[Quality indicators in hip fracture care after the implementation of an orthogeriatrics team]. / Indicadores de calidad en atención a fractura de cadera tras la implementación de un equipo de ortogeriatría.

INTRODUCTION: The incidence of hip fracture will increase dramatically in the coming decades. It has been associated with high mortality and morbidity. Orthogeriatric programs have improved outcomes in fragility hip fracture worldwide. There is little evidence in Mexico on the impact of orthogeriatrics and adherence to quality indicators. OBJECTIVE: To compare adherence to quality indicators in hip fracture before and after the implementation of an orthogeriatrics team compared to the traditional model. MATERIAL AND METHODS: Quasi-experimental study conducted in León, Mexico. Adherence to quality indicators before and after an interconsultant orthogeriatrics team was compared. The indicators measured were: surgical delay, treatment for osteoporosis, early mobilization, type of implant and delirium. RESULTS: We included 83 patients. The surgical delay was reduced from 144 to 116 hours (28 hours), the percentage of patients with early surgery was increased from 7.9 to 18%, in addition the percentage of patients with treatment for osteoporosis was increased and the incidence of delirium was reduced. CONCLUSION: Adherence to indicators is low, however, it was possible to discreetly increase adherence to these indicators. Internal policies must be generated in public hospitals to improve this adherence and see its impact on long-term outcomes.

INTRODUCCIÓN: La incidencia de fractura de cadera se incrementará radicalmente en las siguientes décadas. Se ha asociado a una mortalidad y morbilidad elevada. Los programas de ortogeriatría en hospitales públicos han demostrado mejorar los resultados asistenciales. Hay poca evidencia en México sobre el impacto de la ortogeriatría y el apego a indicadores de calidad. OBJETIVO: Comparar el apego a indicadores de calidad en fractura de cadera antes y después de la implementación de un equipo de ortogeriatría comparado con el modelo tradicional. MATERIAL Y MÉTODOS: Estudio cuasiexperimental realizado en León, México. Se comparó la adherencia a indicadores de calidad antes y después de un equipo interconsultante de ortogeriatría. Los indicadores medidos fueron: demora quirúrgica, tratamiento para osteoporosis, movilización temprana, tipo de implante y delirium. RESULTADOS: Incluimos 83 pacientes. La demora quirúrgica se disminuyó de 144 a 116 horas (28 horas), se incrementó el porcentaje de pacientes con cirugía temprana de 7.9 a 18%, además se incrementó el porcentaje de pacientes con tratamiento para osteoporosis y se logró disminuir la incidencia de delirium. CONCLUSIÓN: El apego a indicadores es bajo; sin embargo, se logró incrementar discretamente el apego a estos indicadores. Se deben generar políticas internas en los hospitales públicos para mejorar esta adherencia y ver su impacto en los resultados a largo plazo.

Hazardous alcohol consumption and risk of alcohol dependence present different neurophysiological correlates. / El consumo de riesgo de alcohol y el riesgo de dependencia al alcohol presentan correlatos neurofisiologicos diferentes.

INTRODUCTION: Hazardous alcohol consumption (HAC) is a pattern of alcohol use that may result in harm for the user and/or for those around them. Prior research has suggested that HAC and alcohol dependence share some neurophysiological features but differ in others. AIM: To determine whether HAC and alcohol dependence presented different neurophysiological correlates. SUBJECTS AND METHODS: Two hundred subjects were screened for HAC or alcohol dependence. A quantitative electroencephalo-graphic analysis of delta, theta, alpha and beta absolute power, relative power and mean frequency in subjects with HAC but not alcohol dependence, subjects with risk of alcohol dependence and controls was performed. RESULTS: One hundred and fourteen subjects met inclusion criteria. The HAC group presented with higher beta absolute power and relative power, as well as a lower beta mean frequency than the control group, while the group with risk of alcohol dependence presented lower delta absolute power than controls. CONCLUSIONS: HAC and risk of alcohol dependence present different neurophysiological correlates. There is an important effect of the severity of alcohol dependence on neurophysiological correlates of this condition. Our results support the existence of two different types of behavioral disinhibition.

