NEURONORMA Cognitive Battery Associations with Cerebrospinal Fluid Amyloid-ß and Tau Levels in the Continuum of Alzheimer's Disease.

BACKGROUND: Neuropsychological assessments are essential to define the cognitive profile and contribute to the diagnosis of Alzheimer's disease (AD). The progress in knowledge about the pathophysiological process of the disease has allowed conceptualizing AD through biomarkers as a biological continuum that encompasses different clinical stages. OBJECTIVE: To explore the association between cerebrospinal fluid (CSF) biomarkers of AD and cognition using the NEURONORMA battery, in a sample of cognitively unimpaired (CU), mild cognitive impaired (MCI), and mild dementia of the Alzheimer type (DAT) subjects, and to characterize the cognitive profiles in MCI subjects classified by A/T/N system. METHODS: 42 CU, 35 MCI, and 35 mild DAT were assessed using the NEURONORMA battery. Core AD biomarkers [amyloid-ß42 (Aß42) peptide, total tau (t-tau), and phosphorylated tau 181 (p-tau181)] proteins were measured in CSF. Correlation coefficients, multivariate regression, and effect sizes were calculated. We explored the age- and education-adjusted cognitive profiles by A/T/N variants within the MCI group. RESULTS: Cognitive outcomes were directly associated with CSF Aß42 and inversely with CSF tau measures. We found differences in both biomarkers and cognitive outcomes comparing all pairs except for CSF measures between cognitively impaired groups. The highest effect size was in memory tasks and biomarkers ratios. Lower performances were in memory and executive domains in MCI subjects with AD pathology (A+T+N±) compared to those with normal levels of AD biomarkers (A- T- N). CONCLUSION: This study provides further evidence of the validity of Spanish NEURONORMA cognitive battery to characterize cognitive impairment in the AD pathological continuum.

Atypical astroglial pTDP-43 pathology in astroglial predominant tauopathy.

We observed atypical astrocytic pTDP-43 pathology in astroglial predominant tauopathy.

Novel P397S MAPT variant associated with late onset and slow progressive frontotemporal dementia.

Mutations in the MAPT gene cause frontotemporal dementia with tau deposits. We report the novel p.P397S MAPT variant in eight subjects from five apparently nonrelated families suffering from frontotemporal dementia with autosomal dominant pattern of inheritance. In silico analysis reported conflicting evidence of pathogenicity. The segregation analysis support that this variant is likely pathogenic. The mean age at onset (61.4 years) and mean disease duration (13.9 years) of these subjects and their affected relatives were significantly higher compared with our series of p.P301L MAPT mutation carriers. These findings suggest that p.P397S variant could be a new MAPT mutation associated with a less aggressive phenotype than other MAPT mutations.

Evaluación de un programa formativo para la prevención de caídas relacionado con la asistencia sanitaria / Evaluation of a training program for the prevention of falls related to health care

Introducción. La prevención de caídas es fundamental en la mejora de la calidad del paciente ingresado. Gran parte de los pacientes que caen durante su ingreso lo hacen estando solos. Proporcionar formación a los equipos asistenciales es fundamental en la prevención de este efecto adverso. objetivo. Evaluar la efectividad de una intervención formativa sobre la prevención de caídas relacionada con la asistencia sanitaria y dirigida al personal de enfermería. Método. Estudio cuasiexperimental desarrollado en cuatro unidades de hospitalización de un hospital universitario. Se realizó una intervención formativa exponiendo el contenido del procedimiento del hospital sobre la prevención de caídas y la cumplimentación de los registros. Se impartieron sesiones formativas en las unidades de hospitalización que participaron. Se evaluaron los conocimientos del personal antes y después de cada sesión mediante una encuesta autocumplimentado. Posteriormente, se evaluó el grado de cumplimentación de los registros de enfermería en relación con la prevención de caídas. Resultados: Participaron 78 profesionales de enfermería. El análisis de los cuestionarios pre y posintervención re-velan un aumento en el porcentaje de respuestas correctas, con diferencias estadísticamente significativas en cuan-to a los ítems que describen la identificación del riesgo y los factores e intervenciones relacionadas. Después de la intervención, se observó un aumento de la cumplimentación de los registros del 92 % en la evaluación del riesgo, el 88 % en la reevaluación y el 72 % en la activación de alerta. Conclusión. Un programa formativo específico sobres caídas dirigido a los profesionales de enfermería mejoró los conocimientos y el aumento del cumplimento de los registros

Introduction. The prevention of falls is fundamental in improving the quality of the patient admitted. Many of the patients who fall during their admission do so alone. Carrying out training for health care teams is fundamental in the prevention of this adverse effect. Objective. To evaluate the effectiveness of a formative intervention on the prevention of falls related to health care and aimed at nursing staff. Method. Quasi-experimental study developed in four hospitalization units of a university hospital. A formative intervention was made exposing the content of the hospital procedure on the prevention of falls and the completion of the records. Training sessions were given in the hospitalization units that participated. Staff knowledge was evaluated before and after each session through a self-completed survey. Subsequently, the degree of completion of the nursing records in relation to the prevention of falls was evaluated. Results. 78 nursing professionals participated. The analysis of the pre- and post-intervention questionnaires reveals an increase in the percentage of correct answers, with statistically significant differences in terms of the items that describe the identification of risk and related factors and interventions. After the intervention, there was an increase in the completion of the records of 92 % in the risk assessment, 88 % in the re-evaluation and 72 % in the activation of the alert. Conclusion. A specific training program on dropped envelopes addressed to nursing professionals improved knowledge and increased compliance with records

The Use of Antidotes for Calcium Gluconate Extravasation: An Experimental Study in Mice.

