ABSTRACT
Realizamos un análisis retrospectivo de los pacientes evaluados en nuestra unidad de memoria en los que se realizó determinación de biomarcadores licuorales de enfermedad de Alzheimer (EA). Se seleccionaron aquellos casos con diagnóstico de deterioro cognitivo leve debido a EA según criterios clínicos (criterios NIA-AA), déficit neuropsicológico comprobado, una puntuación igual a 3 en la escala GDS y un perfil alterado de biomarcadores en líquido cefalorraquídeo. De los 588 casos revisados, 110 cumplieron los criterios de inclusión. Durante el seguimiento, 50 de estos 110 casos (45,45%) progresaron a demencia por EA. Se observaron diferencias significativas en los niveles basales de tau total y tau fosforilada entre los casos que evolucionaron a demencia y los que permanecieron estables como deterioro cognitivo leve, siendo los niveles más altos en el grupo que progresó a demencia. Después del ajuste por edad, sexo, antecedentes de hipertensión, diabetes y nivel educativo, un aumento del 10% en los valores de proteína tau total se asoció con un aumento del 7,60% en el riesgo de progresión a demencia (HR = 2,22, IC 95% [1,28, 3,84], p = 0,004). En pacientes con deterioro cognitivo leve debido a EA un perfil alterado de biomarcadores licuorales, concentraciones progresivamente mayores de tau-t y tau-p se asocian a un mayor riesgo de conversión a demencia.(AU)
We performed a retrospective analysis of the patients assessed at our memory unit for whom Alzheimer disease (AD) cerebrospinal fluid biomarker results were available. We selected patients diagnosed with mild cognitive impairment due to AD (National Institute on Aging-Alzheimer's Association clinical criteria), confirmed neuropsychological deficit, a Global Deterioration Scale score of 3, and an abnormal profile of cerebrospinal fluid biomarkers. Of the 588 cases reviewed, 110 met the inclusion criteria. During follow-up, 50 cases (45.45%) progressed to dementia due to AD. Baseline levels of total and phosphorylated tau were higher in the group of patients that progressed to dementia than in those remaining with mild cognitive impairment. After adjusting for age, sex, history of hypertension, diabetes, and educational level, a 10% increase in total tau protein values was associated with a 7.60% increase in the risk of progression to dementia (hazard ratio: 2.22; 95% confidence interval, 1.28-3.84]; P = .004). Among patients with mild cognitive impairment due to AD and abnormal cerebrospinal fluid biomarker profiles, progressively higher concentrations of total or phosphorylated tau were associated with increased risk of progression to dementia.(AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cognitive Dysfunction , Prognosis , Biomarkers , Alzheimer Disease , Dementia , Retrospective Studies , NeurologyABSTRACT
We performed a retrospective analysis of the patients assessed at our memory unit for whom Alzheimer disease (AD) cerebrospinal fluid biomarker results were available. We selected patients diagnosed with mild cognitive impairment due to AD (National Institute on Aging-Alzheimer's Association clinical criteria), confirmed neuropsychological deficit, a Global Deterioration Scale score of 3, and an abnormal profile of cerebrospinal fluid biomarkers. Of the 588 cases reviewed, 110 met the inclusion criteria. During follow-up, 50 cases (45.45%) progressed to dementia due to AD. Baseline levels of total and phosphorylated tau were higher in the group of patients that progressed to dementia than in those remaining with mild cognitive impairment. After adjusting for age, sex, history of hypertension, diabetes, and educational level, a 10% increase in total tau protein values was associated with a 7.60% increase in the risk of progression to dementia (hazard ratio: 2.22; 95% confidence interval, 1.28-3.84]; Pâ¯=â¯.004). Among patients with mild cognitive impairment due to AD and abnormal cerebrospinal fluid biomarker profiles, progressively higher concentrations of total or phosphorylated tau were associated with increased risk of progression to dementia.
Subject(s)
Alzheimer Disease , Cognitive Dysfunction , Humans , Alzheimer Disease/diagnosis , Prognosis , Retrospective Studies , Amyloid beta-Peptides , Disease Progression , Cognitive Dysfunction/etiology , Cognitive Dysfunction/diagnosis , Biomarkers/cerebrospinal fluidABSTRACT
We performed a retrospective analysis of the patients assessed at our memory unit for whom Alzheimer disease (AD) cerebrospinal fluid biomarker results were available. We selected patients diagnosed with mild cognitive impairment due to AD (National Institute on Aging-Alzheimer's Association clinical criteria), confirmed neuropsychological deficit, a Global Deterioration Scale score of 3, and an abnormal profile of cerebrospinal fluid biomarkers. Of the 588 cases reviewed, 110 met the inclusion criteria. During follow-up, 50 cases (45.45%) progressed to dementia due to AD. Baseline levels of total and phosphorylated tau were higher in the group of patients that progressed to dementia than in those remaining with mild cognitive impairment. After adjusting for age, sex, history of hypertension, diabetes, and educational level, a 10% increase in total tau protein values was associated with a 7.60% increase in the risk of progression to dementia (hazard ratio: 2.22; 95% confidence interval, 1.28-3.84]; P = .004). Among patients with mild cognitive impairment due to AD and abnormal cerebrospinal fluid biomarker profiles, progressively higher concentrations of total or phosphorylated tau were associated with increased risk of progression to dementia.
ABSTRACT
OBJECTIVE: No study has evaluated the impact of a multifaceted intervention on the quality of the antibiotics prescribed more than 5 years later. METHODS: A total of 210 general practitioners (GP) from eight different regions of Spain were asked to participate in two registrations of respiratory tract infections (RTI) in 2008, before, and in 2009, just after a multifaceted intervention including prescriber feedback, clinical guidelines, training sessions focused on appropriate antibiotic prescribing, workshop on rapid tests and provision of these tests in the GP consultation. They were all again invited to participate in a similar registration in 2015. A new group of clinicians from the same areas who had never participated in antimicrobial stewardship courses were also invited to participate and acted as controls. RESULTS: The 121 GPs who continued the study (57.6%) and the 117 control GPs registered 22,407 RTIs. The antibiotic most commonly prescribed was amoxicillin and clavulanic acid, prescribed in 1,801 cases (8.1% of the total), followed by amoxicillin (1,372 prescriptions, 6.2%), being lower among GPs just after the intervention. The third leading antibiotic among GPs just after the intervention was penicillin V (127 cases, 3.3%) whereas macrolides ranked third in the other three groups of GPs. CONCLUSIONS: The use of first-line antibiotic for RTIs wanes over time after an intervention, but their utilisation is still significantly greater among intervened clinicians six years later compared to GPs who have never been exposed to any antimicrobial stewardship programmes.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Antimicrobial Stewardship , Bacterial Infections/drug therapy , Bacterial Infections/epidemiology , Drug Utilization , Drug Prescriptions , Humans , Practice Patterns, Physicians' , Registries , Respiratory Tract Infections/drug therapy , Respiratory Tract Infections/epidemiology , Respiratory Tract Infections/microbiology , Spain/epidemiologyABSTRACT
We report 4 patients who had apnea of variable duration after succinylcholine administration to facilitate orotracheal intubation during anesthesia. After ruling out other causes of apnea unrelated to succinylcholine, we genotyped the cholinesterase variants of these patients and their relatives measuring total plasmatic cholinesterase activity and using the inhibitors dibucaine and fluoride. We found the silent gene (Es1) both in homozygosis (2 cases) and heterozygosis, with the atypical gene (Ea11) (2 cases). The relevance of preoperative screening to prevent anesthetic accidents is emphasized.
