Chronic benzodiazepine usage among older people: prevalence, indications, and treatment modifications in patients admitted to an acute geriatric unit.

AIM: To investigate the prevalence and indications of benzodiazepines (BZD) usage among patients admitted to an acute geriatric unit and assess changes in prescriptions. METHODS: BZD indications were documented reviewing clinical records, with appropriateness assessed based on the STOPP-START criteria. Changes in BZD prescriptions were recorded at discharge and 3 months later. RESULTS: Among the 366 patients included (mean age: 92.8 years, 68% females), 91 (24.9%) were on BZD upon admission, being inappropriate in 93.4%. At discharge, BZD discontinuation was observed in 40.7% and dose reduction initiated in 57.4%. Among patients discharged without prescriptions, 10.8% resumed their use at 3 months. Of those discharged with BZD tapering, 74.1% were still on them 3 months later. CONCLUSIONS: The majority of patients employing BZD lacked a medical indication. Admission to a geriatric ward resulted in successful discontinuation or dose reduction for most patients but was not maintained in the outpatient setting.

Congenital pouch colon: an unusual case report. / Bolsa colónica congénita. Reporte de un caso inusual.

INTRODUCTION: Congenital pouch colon (CPC) is a rare malformation. It causes variable dilatation of the colon associated with anorectal malformation (ARM), usually presenting a fistula towards the genitourinary tract. CASE REPORT: 2-day-old female patient, with no relevant medical history. She had abdominal distension and imperforate anus. She underwent colostomy. She had an irregular evolution with high colostomy debits. Contrast imaging studies were performed, which demonstrated an erroneous exteriorization of the jejunal loop. She underwent an exploratory open surgery, which confirmed the previous diagnosis and incidentally found colonic agenesis, with ileum entering in a pouch of 6 cm of diameter that connects with the bladder. DISCUSSION: CPC is a common pathology in certain eastern countries and extremely rare in western countries. In Ecuador, no records of reported cases were found. A correct pre-surgical analysis of ARM patients should be carried out to achieve an adequate planning and surgical approach, thus reducing morbidity and mortality.

INTRODUCCION: La bolsa colónica congénita (BCC) es una malformación poco común en la que se produce una dilatación variable del colon asociada a malformación anorrectal (MAR), generalmente presenta una fistula hacia el tracto genitourinario. CASO CLINICO: Paciente femenino de 2 días de vida, sin antecedentes médicos de relevancia, presenta distensión abdominal y ano imperforado, es sometida a colostomía, presenta evolución irregular con débitos altos a través de la colostomía, se realizan estudios contrastados de imagen donde se observa exteriorización errónea de asa de yeyuno, se somete a laparotomía exploratoria donde se comprueba lo descrito y además se reporta como hallazgo incidental agenesia colónica con desembocadura del íleon en una bolsa de 6 cm de diámetro que se conecta con la vejiga. DISCUSION: La BCC es una patología común en ciertos países orientales y extremadamente rara en países occidentales; en Ecuador, no se encontraron registros de casos reportados. Se debe realizar un correcto análisis prequirúrgico de los pacientes con MAR para conseguir una adecuada planificación y abordaje quirúrgico disminuyendo con ello la morbimortalidad en el paciente.

Bolsa colónica congénita. Reporte de un caso inusual / Congenital pouch colon: an unusual case report

INTRODUCCIÓN: La bolsa colónica congénita (BCC) es una malformación poco común en la que se produce una dilatación variable del colon asociada a malformación anorrectal (MAR); generalmente presenta una fístula hacia el tracto genitourinario. CASO CLÍNICO: Paciente femenino de 2 días de vida, sin antecedentes médicos de relevancia, presenta distensión abdominal y ano imperforado. Es sometida a colostomía, presenta evolución irregular con débitos altos a través de la colostomía, se realizan estudios contrastados de imagen donde se observa exteriorización errónea de asa de yeyuno, se somete a laparotomía exploratoria donde se comprueba lo descrito y además se reporta como hallazgo incidental agenesia colónica con desembocadura del íleon en una bolsa de 6 cm de diámetro que se conecta con la vejiga. DISCUSIÓN: La BCC es una patología común en ciertos países orientales y extremadamente rara en países occidentales; en Ecuador no se encontraron registros de casos reportados. Se debe realizar un correcto análisis prequirúrgico de los pacientes con MAR para conseguir una adecuada planificación y abordaje quirúrgico, disminuyendo con ello la morbimortalidad en el paciente