BACKGROUND: Calcium gluconate extravasation is a process that can cause serious lesions, such as necrosis and calcification of the soft tissues. The aim of the present study was to analyze the beneficial effects of four possible local antidotes for calcium gluconate extravasation: hyaluronidase, sodium thiosulfate, triamcinolone acetonide, and physiologic saline solution. METHODS: Seventy-four BALB/c mice were used in the study. The substances selected for use in this study were calcium gluconate (4.6 mEq/ml), hyaluronidase (1500 IU/ml), sodium thiosulfate (25%), triamcinolone acetonide (40 mg/ml 0.5 mg/kg), and saline solution 0.9%. Five minutes were allowed to lapse after the calcium gluconate infiltration, and then an antidote was infiltrated. After 3 weeks, a skin biopsy was performed and a radiographic and histologic study was carried out. RESULTS: Only in the group infiltrated with sodium thiosulfate did all skin lesions disappear after the 3-week period after infiltration. In the radiographic study, calcium deposits larger than 0.5 mm were observed in 40 percent of cases without an antidote, in 33 percent with triamcinolone acetonide, in 13 percent with a saline solution, and in none with thiosulfate and hyaluronidase. In the histologic study, calcium deposits were found in 53 percent of cases without antidote, 100 percent of cases with triamcinolone acetonide, 33 percent of cases with saline solution, and 13 percent of cases with sodium thiosulfate or hyaluronidase. CONCLUSION: Sodium thiosulfate and hyaluronidase prevent the development of calcium deposits after calcium gluconate extravasation.

Metabolic syndrome as a cardiovascular disease risk factor: patients evaluated in primary care.

To estimate the prevalence of metabolic syndrome (MS) in a population receiving attention in primary care centers (PCC) we selected a random cohort of ostensibly normal subjects from the registers of 5 basic-health area (BHA) PCC. Diagnosis of MS was with the WHO, NCEP and IDF criteria. Variables recorded were: socio-demographic data, CVD risk factors including lipids, obesity, diabetes, blood pressure and smoking habit and a glucose tolerance test outcome. Of the 720 individuals selected (age 60.3 +/- 11.5 years), 431 were female, 352 hypertensive, 142 diabetic, 233 pre-diabetic, 285 obese, 209 dyslipemic and 106 smokers. CVD risk according to the Framingham and REGICOR calculation was 13.8 +/- 10% and 8.8 +/- 9.8%, respectively. Using the WHO, NCEP and IDF criteria, MS was diagnosed in 166, 210 and 252 subjects, respectively and the relative risk of CVD complications in MS subjects was 2.56. Logistic regression analysis indicated that the MS components (WHO set), the MS components (IDF set) and the female gender had an increased odds ratio for CVD of 3.48 (95CI%: 2.26-5.37), 2.28 (95%CI: 1.84-4.90) and 2.26 (95%CI: 1.48-3.47), respectively. We conclude that MS and concomitant CVD risk is high in ostensibly normal population attending primary care clinics, and this would necessarily impinge on resource allocation in primary care.

Intravitreous hepatocyte growth factor in patients with proliferative diabetic retinopathy: a case-control study.

The aim of the present study was to evaluate the vitreous levels of hepatocyte growth factor (HGF) in patients with proliferative diabetic retinopathy (PDR) and to investigate its relationship with vascular endothelial growth factor (VEGF) and retinopathy activity. In addition, the relationship between intravitreous HGF levels and the presence of epiretinal membranes (ERM), as well as the expression of c-Met in ERM were also investigated. In this case-control study, serum and vitreous samples as well as ERM specimens were obtained during vitrectomy from 28 diabetic patients with PDR and 30 non-diabetic control subjects. HGF and VEGF were determined by ELISA and c-Met expression by immunohistochemistry. Vitreal levels of both VEGF and HGF were higher in patients with PDR in comparison with the control group (p<0.0001). However, after correcting for total vitreous protein concentration, HGF (ng/mg of proteins) was lower in diabetic patients than in non-diabetic control subjects (p=0.02). No correlation was detected between the vitreal levels of HGF and VEGF. In addition, intravitreous VEGF but not HGF was found to be related to PDR activity. Both diabetic patients and non-diabetic patients in whom ERM had been excised presented higher HGF intravitreous levels. Finally, a significant expression of c-Met in ERM membranes were observed in both diabetic patients with PDR and in non-diabetic subjects. In conclusion, both HGF and VEGF increased, but were not related, in the vitreous fluid of diabetic patients with PDR. Our findings suggest that HGF is related to pathological conditions in which fibroproliferative processes or wound healing are involved rather than with angiogenesis itself.

