ABSTRACT
INTRODUCTION: The aging process places the elderly, a worldwide increasing age group, at an increased risk for trauma. This study aims to explore changes over time in admission rates, sociodemographical, clinical, and injury-related data in elderly patients (aged ≥65 y) admitted to the Puerto Rico Trauma Hospital (PRTH) during 2000-2019. MATERIALS AND METHODS: A time-series analysis was conducted. Admission rates were analyzed by fitting an exponential growth curve model. Trends were assessed using the Cochrane-Armitage and Cuzick tests for categorical and continuous data, respectively. RESULTS: Elderly admission rates to the PRTH have shown growth over the past 2 decades, from 6.2 cases per 100 overall admissions in 2000 to 18.2 in 2019. This trend is projected to continue with estimated 24.8 (95% CI: 21.7-27.8) cases per 100 overall admissions in 2023. Trends for mechanisms of injury such as motor vehicle accidents and pedestrians showed a significant decrease, whereas falls presented a clear positive trend, showing an increase from 25.6% in 2000-2004 to 46.2% in 2015-2019. Both Injury Severity Score ≥25 and Glasgow Coma Scale ≤8 declined significantly through time. Finally, in-hospital mortality presented a decreasing trend from 31.7% in 2000-2004 to 21.5% in 2015-2019. CONCLUSIONS: Our analysis demonstrates an increase over time in elderly admissions, especially fall-related trauma. Also, it projects this upward trend will continue. This imposes new challenges for PRTH and other healthcare services and is a gateway for the implementation of adapted clinical management.
Subject(s)
Hospitalization , Wounds and Injuries , Aged , Hospital Mortality , Hospitals , Humans , Injury Severity Score , Puerto Rico/epidemiology , Retrospective Studies , Trauma Centers , Wounds and Injuries/epidemiology , Wounds and Injuries/therapyABSTRACT
Introducción. Evaluar los efectos de un programa de intervención neuropsicológica basado en mindfulness en la evolución clínica de la enfermedad de Alzheimer. Material y método. Se realizó un ensayo clínico aleatorizado de dos años de duración a doble ciego. En el estudio participaron 127 personas mayores con enfermedad de Alzheimer probable según criterios de la NINCDS-ADRDA. Se agruparon los enfermos en tres grupos experimentales (estimulación cognitiva, relajación muscular progresiva y mindfulness) y un grupo control. Todos los enfermos estaban en tratamiento con donepezilo. Se evaluaron las capacidades cognitivas con el CAMCOG y MMSE, el área funcional con el RDRS-2 y el área psicopatológica con el NPI. Se desarrollaron tres sesiones a la semana durante 2 años con medidas semestrales de seguimiento. Resultados. Las mediciones de la función cognitiva global, la funcionalidad y los trastornos de conducta asociados a la demencia indicaron que los enfermos del grupo experimental basado en mindfulness se han mantenido estables durante los dos años, mientras que los controles y el resto de los grupos experimentales muestran un leve pero significativo empeoramiento de sus capacidades mentales. Conclusión. El programa de intervención neuropsicológica basado en mindfulness se ha asociado con la estabilidad cognitiva y funcional y mejoras significativas en la situación psicopatológica de los enfermos de Alzheimer en fase leve y moderada. Estos resultados apoyan la idea de que la intervención basada en mindfulness puede producir un beneficio clínicamente relevante en el tratamiento de la demencia. Se debe seguir trabajando en esta línea para confirmar estos datos (AU)
Introduction. The purpose of this research was to assess effects of a mindfulness based neuropsychological intervention on the clinical course of Alzheimer's disease. Material and method. A two year randomized and double blind clinical trial was conducted on 127 probable Alzheimer's disease patients, according to NINCDS-ADRDA scale. Patients were grouped into three experimental groups (cognitive stimulation, progressive muscular relaxation, and mindfulness) plus a control group. All participants were receiving donepezil. Cognitive skills were assessed with CAMCOG and MMSE, functional area with RDRS-2, and NPI was used for psychopathology screening. Three treatment sessions per week were carried out for two years, and follow up measurements were taken every six months. Results. The global cognitive function, functionality and behavioral disorders measurements indicated that patients from the experimental group based on mindfulness were stable during the two years, while patients from the control group, as well as the other experimental groups, showed a mild but significant worsening of their mental capacities. Conclusion. The mindfulness based neuropsychological program showed better cognitive and functional stability, as well as significant improvement in the psychopathological condition of mild to moderate Alzheimer patients. These results support the idea that a mindfulness based intervention can produce a clinically relevant improvement in the treatment of dementia. More research is needed to confirm these data (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Randomized Controlled Trials as Topic/methods , Alzheimer Disease/epidemiology , Alzheimer Disease/prevention & control , Cognition , Double-Blind Method , Psychopathology/methods , Psychopathology/trends , Neuropsychology/methods , Neuropsychology/statistics & numerical dataABSTRACT