INTRODUCTION: Congenital pouch colon (CPC) is a rare malformation. It causes variable dilatation of the colon associated with anorectal malformation (ARM), usually presenting a fistula towards the genitourinary tract. CLINICAL CASE: 2-day-old female patient, with no relevant medical history. She had abdominal distension and imperforate anus. She underwent colostomy. She had an irregular evolution with high colostomy debits. Contrast imaging studies were performed, which demonstrated an erroneous exteriorization of the jejunal loop. She underwent an exploratory open surgery, which confirmed the previous diagnosis and incidentally found colonic agenesis, with ileum entering in a pouch of 6 cm of diameter that connects with the bladder. DISCUSSION: CPC is a common pathology in certain eastern countries and extremely rare in western countries. In Ecuador, no records of reported cases were found. A correct pre-surgical analysis of ARM patients should be carried out to achieve an adequate planning and surgical approach, thus reducing morbidity and mortality

Medical Students for Tissue Procurement, a 10-Year Experience in a Large University Hospital: An Exportable Model?

OBJECTIVE: The objective of this study was to describe tissue procurement activity performed during 10 years (2004-2014) by trained medical students in a large university hospital. METHODS: In this study, third to sixth year medical students were trained as in-hospital Tissue Coordinators (Tc) to perform tissue procurement activity on a 24/7 schedule supervised by an on-call senior Transplant Coordinator (sTC) in a large university hospital. Tc duty consisted of detection, initial evaluation of all hospital deaths, donor's family approach for tissue donation, and retrieval logistics organization, including corneal tissue retrieval after training and certification. They also assist sTC in organ procurement activity. RESULTS: A total of 18,931 deaths were prospectively evaluated, 79% of whom (n = 14,879) presented medical contraindications for tissue donation. Of the remaining 4052 (21%) potential tissue donors (PTD), 2522 (62%) were not converted into real donors, mostly due to family refusal (66%; n = 1650) followed by detection system failure and other logistical issues (34%; n = 872). A total of 2814 corneal units, 225 skin donations, 327 muscleskeletal tissue donations, 91 blood vessels donations, and 177 heart valve donations were obtained from the remaining 1530 (38%) real donors. Tissue potentiality increased from 19% to 43% throughout the study period as a consequence of the fluctuating acceptance criteria used by tissue banks depending on tissue demand. CONCLUSIONS: The tissue donation program performed by trained students was successful in achieving a high and sustainable tissue donation rate in a large university hospital.

[Early attention in Europe]. / La atención temprana en Europa.

INTRODUCTION: Early attention is one of the tasks of maximum priority. It is the subject of investigation throughout Europe from the educational point of view. OBJECTIVE: We describe the principal characteristics and organization of Early Attention in 18 European countries: the 15 states which are members of the European Union, Norway, Iceland and Lithuania. MATERIAL AND METHODS: The information is based on the study done by the European Agency at the end of 1998 in 17 countries, updated in 2001 and extended to 21 countries. The data obtained from the countries recently included is currently being analyzed bit is not yet fully available. The previous European studies have been repeated and brought up to date by means of questionnaires. The findings have been completed by analysis of practical examples provided by professionals from different countries. RESULTS: We present general information regarding the situation of Early Attention in these 18 countries: its relationship with the educational services, its organization, composition, financing; the organization, function and qualification of the professionals belonging to the Early Attention teams; participation of the families. Conclusion. We show a series of critical factors: the importance of attention being very early, overall evaluation of the child s possibilities and effective cooperation of the child's relatives.