TITLE: El consumo de riesgo de alcohol y el riesgo de dependencia al alcohol presentan correlatos neurofisiologicos diferentes.Introduccion. El consumo de riesgo de alcohol (CRA) es un patron de consumo que puede resultar dañino para el usuario o para los demas. Investigaciones previas sugieren que el CRA y la dependencia al alcohol comparten algunas caracteristicas neurofisiologicas, pero difieren en otras. Objetivo. Determinar si el CRA y la dependencia al alcohol presentan correlatos neurofisiologicos diferentes. Sujetos y metodos. Doscientos sujetos realizaron la prueba de deteccion de CRA y riesgo de dependencia al alcohol (DEP). Se realizo un estudio de electroencefalografia cuantitativa para determinar la potencia absoluta, la potencia relativa y la frecuencia media de las bandas delta, theta, alfa y beta en sujetos con CRA, con DEP y controles. Resultados. Un total de 114 sujetos cumplio los criterios de inclusion. El grupo con CRA presento mayor potencia absoluta, mayor potencia relativa y menor frecuencia media de la banda beta en comparacion con los controles, mientras que el grupo con DEP presento menor potencia absoluta de la banda delta que los controles. Conclusiones. El DEP y el CRA presentan diferentes correlatos neurofisiologicos. Hay un efecto importante de la gravedad de la dependencia al alcohol sobre sus correlatos neurofisiologicos. Nuestros resultados apoyan la existencia de dos tipos distintos de desinhibicion conductual.

Plasma cytokines as potential biomarkers of kidney damage in patients with systemic lupus erythematosus.

BACKGROUND: Systemic lupus erythematosus is a heterogeneous chronic inflammatory autoimmune disorder characterized by an exacerbated expression of cytokines and chemokines in different tissues and organs. Renal involvement is a significant contributor to the morbidity and mortality of systemic lupus erythematosus, and its diagnosis is based on renal biopsy, an invasive procedure with a high risk of complications. Therefore, the development of alternative, non-invasive diagnostic tests for kidney disease in patients with systemic lupus erythematosus is a priority. AIM: To evaluate the plasma levels of a panel of cytokines and chemokines using multiplex xMAP technology in a cohort of Colombian patients with active and inactive systemic lupus erythematosus, and to evaluate their potential as biomarkers of renal involvement. RESULTS: Plasma from 40 systemic lupus erythematosus non-nephritis patients and 80 lupus nephritis patients with different levels of renal involvement were analyzed for 39 cytokines using Luminex xMAP technology. Lupus nephritis patients had significantly increased plasma eotaxin, TNF-α, interleukin-17-α, interleukin-10, and interleukin-15 as compared to the systemic lupus erythematosus non-nephritis group. Macrophage-derived chemokine, growth regulated oncogene alpha, and epidermal growth factor were significantly elevated in systemic lupus erythematosus non-nephritis patients when compared to lupus nephritis individuals. Plasma eotaxin levels allowed a discrimination between systemic lupus erythematosus non-nephritis and lupus nephritis patients, for which we performed a receiver operating characteristic curve to confirm. We observed a correlation of eotaxin levels with active nephritis (Systemic Lupus Erythematosus Disease Activity Index). Our data indicate that circulating cytokines and chemokines could be considered good predictors of renal involvement in individuals with systemic lupus erythematosus.

Determination of derived volumetric properties and heat capacities at high pressures using two density scaling based equations of state. Application to dipentaerythritol hexa(3,5,5-trimethylhexanoate).

