific HRQL questionnaires for Spanish population with BPH until now. The Spanish version of the BII questionnaire fulfils with the psychometric properties that are necessary to evaluate HRQL in patients with BPH; furthermore, it has been confirm the considerable impact of this disease in the quality of life of this patients (AU)

Trombosis venosa cerebralprofunda puerperal / Puerperal deep cerebral venous thrombosis

No disponible

A simplified cyclic adenosine monophosphate-mediated sweat rate test for quantitative measure of cystic fibrosis transmembrane regulator (CFTR) function.

OBJECTIVE: Sweat production is stimulated by both cholinergic and beta-adrenergic pathways in the sweat gland secretory coil. beta-Adrenergic pathway-mediated sweating is absent in cystic fibrosis (CF) because cyclic adenosine monophosphate (cAMP)-mediated chloride transport through the cystic fibrosis transmembrane regulator (CFTR) is disrupted. We report the development of a rapid, reproducible, macroscopic, and quantitative methodology to test the hypothesis that beta-adrenergic sweat rate discriminates among 3 different CFTR phenotypes-CF, heterozygote CF carriers, and non-CF. STUDY DESIGN: Intradermal injection of a mixture of 50 micromol/L isoproterenol, 5 mmol/L aminophylline (to potentiate the beta-adrenergic stimulation), and 140 micromol/L atropine (to block potential cholinergic stimulation) in lactated Ringer's solution was performed in duplicate on one forearm. A single injection of 0.5 mmol/L methacholine to stimulate sweat production by the cholinergic pathway was performed on the other forearm. Sweat rate was determined as the amount of sweat collected on filter paper over 20 minutes. RESULTS AND CONCLUSIONS: Median cAMP-mediated sweat rates were 1.45 mg/20 min (CF, n = 29), 2.55 mg/20 min (CF heterozygote carriers, n = 30), and 3.65 mg/20 min (non-CF, n = 30) and were significantly different in all 3 groups (P =.0001, Kruskal-Wallis test). Methacholine-stimulated sweat rates were similar for all 3 groups. The cAMP-mediated sweat rate test may be a useful endpoint for studies of new agents to increase the function of CFTR.

Isolation and characterization of libraries of monoclonal antibodies directed against various forms of tubulin in Paramecium.

Ciliates are very good models for studying post-translationally generated tubulin heterogeneity because they exhibit highly differentiated microtubular networks in combination with reduced genetic diversity. We have approached the analysis of tubulin heterogeneity in Paramecium through extensive isolation and characterization of monoclonal antibodies using various antigens and several immunization protocols. Eight monoclonal antibodies and 10 hybridoma supernatants were characterized by: i) immunoblotting on ciliate and pig brain tubulins as well as on peptide maps of Paramecium axonemal tubulin; ii) immunoblotting on ciliate tubulin fusion peptides generated in E coli, a procedure which allows in principle to discriminate antibodies that are directed against tubulin sequence (reactive on fusion peptides) from those directed against a post-translational epitope (non-reactive); and iii) immunofluorescence on Paramecium, 3T3 and PtK2 cells. Twelve antibodies labeled all microtubules in Paramecium cells and were found to be directed against tubulin primary sequences (nine of them being located in the alpha N-terminal domain, one in the beta C-terminal one, and two in alpha and beta central stretches). The remaining ones decorated only a specific subset of microtubules within the cell and were presumably directed against post-translational modifications. Among these, three antibodies are directed against an N-terminal acetylated epitope of alpha-tubulin whereas the epitopes of three other ones (TAP 952 degrees, AXO 58 and AXO 49 degrees) apparently correspond to still unidentified post-translational modifications, located in the C-terminal domain of both alpha- and beta-tubulins. The AXO 49 degrees specificity is similar to that of a previously described polyclonal serum raised against Paramecium axonemal tubulin [2]. The results are discussed in terms of identification and accessibility of the epitopes and immunogenicity of ciliate tubulin with reference to mammalian and ciliate tubulin sequences.