La atención temprana en Europa / Early attention in europe

Introducción. La atención temprana constituye uno de los temas de trabajo prioritarios, objeto de análisis a escala europea, desde el ámbito educativo. Objetivo. Se describen las principales características y la organización de la atención temprana en 18 países europeos: los 15 estados miembros de la Unión Europea, Noruega, Islandia y Lituania. Material y métodos. La información está basada en el estudio que la Agencia Europea llevó a cabo a finales de 1998 en 17 países, puesta al día en el 2001 y ampliada a 21 países. La recogida de datos a los nuevos países está en pleno proceso de análisis, pero en este momento no está disponible en su totalidad. Los trabajos realizados anteriormente en el ámbito europeo han sido retomados y actualizados a través de cuestionarios. Los resultados obtenidos se han completado mediante el análisis de ejemplos prácticos remitidos por profesionales de los diferentes países. Resultados. Se presenta una información general sobre la situación de la atención temprana en los 18 países mencionados anteriormente: su relación con los servicios de educación; su organización; composición y financiación; la organización, funciones y cualificación de los profesionales que componen los equipos de atención temprana; la participación de las familias. Conclusión. Ponemos en evidencia una serie de elementos críticos: la importancia de la precocidad en la atención, la evaluación global de las posibilidades del niño/a y la colaboración efectiva de la familia (AU)

Molecular basis of fish-eye disease in a patient from Spain. Characterization of a novel mutation in the LCAT gene and lipid analysis of the cornea.

The genetic and biochemical basis of fish-eye disease (FED) was investigated in a 63-year-old female proband with low plasma HDL cholesterol. Analyses of corneal and plasma lipids of the proband were consistent with impaired lecithin:cholesterol acyltransferase (LCAT) activity. Free cholesterol and phospholipid levels were elevated relative to control values, whereas cholesteryl ester levels were greatly reduced. Fatty acid compositions of corneal lipids from the proband and control subjects differ from the respective fatty acid compositions of their plasma lipids. This suggests that the metabolic pathways and acyl chain specificities for phospholipid, cholesteryl ester, and triglyceride metabolism within the cornea are distinct from those of plasma. Sequencing of the LCAT gene from the proband revealed a novel mutation at nucleotide 399, corresponding to an Arg99-->Cys substitution. Secretion of LCAT (Arg99-->Cys) by transfected COS-6 cells was approximately 50% of that of the wild type, but its specific activity against reassembled HDL was 93% lower than that of wild-type LCAT. The specific activities of wild-type and LCAT (Arg99-->Cys) against LDL were reduced similarly, suggesting that the appearance of the FED phenotype does not require enhanced activity against LDL. Our data support the hypothesis that FED is a partial LCAT deficiency in which poor esterification in specific types of HDL particles may contribute to the appearance of the corneal opacities.

In vitro oxidised HDL exerts a cytotoxic effect on macrophages.

The cytotoxic effect of native high density lipoprotein (n-HDL) and oxidised high density lipoprotein (ox-HDL) on macrophages was studied and compared with that of low density lipoprotein (LDL). Copper-mediated oxidation of HDL and LDL was conducted in vitro and assessed by the analysis of conjugated dienes (CD). The kinetics of CD production during lipoprotein oxidation showed that HDL, relative to LDL, exhibited a shorter lag phase (47.7 +/- 17.8 vs. 82.9 +/- 24.5 min), higher diene production (242.2 +/- 23.0 vs 210.4 +/- 14.9 nmol/mg lipid) and reached maximal diene concentration in less time (100.0 +/- 35.4 vs 136.4 +/- 27.9 min). The maximal rate of CD production was 5.38 +/- 1.30 nmol/mg lipid/min for HDL and 4.42 +/- 0.60 nmol/mg lipid/min for LDL. Vitamin E concentration was higher in HDL than in LDL (2.76 +/- 0.41 vs. 2.19 +/- 0.33 micrograms alpha-tocopherol equivalent/mg lipid). Ox-HDL and oxidised LDL (ox-LDL), under the same experimental conditions, were cytotoxic to macrophages in a dose-dependent manner. At the same protein, or total mass concentration, ox-HDL was less cytotoxic than ox-LDL. However, when both lipoproteins were compared at the same lipid or cholesterol concentrations, ox-HDL was equally or more cytotoxic than ox-LDL. In conclusion, HDL is more susceptible to in vitro oxidation than LDL and the resultant modification of HDL converts this lipoprotein into a cytotoxic particle.