Reliable equations of state (EoS) together with heat capacities at atmospheric pressure make it possible to determine properties such as the isobaric thermal expansivity, compressibility, both isothermal and isentropic, high pressure isobaric heat capacities or speed of sound. In this work, we analysed the reliability of two density scaling based EoS, Power-Law Density Scaling (PLDS) and General Density Scaling (GDS), and the Tammann-Tait EoS to determine these quantities. For this aim, dipentaerythritol hexa(3,5,5-trimethylhexanoate), diPEiC9, was chosen because it has been recently proposed as a candidate to fill the gap of reference fluids suitable for high pressure viscometer calibration or their verification. New experimental densities measured between (283.15 and 398.15) K at pressures up to 70 MPa together with isobaric heat capacities between (282.93 and 399.92) K and thermal conductivities between (283 and 333) K at 0.1 MPa of diPEiC9 are reported. Literature relative volumes up to 400 MPa for this compound were also used. The three EoSs give rise to coherent values of the above properties. The most difficult property to describe is isobaric thermal expansivity for which the isobaric curves can present minima and/or maxima and the isotherm curves can cross at different pressures. The loci of the maxima of the isobaric thermal expansivity in p-T diagrams of the GDS and PLDS EoSs are very close.

Heat Transfer Capability of (Ethylene Glycol + Water)-Based Nanofluids Containing Graphene Nanoplatelets: Design and Thermophysical Profile.

This research aims at studying the stability and thermophysical properties of nanofluids designed as dispersions of sulfonic acid-functionalized graphene nanoplatelets in an (ethylene glycol + water) mixture at (10:90)% mass ratio. Nanofluid preparation conditions were defined through a stability analysis based on zeta potential and dynamic light scattering (DLS) measurements. Thermal conductivity, dynamic viscosity, and density were experimentally measured in the temperature range from 283.15 to 343.15 K and nanoparticle mass concentrations of up to 0.50% by using a transient plate source, a rotational rheometer, and a vibrating-tube technique, respectively. Thermal conductivity enhancements reach up to 5% without a clear effect of temperature while rheological tests evidence a Newtonian behavior of the studied nanofluids. Different equations such as the Nan, Vogel-Fulcher-Tamman (VFT), or Maron-Pierce (MP) models were utilized to describe the temperature or nanoparticle concentration dependences of thermal conductivity and viscosity. Finally, different figures of merit based on the experimental values of thermophysical properties were also used to compare the heat transfer capability and pumping power between nanofluids and base fluid.

The effect of co-administration of intravenous calcium chloride and oxytocin on maternal hemodynamics and uterine tone following cesarean delivery: a double-blinded, randomized, placebo-controlled trial.

BACKGROUND: Oxytocin administration to prevent uterine atony following cesarean delivery is associated with adverse effects including hypotension, tachycardia, and nausea. Calcium chloride increases mean arterial pressure, systemic vascular resistance, and uterine smooth muscle contractility. This study evaluated whether the co-administration of calcium chloride with oxytocin following cesarean delivery could alter maternal hemodynamics. Secondary outcomes included uterine tone and blood loss. METHODS: Sixty healthy parturients with singleton, term, vertex pregnancies undergoing elective cesarean delivery under spinal anesthesia were randomized to one of three study solutions given intravenously immediately after umbilical cord clamping: (1) placebo, oxytocin 5U alone; (2) CA-200, oxytocin 5U+calcium chloride 200mg; or (3) CA-400, oxytocin 5U+calcium chloride 400mg. Blood pressure, heart rate, uterine tone, vasopressor or alternate uterotonic use and the incidence of nausea or vomiting were recorded. Baseline and intraoperative plasma concentration of ionized calcium and hematocrit were measured. RESULTS: Plasma concentration of ionized calcium was elevated in both study groups compared with placebo (P=0.001). Blood pressure decreased and heart rate increased in all groups (P <0.0001), with no differences between groups. No differences were observed between groups in uterine tone, vasopressor use, hematocrit change, estimated blood loss, incision-to-delivery interval, delivery-to-skin closure interval, total intravenous fluid administered or incidence of nausea. CONCLUSIONS: The decrease in blood pressure associated with oxytocin administration following cesarean delivery was not attenuated with co-administration of calcium chloride at the doses evaluated. Vasopressor use, uterine tone, and blood loss were also unaffected.

