Brief cognitive tests as a decision-making tool in primary care. A population and validation study.

INTRODUCTION AND OBJECTIVES: Brief cognitive tests (BCT) are used in primary care (PC) for the detection of cognitive impairment (CI). Still, there are little data on their diagnostic utility (DU) in a community setting. This work evaluates the DU at the population level of Fototest, T@M, AD8 questionnaire and MMSE. It provides new cut-off points (CoP) validated in a CI early detection program. MATERIAL AND METHODS: In the population and validation samples, the evaluation was carried out in two phases, a first of screening and administration of BCT and a second of clinical diagnosis, blinded to the results of the BCT, applying the current NIA-AA criteria. The DU of BCT in the population sample was evaluated with the area under the ROC curve (aROC). Youden index and the CoP with the best specificity that ensured a sensitivity of 80% were used to decide on the most appropriate CoP. The sensitivity, specificity, and predictive values for these CoP were calculated in the validation sample. RESULTS: 260 participants (23.1% with CI) from the population sample and 177 (42.4% with CI) from the validation sample were included. The Fototest has the best UD at the population level (aROC 0.851), which improves with the combination of Fototest and AD8 (aROC 0.875). The proposed CoP are AD8 ≥ 1, Fototest ≤ 35, T@M ≤ 40, and MMSE ≤ 26. CONCLUSION: BCT are helpful in detecting CI in PC. This work supports the use of more demanding PoC.

Human chorionic gonadotropin (hCG) plasma levels at oocyte retrieval and IVF outcomes.

PURPOSE: The aim of our study was to ascertain the influence of hCG levels at oocyte pick-up on IVF outcomes, and their relationship with clinical parameters. METHODS: A prospective study was performed including 473 women undergoing IVF, aged under 40 years. Blood samples to analyze hCG levels were obtained at the time of follicular aspiration, 36 h after the administration of 250 µg of recombinant hCG. RESULTS: Neither the numbers of oocytes obtained or fertilized, nor the pregnancy rate, were correlated with hCG levels. Moreover, hCG values were very similar in women who did and did not become pregnant (123.3 ± 48.7 and 117.5 ± 44.7 mUI/mL). Cases in which no oocytes were recovered after follicular aspiration had similar hCG levels to those in which more than 1 oocyte was obtained. On the other hand, hCG levels were negatively related to body mass index, weight, and age. CONCLUSIONS: These data indicate that after the administration of 250 µg of recombinant hCG, hCG levels are not responsible for failure to recover oocytes. Specifically, there was no correlation between plasma hCG levels and the number of oocytes obtained or other markers of IVF outcome. There was, however, an inverse relationship with BMI, body weight and age.

Prognostic value of serum progesterone and LH values on the day of hCG administration in IUI GnRH antagonist cycles.

OBJECTIVE: to evaluate the effect of LH surge and progesterone rise in IUI cycles under gonadotropin stimulation with GnRH antagonist coadministration on pregnancy rates (PR). STUDY DESIGN: The population under study consisted of 152 women prospectively studied and subjected to IUI. RESULTS: The higher the progesterone cutoff value, the lower the PR were 26.5% and 10.9% when the cutoff was 1 ng/mL, 26.0% and 8.6% when the cutoff was 1.2 ng/mL, 25.6% and 7.1% when the cutoff was 1.4 ng/mL and 25.3% and 0% when the cutoff was 1.6 ng/mL. CONCLUSION: In IUI cycles under GnRH antagonist coadministration, serum progesterone levels over 1.0 ng/mL are associated with lower PR, the higher the progesterone levels, the lower the PR.

[Bilateral chylothorax in a case of metastatic adenocarcinoma of unknown primary]. / Quilotórax bilateral en un caso de adenocarcinoma metastásico de primario desconocido.

We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax.

Quilotórax bilateral en un caso de adenocarcinoma metastásico de primario desconocido / Bilateral chylothorax in a case of metastatic adenocarcinoma of unknown primary

Presentamos el caso de una paciente diagnosticada de quilotórax bilateral y de linfangitis carcinomatosa pulmonar, que evolucionó de forma desfavorable conduciendo al fallecimiento por insuficiencia respiratoria, en el contexto de un adenocarcinoma metastásico de primario desconocido tras el estudio necrópsico. A partir de este caso, revisamos la etiología, el diagnóstico y las opciones disponibles en el tratamiento de los quilotórax

We present a case of bilateral chylothorax and lung carcinomatous lymphangitis. Clinical evolution was unfavorable, leading to death due to respiratory insufficiency. Necropsy showed widespread metastatic adenocarcinoma of unknown primary. From this case, we review the etiology, diagnosis and therapeutic options available in chylothorax