An enzyme-linked immunosorbent assay method to measure human apolipoprotein E levels using commercially available reagents: effect of apolipoprotein E polymorphism on serum apolipoprotein E concentration.

A sensitive and specific enzyme-linked immunosorbent assay (ELISA) for human apolipoprotein E (apo E) quantification using commercially available reagents is described. The assay is a noncompetitive, sandwich ELISA in which the wells were coated with a monoclonal EO1 antibody anti-human apo E and detected with a polyclonal antibody-peroxidase conjugate anti-apo E. The mean apo E concentration in 168 middle-aged subjects randomly selected from general population was 51.7 +/- 12.4 mg/liter. Apo E levels were highly correlated with apo E phenotypes. Apo E polymorphism, which shows a modulating effect in the catabolism of apo E containing lipoproteins, may explain a large fraction, 18.5%, of the variability of serum apo E levels in middle-aged population. Isoforms apo E2 and apo E4 have an opposite effect on the regulation of serum apo E concentrations. Individuals that express apo E2 isoform present higher apo E levels (65.5 mg/liter for apo E2/E3), whereas the average of individuals with apo E4 is lower (42.8 mg/liter for apo E4/E3) than general population.

[Effectiveness of hypercholesterolemia detection in high risk individuals compared to opportunistic detection]. / Eficacia de la detección de la hipercolesterolemia en los individuos de más alto riesgo frente a la búsqueda oportunista.

BACKGROUND: The aims of this study were to estimate the number of people who should receive some intervention (pharmacologic and/or dietetic) to reduce cholesterol concentrations and to evaluate selective case finding in comparison to opportunistic detection. METHODS: Six hundred twenty-five individuals participating in a study of cardiovascular risk factors were included in the study. Those with total cholesterol concentrations (TC) greater than 6.2 mmol/l and those with CT concentrations greater than 5.2 mmol/l observed upon lipid profile analysis and history of cardiovascular disease and/or risk factors were considered as candidates. Out of these individuals, those with cholesterol concentrations linked to low density lipoproteins greater than 4.14 mmol/l or greater than 3.37 mmol/l and previous history of cardiovascular disease or two risk factors were considered candidates to undergo intervention to reduce cholesterol concentrations. Moreover, the number of individuals with CT concentrations greater than 6.2 mmol/l which would not be detected if CT was only determined in those who already had another cardiovascular risk factor was estimated. RESULTS: 37.5% (CI 95%; 33.8%-41.5%) of the individuals required lipid profile and out of these 88.8% (CI 95%; 3.8%-92.4%) were candidates to receive intervention. Upon evaluating the efficacy of the strategy of selective case finding it was observed that the sensitivities of the risk factors were low, ranging from 22.6% in those with family history of cardiovascular disease to 34.8% in cases with personal history of high blood pressure. CONCLUSIONS: If selective case finding of high risk subjects was the only strategy applied, many individuals with hypercholesterolemia would remain undetected, therefore the strategy of opportunistic detection is preferable whenever possible.

A rapid procedure for eliminating chromatofocusing buffer and concentrating minor active subforms of mitochondrial malate dehydrogenase.

Mitochondrial malate dehydrogenase from several sources contains different molecular forms whose origin is still under discussion. Separation of these subforms has been achieved by chromatofocusing. A simple and rapid method, based on 5' AMP Sepharose chromatography, has been developed to concentrate mitochondrial malate dehydrogenase subforms and simultaneously remove chromatofocusing buffer.