Selective estrogen receptor modulators (SERMs): new alternatives for osteoarthritis?

The dramatic rise in the prevalence rate of osteoarthritis (OA) after the menopause and the presence of estrogen receptors in joint tissues suggest that estrogen may help protect against the development of OA. Trials of estrogen therapy have produced inconclusive results, however, partly because of flaws in study design and partly because of the complexity of the mechanisms underlying estrogen's effects on joint tissues. Initial studies of the use of selective estrogen receptor modulators (SERMs) have reported beneficial effects in OA. These agents may exert both a direct effect upon joint cartilage and indirect effects on subchondral bone, synovium, muscle, tendons and ligaments. SERMs may be particularly beneficial for postmenopausal patients with osteoporotic OA, a phenotype defined by decreased bone density, associated with high remodeling in subchondral bone. More research is needed, though, before SERMs can become a therapeutic option for OA.

Effects of PTH [1-34] on synoviopathy in an experimental model of osteoarthritis preceded by osteoporosis.

PURPOSE: Synoviopathy contributes to cartilage degradation in osteoarthritis (OA). Intermittent parathyroid hormone (PTH) [1-34] administration inhibits terminal differentiation of human chondrocytes and prevents cartilage damage. We aimed to determine whether PTH [1-34] could modify synovial changes in experimental OA preceded by osteoporosis (OP). METHODS: Twenty osteoporosis (OP) rabbits underwent knee surgery to induce OA. They were administered either saline vehicle or PTH for 10 weeks. Ten healthy rabbits were used as controls. Following sacrifice, synovial changes were assessed by Krenn synovitis score, immunohistochemistry for macrophages (RAM-11), B and T lymphocytes, type I collagen, parathyroid hormone 1 receptor (PTH1R), and anti-proliferating cell nuclear antigen (PCNA). Synovial mRNA levels of Col1A1, IL-1ß, cyclooxygenase 2 (COX-2), matrix-degrading metalloproteinases (MMP-9, MMP-13), and monocyte chemotactic protein-1 (MCP-1), as well as protein expression of PTH1R were also determined. Cartilage damage was analyzed by Mankin score. RESULTS: OPOA + vehicle rabbits showed an increase in synovitis score vs controls (P = 0.003), mainly due to synovial hyperplasia and fibrosis, while PTH reduced these changes (P = 0.017). Mankin and Krenn scores were well correlated in all groups (r = 0.629, P = 0.012). Immunostaining for RAM-11 and B lymphocytes was increased (P ≤ 0.05), whereas PTH1R protein levels tended to be higher in OPOA + vehicle animals vs controls. PTH did not modify RAM-11 staining or PTH1R levels; however, it restored PTH1R localization to the vicinity of synovial vessels. PTH also decreased type I collagen, MCP-1, and MMP-13 expression (P < 0.05), as well as PCNA staining compared to vehicle-treated OPOA rabbits. CONCLUSIONS: In our model of OA aggravated by previous OP, synoviopathy correlated well with cartilage damage. Intermittent PTH [1-34] administration ameliorated both hyperplasia and fibrosis.

Improving subchondral bone integrity reduces progression of cartilage damage in experimental osteoarthritis preceded by osteoporosis.