La interacción constante del organismo humano con diferentes sustancias, que incluso en muchas ocasiones se consideran inofensivas, tiene un alto impacto sobre todos los sistemas, siendo el cardiovascular uno de los más afectados. Por lo tanto, es vital reconocer los mecanismos por los cuales estas sustancias ejercen su efecto tóxico sobre este sistema, bien sea afectando la estabilidad de membrana y la función contráctil o generando disfunción de organelos intracelulares y estrés oxidativo. Numerosos estudios han descubierto efectos lesivos de sustancias, como la clozapina y las catecolaminas, que han tenido amplio uso durante largos años. En la actualidad aún se realizan investigaciones que buscan esclarecer los mecanismos cardiotóxicos de medicamentos de formulación común, entre ellos antineoplásicos y anti-inflamatorios no esteroideos (AINE), así como de sustancias de uso habitual que causan adicción, tales como alcohol, cocaína y cocaetileno, su metabolito activo.
The constant interaction of the human body with different substances that are even in many cases considered harmless has a high impact on all systems, being the cardiovascular system one of the most affected. Therefore, it is vital to recognize the mechanisms by which these substances exert their toxic effect on this system, either affecting the membrane stability and the contractile function, or generating intracellular organelles dysfunction and oxidative stress. Numerous studies have found that drugs which have been widely used for many years such as clozapine and catecholamines, have harmful effects. Research is still being done seeking to clarify the cardiotoxic mechanisms of drugs commonly formulated, including anticancer and non steroidal anti-inflammatory drugs (NSAIDs), as well as commonly used substances that cause addiction, such as alcohol, cocaine and cocaethylene, its active metabolite.
Subject(s)
Catecholamines , ClozapineABSTRACT
BACKGROUND: BLAST is one of the most common and useful tools for Genetic Research. This paper describes a software application we have termed Windows .NET Distributed Basic Local Alignment Search Toolkit (W.ND-BLAST), which enhances the BLAST utility by improving usability, fault recovery, and scalability in a Windows desktop environment. Our goal was to develop an easy to use, fault tolerant, high-throughput BLAST solution that incorporates a comprehensive BLAST result viewer with curation and annotation functionality. RESULTS: W.ND-BLAST is a comprehensive Windows-based software toolkit that targets researchers, including those with minimal computer skills, and provides the ability increase the performance of BLAST by distributing BLAST queries to any number of Windows based machines across local area networks (LAN). W.ND-BLAST provides intuitive Graphic User Interfaces (GUI) for BLAST database creation, BLAST execution, BLAST output evaluation and BLAST result exportation. This software also provides several layers of fault tolerance and fault recovery to prevent loss of data if nodes or master machines fail. This paper lays out the functionality of W.ND-BLAST. W.ND-BLAST displays close to 100% performance efficiency when distributing tasks to 12 remote computers of the same performance class. A high throughput BLAST job which took 662.68 minutes (11 hours) on one average machine was completed in 44.97 minutes when distributed to 17 nodes, which included lower performance class machines. Finally, there is a comprehensive high-throughput BLAST Output Viewer (BOV) and Annotation Engine components, which provides comprehensive exportation of BLAST hits to text files, annotated fasta files, tables, or association files. CONCLUSION: W.ND-BLAST provides an interactive tool that allows scientists to easily utilizing their available computing resources for high throughput and comprehensive sequence analyses. The install package for W.ND-BLAST is freely downloadable from http://liru.ars.usda.gov/mainbioinformatics.html. With registration the software is free, installation, networking, and usage instructions are provided as well as a support forum.