Relación entre variables sociodemográficas y clínicas y calidad de vida relacionada con la salud en pacientes con enfermedad inflamatoria intestinal / Relationship between socio-demographic and clinical variables, and health-related quality of life in patients with inflammatory bowel disease

Objetivo: el objetivo principal del presente trabajo consiste en evaluar la influencia de las variables sociodemográficas y clínicas en la calidad de vida relacionada con la salud de los pacientes con enfermedad inflamatoria intestinal. Pacientes y método: se trata de un estudio transversal. La calidad de vida relacionada con la salud se investigó utilizando el “Inflammatory Bowel Disease Questionnaire” (IBDQ). Un total de 120 pacientes, 60 con colitis ulcerosa y 60 con enfermedad deCrohn participaron en el estudio. Resultados: no se apreciaron diferencias significativas en la calidad de vida relacionada con la salud en las dimensiones delIBDQ en función de la enfermedad, sin embargo, tras el análisis multivariante, el sexo, el tipo de tratamiento, las manifestaciones extradigestivas, el número de recaídas anual, la satisfacción con la cirugía y la necesidad de apoyo psicológico aparecieron relacionadascon la calidad de vida relacionada con la salud.Conclusiones: la identificación de las variables de calidad de vida relacionada con la salud en pacientes con enfermedad inflamatoria intestinal parece vinculada básicamente a elementos externos al tipo de enfermedad. El conocimiento de tales elementos puede resultar muy útil para orientar y modificar factores específicosen futuras actuaciones

Objective: the principal aim of the present study is to evaluate the influence of socio-demographic and clinical variables on health-related quality of life (HRQL) in patients with inflammatory bowel disease. Patients and method: this was a cross-sectional study. health-related quality of life was measured with the Inflammatory ;;Bowel Disease Questionnaire (IBDQ). A total of 120 patients, 60 with ulcerative colitis and 60 with Crohn’s disease, participated in the study. Results: no significant differences were observed between ulcerative ;;colitis and Crohn’s disease patients in IBDQ dimensions. ;;However, a multivariate analysis revealed that sex, type of treatment, extraintestinal symptoms, number of relapses in previous year, satisfaction with surgery, and need for psychological support were related to HRQL. ;;Conclusions: the identification of these variables associated with HRQL in patients with inflammatory bowel disease shows them to be basically non-disease factors. Knowledge of such elements can turn out to be very useful in order to guide future research and modify specific factors in further interventions

Association between vitamin D receptor FokI. Polymorphism and serum parathyroid hormone level in patients with chronic renal failure.

We investigated the relationship between vitamin D receptor (VDR) start codon polymorphism and serum levels of PTH, calcidiol, and calcium in 64 Spanish patients with chronic renal failure (CRF). An exon 2 fragment of the VDR gene was amplified by PCR, and cleaved with the restriction enzyme FokI. The alleles were identified according to the digestion pattern obtained as F (absence of restriction site) and f (presence of restriction site). Genotype frequencies in the patient population were 54.7% FF, 28.1% Ff and 17.2% ff, vs 46.7% FF, 43.3% Ff and 10% ff in a healthy control population. The difference between the two populations was statistically significant (p<0.01). Within the patient population, mean serum PTH level in the FF group was significantly higher (159.77+/-25.69 pg/ml) than in both the Ff and ff groups (106.67+/-19.07 and 77.55+/-15.85 pg/ml, respectively; p<0.05). However there were no significant differences in serum levels of calcidiol or calcium among genotypes. These results suggest that FokI polymorphisms of the VDR gene may determine parathyroid response in CRF patients.

Relationship between socio-demographic and clinical variables, and health-related quality of life in patients with inflammatory bowel disease.

OBJECTIVE: The principal aim of the present study is to evaluate the influence of socio-demographic and clinical variables on health-related quality of life (HRQL) in patients with inflammatory bowel disease. PATIENTS AND METHOD: This was a cross-sectional study. health-related quality of life was measured with the Inflammatory Bowel Disease Questionnaire (IBDQ). A total of 120 patients, 60 with ulcerative colitis and 60 with Crohn s disease, participated in the study. RESULTS: No significant differences were observed between ulcerative colitis and Crohn s disease patients in IBDQ dimensions. However, a multivariate analysis revealed that sex, type of treatment, extraintestinal symptoms, number of relapses in previous year, satisfaction with surgery, and need for psychological support were related to HRQL. CONCLUSIONS: The identification of these variables associated with HRQL in patients with inflammatory bowel disease shows them to be basically non-disease factors. Knowledge of such elements can turn out to be very useful in order to guide future research and modify specific factors in further interventions.