PURPOSE: Impairment of subchondral bone density and quality aggravates cartilage damage in osteoarthritis (OA). Accordingly, we assessed whether improving microstructure and quality at subchondral bone by the bone-forming agent parathyroid hormone (PTH) [1-34] prevent cartilage damage progression in a rabbit model of OA preceded by osteoporosis (OP). METHODS: OP was induced in 20 female rabbits. At week 7, these rabbits underwent knee surgery to induce OA and, at week 12, they started either saline vehicle (n=10) or PTH (n=10) for 10 weeks. Ten healthy animals were used as controls. At week 22, microstructure was assessed by micro-computed tomography and bone remodelling by protein expression of alkaline phosphatase (ALP), metalloproteinase-9 (MMP9), osteoprotegerin (OPG) and receptor activator of nuclear factor-κB ligand (RANKL) at subchondral bone. Cartilage damage was evaluated using Mankin score. RESULTS: PTH reversed the decrease of bone area/tissue area, trabecular thickness, plate thickness, polar moment of inertia, ALP expression and OPG/RANKL ratio, as well as counteracted the increase of fractal dimension and MMP9 expression at subchondral bone of osteoarthritis preceded by osteoporosis (OPOA) rabbits compared to vehicle administration (P<0.05). Likewise, PTH decreased cartilage damage severity in OPOA rabbits. Good correlations were observed between subchondral bone structure or remodelling parameters, and cartilage Mankin score. CONCLUSIONS: Improvement of microstructural and remodelling parameters at subchondral bone by PTH [1-34] contributed to prevent cartilage damage progression in rabbits with early OPOA. These findings support the role of subchondral bone in OA. Further studies are warranted to establish the place of bone-forming agents as potential treatment in OA.

PTH increases jaw mineral density in a rabbit model of osteoporosis.

Intermittent parathyroid hormone (PTH) administration has been shown to be a promising therapy for systemic bone loss. Accordingly, we hypothesized that PTH could have positive results in treating oral complications of osteoporosis. Hence, we evaluated both mandibular bone loss and its response to PTH in a rabbit model of osteoporosis induced by ovariectomy and glucocorticoid administration. There was a significant and marked decrease in bone mineral density (BMD), bone mineral content (BMC), and calcium content in ash from the osteoporotic peri-alveolar region, which influenced global jaw loss. Remarkably, PTH (1-34) administration to osteoporotic rabbits almost completely reversed BMD, BMC, and calcium content fall in the peri-alveolar region, subsequently reducing global mandibular bone loss. Thus, although the peri-alveolar region is particularly susceptible to osteoporosis, it also responds well to intermittent PTH. Therefore, these results suggest that PTH might represent a valid therapy for improving the osseointegration of dental implants in persons with osteoporosis.

Intravitreal bevacizumab and cataract surgery after wet age-related macular degeneration / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report the use of intravitreal bevacizumab associated with cataract surgery to prevent the re-activation of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD).METHODS: Twelve eyes from 12 patients who had been previously treated for wet AMD and presented cataracts were operated on by clear cornea phacoemulsification with intraocular lens implantation, and an intravitreal injection of 1.25mg (0.05mL) bevacizumab was performed by the end of the procedure. The results were evaluated in terms of visual acuity improvement and reactivation of CNV, as determined by the appearance of fluid in optical coherence tomography (OCT). RESULTS: Best-corrected visual acuity(BCVA) significantly improved after surgery (P<0.01 and P=0.049 for BCVA after CNV closure and BCVA after cataract development respectively, Student's t test for paired data). Mean follow-up after cataract surgery was 11.8 months (SD 6.1, range 3 to 22 months). CNV reactivation or appearance of new CNV lesions was not observed in any case during follow-up. CONCLUSION: Intravitreal bevacizumab immediately after cataract surgery may prevent CNV reactivation in patients previously treated from CNV secondary to AMD.

Macular atrophy after combined intravitreal triamcinolone and photodynamic therapy to treat choroidal neovascularization / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To report the appearance of choriocapillaris atrophy after combined high dose intravitreal triamcinolone acetonide (TA) and photodynamic therapy (PDT) to treat choroidal neovascularization (CNV) associated with age related macular degeneration (AMD).METHODS: The present study was retrospective about non-randomized interventional case series. Fifty-one consecutive eyes with subfoveal (all types) CNV associated with AMD were treated by PDT and intravitreal (19.4±2.1)mg per 0.1mL TA at the Alicante Institute of Ophthalmology. The appearance of macular choriocapillaris and retinal pigment epithelium (RPE) atrophy was considered at two years follow-up. Thirty consecutive eyes treated by PDT alone, matched for age, sex, and type and size of CNV were considered as control group. RESULTS: Twenty-one of 47 eyes in the study group (45%) and 7 of 30 eyes in the control group (23%) developed macular RPE and choriocapillaris atrophy in the treated area at month 24 (P =0.04, Chi-square test). The greatest diameter of the atrophic areas averaged (5 044±1 666)μm in the study groupvs(4 345±1 550)μm in the control group. Mean final best corrected visual acuity (logarithm of minimal angle of resolution) was (0.87±033) in the cases with RPE atrophyvs(0.66±0.26) in the cases with no RPE atrophy in the study group (P=011, Mann-Whitney U test). CONCLUSION: The association of high doses of intravitreal TA and PDT may increase the risk for RPE and choriocapillaris atrophy.

Safe taste memory consolidation is disrupted by a protein synthesis inhibitor in the nucleus accumbens shell.

Consolidation is the process by which a new memory is stabilized over time, and is dependent on de novo protein synthesis. A useful model for studying memory formation is gustatory memory, a type of memory in which a novel taste may become either safe by not being followed by negative consequences (attenuation of neophobia, AN), or aversive by being followed by post-digestive malaise (conditioned taste aversion, CTA). Here we evaluated the effects of the administration of a protein synthesis inhibitor in the nucleus accumbens (NAc) shell for either safe or aversive taste memory trace consolidation. To test the effects on CTA and AN of protein synthesis inhibition, anisomycin (100microg/microl) was bilaterally infused into the NAc shell of Wistar rats' brains. We found that post-trial protein synthesis blockade impaired the long-term safe taste memory. However, protein synthesis inhibition failed to disrupt the long-term memory of CTA. In addition, we infused anisomycin in the NAc shell after the pre-exposure to saccharin in a latent inhibition of aversive taste. We found that the protein synthesis inhibition impaired the consolidation of safe taste memory, allowing the aversive taste memory to form and consolidate. Our results suggest that protein synthesis is required in the NAc shell for consolidation of safe but not aversive taste memories, supporting the notion that consolidation of taste memory is processed in several brain regions in parallel, and implying that inhibitory interactions between both taste memory traces do occur.

Diabetes, obesity and non-optimum blood pressure levels in a group of employees of the University of Puerto Rico, Medical Sciences Campus, 2003

OBJECTIVE: To estimate the proportion of diabetes, obesity and non-optimum blood pressure levels in a group of employees of the University of Puerto Rico Medical Sciences Campus that participated in a diabetes health fair at the [quot ]Centro de Diabetes para Puerto Rico[quot ]. METHODS: A total of 113 participants of the diabetes health fair completed a questionnaire to obtain demographic characteristics and the frequency of self-reported diabetes. The nursing staff examined the participants in order to obtain the following clinical characteristics: body mass index, blood pressure and blood glucose levels. RESULTS: The proportion of self-reported diabetes, obesity (> or = 30 kg/m2) and non-optimum blood pressure levels (systolic > or = 20 mm/Hg or diastolic > or = 80 mm/Hg) were 15.4(95CI: 8.5- 25.7), 80.0(95CI: 70.8-86.9) and 70.5(95CI: 61.1-78.6), respectively. Although it was not statistically significant, diabetes was higher among females (15.4) compared to males (12.0). All participants with self-reported diabetes were overweight or obese, and 91.7showed non-optimum blood pressure levels. A significant positive correlation (p < 0.001) was observed between blood pressure levels and body mass index (r = 0.3). CONCLUSIONS: The percentage of persons with diabetes, obesity, and non-optimum blood pressure levels in this sample of Medical Sciences Campus employees underscores the need for confirming these results in a larger study and developing strategies focused on reducing health risks in this population.