¿Se puede mejorar el postoperatorio de la hemorroidectomía? Estudio comparativo del dispositivo Ligasure® frente a la hemorroidectomía con diatermia / Can posthemorrhoidectomy pain be improved? Ligasure® vs diathermy hemorrhoidectomy

Introducción. La hemorroidectomía es una técnica de uso frecuente y con una importante morbilidad, fundamentalmente en forma de dolor postoperatorio.El presente trabajo tiene el objetivo de comparar, en términos de dolor postoperatorio, un nuevo tipo de hemorroidectomía mediante el empleo del sellador de vasos Ligasure®.Pacientes y métodos. Cincuenta pacientes consecutivos intervenidos de hemorroides grados II, III y IV fueron aleatorizados en 2 grupos: en 24 pacientes se realizó una hemorroidectomía abierta con Ligasure®y en 26, como grupo control, una hemorroidectomía con diatermia. Se valoró el dolor postoperatorio mediante escala analógica visual en el primer, tercer y séptimo días, en la tercera semana y en el tercer mes.Un investigador independiente realizó una encuesta de satisfacción al final del estudio.Resultados. Treinta y tres mujeres (66 por ciento) y 17 varones (34 por ciento) con una edad media de 54 años fueron intervenidos de hemorroides: 24 con el dispositivo Ligasure® y 26 con técnica de diatermia. La distribución por grados fue de 4 pacientes con grado II, 28 con grado III y 18 con grado IV. El número de paquetes intervenidos fue de un paquete en 2 pacientes, dos en 7 pacientes, tres en 39 y cuatro en 2. No se detectaron diferencias entre los grupos en relación con la edad (p = 0,724), el sexo (p = 0,556), el grado hemorroidal (p = 0,39), el número de paquetes (p = 0,25), el tiempo de intervención (p = 0,122), la escala analógica visual al primer, tercer y séptimo días postoperatorios (p = 0,850, 0,595 y 0,969, respectivamente), el tacto rectal a la tercera semana y el tercer mes (p = 0,931) así como el número y el tipo de complicaciones.Conclusiones. En nuestra experiencia, en términos de dolor postoperatorio, no hay diferencias entre la cirugía hemorroidal con diatermia y el empleo del Ligasure® (AU)

Echocardiographic modeling of cardiac dyssynchrony before and during multisite stimulation: a prospective study.

Multisite biventricular pacing therapy offers significant clinical improvement in some stimulated patients with electrocardiographic criteria of cardiac dyssynchrony. However, observational data increasingly suggest that patients suffering from congestive heart failure in presence of modest QRS widening may also derive benefit from cardiac resynchronization therapy (CRT), and that some patients can be significantly improved clinically after system implantation despite no apparent change in QRS width. This pilot study explored the value of an echocardiographic model to identify cardiac electromechanical dyssynchrony parameters (EDP) in candidates for CRT, and their potential correction after implantation. The study included 66 consecutive CRT recipients of CRT in NYHA functional class III or IV who had one or more atrioventricular, interventricular or intraventricular dyssynchrony criteria. An immediate improvement was observed in 85% of the population with a partial or total correction of their EDP. However, the modifications in EDP differed considerably between recipients of de novo CRT systems and patients with previously implanted standard pacing systems upgraded with the implantation of a left ventricular lead. EDP measurements appear to identify potential candidates for CRT, and to confirm the success of system implantation.

Study of interactions between permanent pacemakers and electronic antitheft surveillance systems.

Interference of electronic antitheft systems (EASs) with pacemakers has been an object of controversy. This study was performed in 204 patients followed by our pacemaker surveillance center. The data from a total of 408-patient exposures to the EAS were analyzed. The device tested consisted of 129 DDD, 71 VVI, and 4 VDD pacemakers from seven manufacturers. The EAS studied consisted of an "acoustomagnetic" system that emits an intermittent 58-kHz signal, and a magnetic audio frequency system that emits a continuous 73-Hz signal. Complete interrogation of the pacemakers was performed before and after the consecutive exposure of the patients to both EASs. Electrocardiograms were recorded while the patients were exposed to the magnetic fields of each EAS for up to 30 seconds. One or more EAS interferences occurred in 17% of patients. EAS was observed in 26 (20%) of 129 patients with DDD, 7 (10%) of 71 patients with VVI, and 2 (50%) of 4 patients with VDD pacemakers. Over twice as many instances of EAS interference were observed with the "acoustomagnetic" system as were with the magnetic audio frequency system. Among pacemakers programmed in the DDD mode, a considerably greater prevalence of interference was observed at the atrial versus ventricular level, despite the same programmed sensing polarity in both chambers in all but one case. Sensing anomalies were the most common EAS induced disturbance, and typically lasted for the duration of exposure. In a few instances of pacing inhibition, the phenomenon was limited to 1 cycle at the onset of EAS exposure. No changes occurred in the programming of the pacemakers, and a single patient experienced palpitation during EAS induced rapid pacing. During exposure to EAS mimicking the normal use of the systems, interference with a variety of pacemakers was relatively common. However, the anomalies observed were transient and the cause of no symptom or device reprogramming. Patients should be advised to not stand unnecessarily in the close proximity of EASs.