Type 2 diabetes mellitus among youth in Puerto Rico, 2003

AIMS: To describe the clinical characteristics, and estimate the prevalence of type 2 diabetes mellitus among Puerto Rican youth, 1995-2003. METHODS: All patients aged less than 20 years with a confirmed diagnosis of type 2 diabetes were identified from pediatric endocrinologists' medical practices. Medical records of each patient were reviewed to confirm the diagnosis, classify the type of diabetes, and gather sociodemographic and clinical characteristics. From 1995 to 2003 a total of 32,444 records were reviewed. A total of 2,800 children with diabetes were identified, of which 2,702 were type 1 and 93 type 2; typel/type 2 ratio was 29:1. Frequency distributions were obtained for categorical variables, and summary measures (mean +/- standard deviation) for quantitative measure were computed. RESULTS: Mean age at first visit was 14 years. The majority of cases were females (69), for a female/ male ratio of 2.2:1. 78.5had a family history of the disease, 74.2were overweight, and 48had acanthosis nigricans. 64.5of the cases were receiving some type of hypoglycemic therapy. 18.5of the cases had severe hypertension while 17.5had cholesterol levels considered at increased risk (e[quot ]200). The overall prevalence was 13.5 per 100,000 population. CONCLUSIONS: This study is the first that describes the frequency and clinical presentation of type 2 diabetes in children and adolescents in a sample of Puerto Ricans. Further investigations must be conducted to obtain a more precise estimate of the burden of type 2 diabetes in youth and to raise awareness of this condition among health care professionals.

Differential effects of bicuculline and muscimol microinjections into the nucleus basalis magnocellularis in taste and place aversive memory formation.

The role of the nucleus basalis magnocellularis (NBM) in learning and memory has been demonstrated in different learning paradigms such as conditioned taste aversion (CTA) and inhibitory avoidance (IA). This participation has been related to the cholinergic system, but recent studies have reported the potential role of other neurotransmitters such as GABA. The effects of acute intracerebral administration of the GABAergic antagonist bicuculline (0.05 microg) and the GABAergic agonist muscimol (0.05 microg) into the NBM of male Wistar rats were assessed in CTA and IA learning. In both learning tasks, the drug administration was performed before the acquisition. Taste aversion learning was not affected by the infusion of any of the drugs administered. IA acquisition was not affected by the administration of bicuculline or muscimol, requiring similar number of trials to reach the learning criterion. However, when the rats were tested 24 h later, those injected with bicuculline or muscimol showed an impairment of the IA learning. The present results support a role of the GABAergic system in the consolidation process of IA learning.

Effects of an exercise program on the rehabilitation of patients with spinal cord injury.

OBJECTIVES: To evaluate the impact of directed physical exercise in patients with spinal cord injury (SCI) and to measure functional independence before and after an exercise program. DESIGN: Case series. SETTING: Tertiary care center. PARTICIPANTS: Thirteen volunteers with thoracic SCI. INTERVENTION: Patients participated in a 16-week exercise program, consisting of 3 weekly 120-minute sessions. They performed mobility, strength, coordination, aerobic resistance, and relaxation activities. MAIN OUTCOME MEASURES: The FIM instrument, arm crank exercise test, wheelchair skills, maximum strength, anthropometry (body composition measurements), and lipid levels. The results were processed by using nonparametric statistical tests. RESULTS: After comparing the values at the beginning and end of the program, patients showed a significant increase in the following parameters: average FIM score (p < .001) 113 +/- 7.1; weight lifted in the bench press exercise (46%, p < .0001), military press (14%, p < .0002), and butterfly press exercise (23%, p < .0001), and number of repetitions for biceps (10%, p <.0001), triceps (18%, p < .0001), shoulder abductors (61%, p < .0001), abdominals (33%, p <.009), and curl back neck exercise (19%, p < .0001). The maximum resistance achieved during the arm crank exercise test increased (p < .001), and heart rate 6 minutes after the exercise test decreased (p <.05). The time required for the wheelchair skill tests significantly decreased in all the tasks. No statistically significant changes occurred in body weight (p < .154), percentage of body fat (p < .156), lean body weight (p < .158), cholesterol/high-density lipoprotein cholesterol ratio (p < .076), or maximum heart rate (p < .20). The only complication arose in a patient who developed transient sinus bradycardia and hypotension after the arm crank exercise test. CONCLUSION: The directed exercise program had a positive impact for most of the variables of the study.

The public health burden of diabetes: a comprehensive review.

The review of several diabetes epidemiological studies confirms that diabetes is one of the most prevalent non-communicable diseases globally, and it is the fourth or fifth leading cause of death in most developed countries. Diabetes prevalence ranges from nearly 0% in New Guinea to 50% in the Indians of Arizona. No modifiable risk factors have been clearly established in persons with type 1 diabetes, but major environmental determinants have been suggested. Impaired glucose tolerance, gestational diabetes, insulin resistance, obesity and lack of physical activity have been consistently identified as risk factors for type 2 diabetes. The prevalence of diabetes increases with age, but a sex-specific tendency has not been consistent. In addition, the prevalence of diabetes is higher in African-Americans and Hispanics when compared to other ethnic groups. Diabetes affects almost all organs of the body and is the leading cause of blindness and amputations of legs, imposing both clinical and economic costs to patients and society.

Prevalence of diabetes mellitus among insured of a health insurance company in Puerto Rico: 1997-1998.

OBJECTIVE: The purpose of this study was to determine the prevalence of diabetes mellitus in persons covered by a health insurance company. METHODS: The medical claims of persons insured with Triple S Health Insurance Co. of Puerto Rico, whose main diagnosis was diabetes (ICD9-250.0-9), were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: Overall prevalence was 4.73%. Prevalence in the male population (5.07%) was higher than that of females (4.43%) in all age groups, but the difference was not statistically significant (p > 0.05). The proportion of diabetic cases was larger in the > 60 age group. 64% of the cases had 1 or more visits to a physician office, 2% were hospitalized, and almost 3% had emergency room visits. 29% of the cases had insulin prescriptions while 59% had oral prescriptions. The younger age group (< or = 44 years) had a larger utilization rate of emergency room and hospital admissions. Health service utilization varied by age and sex, however, the only significant difference was observed in glucose test services utilization (p < 0.05). CONCLUSIONS: The prevalence of diabetes in this group was lower than the prevalence reported in the Behavioral Risk Factor Surveillance System. This may be partially explained by the fact that the study group did not represent the composition of the Puerto Rican population. Prevalence studies using other groups will be helpful to determine the prevalence of diabetes in Puerto Rico.

Prevalence of diabetes and patterns of health services utilization: a comparative analysis between a private and a health reform group of insured, 1997-1998.

OBJECTIVE: To compare the prevalence and health services utilization patterns of diabetes mellitus in a group of insured under the Puerto Rico Health Reform Act and the private sector of the same insurance company. METHODS: The medical claims of the public sector insured whose main diagnosis was diabetes mellitus (ICD9-250.0-9) were selected for analysis. Prevalence and medical utilization rates were estimated. General characteristics and services utilization were compared by age and sex using the chi-square distribution. RESULTS: A total of 38,139 diabetic cases were identified during the study period. Overall prevalence was 6.23% (95% CI: 6.17%-6.29%); 5.22% among males (95% CI: 5.14-5.30) and 7.09% among females (95% CI: 7.00%-7.18%). The proportion of cases was larger in persons aged 65 years or more (60.3%) and females (61.6%). Overall, 84.7% of insured diabetics had medical office visits, while 7.8% had emergency room services and 1.3% had hospital admissions. Female cases had more physician office visits (62%) and insulin prescriptions (65%) compared to males (p < 0.05). The most reported complication was cerebrovascular accident (4.4%). The prevalence of diabetes was higher in the public sector (6.23%) when compared to the private sector (4.73%) (p < 0.01). The mean number of oral hypoglycemic (32.77 +/- 0.40) and insulin (40.99 +/- 0.54) prescriptions were higher in the public sector (p < 0.01). Emergency room utilization rate was larger among males in the younger age groups of the private sector. However, hospital admissions were larger in both sexes of the younger age group of the public sector when compared with the private sector. CONCLUSIONS: A higher prevalence of diabetes and mean service utilization was observed in the public sector. An in-depth analysis of the health care of patients with diabetes in the public sector is needed.