Reduction in energy pacing thresholds by overlapping biphasic stimulation versus conventional bipolar pacing.

UNLABELLED: Overlapping biphasic (OLBI) stimulation is a new pacing waveform consisting of two simultaneous monophasic pulses of opposite polarities applied to a bipolar electrode. The goal of this prospective study was to compare, using conventional pacing leads, the acute energy pacing thresholds, measured at 0.5-ms pulse duration, associated with bipolar versus OLBI (mode 7 and mode 8) pulse delivery. RESULTS: Thirty one leads were tested in 20 patients. Of these leads, 7 (23%) were implanted chronically, 12 (39%) were in atrial positions, and 19 (61%) in ventricular positions. Energy pacing thresholds were significantly lower (-25.6 +/- 25.6%, P = 0.005) in OLBI mode 8 (1.30 +/- 3.96 microJ) compared to bipolar (1.55 +/- 4.37 microJ) pacing, regardless of the pacing site or length of service of the leads. In contrast, OLBI mode 7, which has an anodal component, at the tip electrode was associated with higher energy pacing thresholds (3.65 +/- 6.48 microJ; +358.3 +/- 219.4%, P = 0.002). CONCLUSIONS: Mode 8 OLBI pacing is associated with lower acute energy pacing thresholds when used with bipolar leads in contact with the myocardium. OLBI pacing may increase pacemaker longevity by reducing long-term energy consumption.

Reliability of an automatic sensing test with beat-to-beat display of the signal amplitude.

In contrast to testing of the capture threshold, the reliability of sensing tests has been little studied. This study was performed to test the automatic sensing algorithm included in the Biotronik pacing systems. The automatic measurements made by the devices were compared with the direct manual measurements made of 271 atrial (72%) or ventricular (28%) electrograms recorded in ten patients. A high correlation (r = 0.995, P < 0.0001) was found between the two types of measurements. The use of this function should facilitate the verification of accurate sensing during the long-term follow-up of pacemaker patients, and offers a tool to analyze the variations in amplitude of intracardiac signals.

[Comparative study of secretory IgA]. / Estudio comparativo de la IgA secretora.

OBJECTIVE: The aim of this study was measure and compare Secretory IgA levels in the respiratory tract. DESIGN: Cross-sectional study. SETTING: Neumology Department of General Hospital. La Raza Medical Center Mexico. MATERIAL AND METHOD: There were 35 volunteers. Samples of sputum, washings nasopharyngeal and bronchial was obtained from thirty five patients with COPD. Measurement of SIgA levels was performed by nephelometric technique. Results is reported as ratio of SIgA concentration/Total proteins concentration named SIgA relative concentration. Correlation index was obtained of three type of samples. RESULTS: The SIgA values of sputum, washings nasopharyngeal and bronchial was similar similar +/- 0.011, 0.064 +/- 0.007 and 0.082 +/- 0.017 respectively). Multiple correlation was r = 0.508 (p < 0.01).

Permanent left ventricular pacing with transvenous leads inserted into the coronary veins.

This paper describes a preliminary experiment-conducted jointly by 2 centers-of permanent left ventricular pacing using leads inserted by the transvenous route and through the coronary sinus into the cardiac veins of the left ventricle free wall. The aim was to obtain permanent biventricular pacing in a totally endocavitary configuration in patients with severe LV dysfunction and drug-refractory heart failure. Two types of leads were used: nonspecific unipolar leads at the beginning of the experiment, followed by leads specifically designed to be used in the coronary sinus in a second step. The electrode could be fitted in an adequate location in 35 of the 47 patients (75.4%), with a 1.15 +/- 0.7 V acute pacing threshold and 11.8 +/- 5.7 mV R wave amplitude. The success rate was significantly higher with the specific electrodes (81.8% vs 53.3%, p < 0.001). The pacing and sensing thresholds upon implantation were not influenced by the type of lead or by the localization of the cardiac vein that was catheterized (great cardiac vein, lateral vein, postero-lateral or posterior vein, mid cardiac vein). In contrast, the pacing threshold was significantly lower (0.8 +/- 0.2 vs 1.8 +/- 0.8 V; p = 0.002) and the R wave amplitude tended to be greater (13.1 +/- 4.5 mV vs 9.3 +/- 6.5 mV; p = 0.07) when the tip electrode could be inserted distally into the vein, by comparison with a proximal site near the ostium. At the end of follow-up (10.2 +/- 8.7 months), 34 out of the 35 leads were still fully functional, with a chronic pacing threshold of 1.8 +/- 0.7 V and a R wave amplitude of 10.7 +/- 6 mV. To conclude, permanent LV pacing via the transvenous route is possible in most patients, with excellent safety and long-term results.

[The rehabilitation of chronic respiratory insufficiency]. / La rééducation-rédaptation des insuffisants respiratoires chroniques.

Respiratory rehabilitation is defined as a medical practice including a multidisciplinary medical program fitting each individual. Personalized retraining by means of exercises, is the master part of it, its aim is to improve the physical fitness in specialised institution then to maintain it when he becomes an out patient. In both cases, this retraining complies with strict rules concerning the mode of exercises (imposed power--duration of sessions--weekly frequency--progressiveness of overloading ...). This codification rests mainly on the recommendations of the American College of Sports Medicine. The choice of intensity at the beginning of the stay will be determined either by the maximal reserve of cardiac frequency or by the ventilatory threshold. This training has to involve extensive muscular mass and must not neglect the upper limbs. Ventilatory physiotherapy also plays an important part. The other components of rehabilitation concern optimisation of bronchodilator treatment, cessation of smoking, health education, physical education and relaxation, appraisal of nutritional status, assessment of therapeutic programs, of the quality of life and a long-term program for reinforcement of acquisitions. The therapeutic programs improve ventilatory performance, maximal oxygen intake, maximal tolerated power and quality of life. An adaptation of the St. George's Respiratory Questionnaire to patients hosted at the TOKI EDER Medical Center points out that the quality of life of patients with chronic respiratory failure is improved very highly significantly by this rehabilitation.

[Measurement of sIgA in patients with chronic stable bronchitis]. / Cuantificación de la SIgA en pacientes con bronquitis crónica estable.

As we know secretory IgA of respiratory system has a very important role in defense mechanism. We studied 100 human beings, 50 healthy persons and 50 chronic bronchitis patients. Lavage nasal samples were tacked from healthy persons and sputum samples from chronic bronchitis patients. The laboratory test was nefelometry laser. Samples were analyzed was 1 student. Our results showed light increased of IgA in chronic bronchitis patients not significative. We concluded that this light increased is secondary to continuous stimulus of bronchial mucous as a part of defense mechanism.

[First experience in treatment of terminal cardiac insufficiency using multisite stimulation]. / Première expérience de traitement de l'insuffisance cardiaque terminale par la stimulation multisite.

We hypothesized that the presence of an abnormal ventricular mechanical activation sequence and/or a delayed left ventricular (LV) contraction may have adverse hemodynamic effects in congestive heart failure (CHF) and could be improved by synchronous RV-LV pacing in a multisite (MS) configuration. 8 NYHA IV CHF patients were included with a LV delay due to 1/ preexistent pacemaker in 4 pts (2 VVI and 2 DDD); 2/ left bundle branch block in 2 pts; 3/ intraventricular conduction delays in 2 pts. An acute hemodynamic evaluation was performed. Hemodynamics were optimized in standard RV pacing by modifying RV lead position from apex to outflow tract (RVOT) in VVI for AF patients and in VDD for sinus rhythm patients at different AV delays. RV pacing did not change hemodynamics whatever the lead position. BV pacing improved CI by 25% (p < 0.006), V wave by 26% (p < 0.004) and PCWP by 17% (p < 0.01). Chronic implantation was performed in 7pts. LV lead was implanted via the coronary sinus in 2 cases and epicardial via a thoracoscopic approach in the remaining ones. 1 pt died during LV lead implantation. Hemodynamics were tested at 2 months followup (FU). Switching BV pacing off was associated with immediate deterioration. At 6 +/- 6 months Followup 4 pts are stable in Class II. 1 pt died of cardiac cause. 1 pt could be transplanted at 17 months FU. In conclusion, BV pacing through a multisite configuration is feasible and can help in CHF patients managing.