Comparison of four corneal pachymetry technique;s in corneal refractive surgery.

PURPOSE: To assess the effectiveness of optical and ultrasonic pachymetry when examining corneas of patients before and after laser in situ keratomileusis (LASIK). METHODS: We conducted a prospective study of 25 patients (50 eyes) who had LASIK for myopia or myopic astigmatism (mean spherical equivalent refraction -4.80 +/- 3.60 D; range -1.75 to -12.00 D). Corneal thickness was measured using 1) conventional ultrasonic pachymetry (20 MHz probe) in the central cornea, 2) ASL confocal microscopy (CMTF analysis), 3) Orbscan II Analyzer, and 4) ultrasound biomicroscopy (UBM) (50 MHz probe) preoperatively and 3 months postoperatively. RESULTS: Preoperative pachymetry values measured with the Orbscan II Analyzer (551.3 +/- 27.3 microm) were almost identical to those measured with the 20 MHz ultrasonic probe (553.7 +/- 25.7 microm; t-test P = .652). The mean preoperative pachymetry for UBM was 566.7 +/- 38.8 microm and for CMTF was 553.2 +/- 15.5 microm. The optic and ultrasonic system measurements differed in operated eyes; 20 MHz ultrasonic pachymetry yielded an average 478.7 +/- 23.5 microm and the UBM, 482.4 +/- 40.3 microm. These measurements differed from the Orbscan II (Tukey test; P = .023) measurement of 461.1 +/- 37.5 microm but not from the confocal microscopy measurement of 475.2 +/- 41.8 microm. UBM registered greater values that were more variable than those obtained with ultrasonic pachymetry. CONCLUSIONS: In non-operated eyes, corneal thickness was similar using conventional ultrasound, Orbscan II, or confocal techniques, with ultrasound biomicroscopy giving thicker readings.

[Blood lead levels and exposure factors in children of Morelos state, Mexico]. / Niveles de plomo en sangre y factores de exposición en niños del estado de Morelos, México.

OBJECTIVE: To assess blood lead levels and lead exposure factors in children living in Morelos State, Mexico. MATERIAL AND METHODS: A cross-sectional study was conducted between June and October 1996, in 232 children aged 1-12 years, at Hospital del Niño Morelense de Cuernavaca, Morelos, Mexico. Blood lead levels were measured by anodic voltameter, and exposure factors were collected by questionnaire. The lead concentration value was log transformed for statistical analysis. Odds ratios were obtained for some risk factors. The statistical significative risk factors were later analyzed with ANOVA. RESULTS: A total of 232 children were recruited (50% female); 73% resided in Cuernavaca City. The geometric mean blood lead level was 6.7 micrograms/dl; 29.7% of the children had levels over 10 micrograms/dl; 66% reported use of lead glazed pottery for cooking, 36% for storing food, and 19% for drinking. CONCLUSIONS: Blood lead levels were similar to those reported in other Mexican children studies, after the reduction of lead in gasoline. The main risk factors were use of lead glazed pottery and vehicle traffic intensity near the household. These results will be useful for future prevention and control interventions. This paper is available too at: http://www.insp.mx/salud/index.html.

Niveles de plomo en sangre y factores de exposición en niños del estado de Morelos, México / Blood lead levels and exposure factors in children of Morelos State, Mexico

OBJETIVO: Evaluar los niveles de plomo en sangre de niños morelenses y sus factores de exposición. MATERIAL Y MÉTODOS: Estudio transversal para analizar, por voltametría anódica, los niveles de plomo en sangre de 232 niños de 1 a 12 años de edad, que acudieron de junio a octubre de 1996 al Hospital del Niño Morelense de Cuernavaca, Morelos, México. Los factores de exposición se indagaron por cuestionario. El valor de concentración de plomo se transformó al logaritmo natural; se estimó la razón de momios para algunos factores de exposición que se incorporaron a un modelo de ANOVA. RESULTADOS: Se reclutaron 232 niños (50 por ciento mujeres); 73 por ciento residentes en Cuernavaca. La media geométrica de plomo en sangre fue 6.7 æg/dl; 29.7 por ciento rebasaron los 10 æg/dl; 66 por ciento tenían antecedente de cocinar alimentos en barro vidriado; 36 por ciento de almacenar alimentos, y 19 por ciento, consumo de líquidos en ese material. CONCLUSIONES: Los niveles encontrados son similares a los reportados en otras poblaciones pediátricas mexicanas en los últimos años. Entre los principales factores de exposición destacan el uso de barro vidriado para consumo de alimentos o líquidos y la intensidad del tráfico donde viven. Este es el primer estudio que documenta los niveles de plomo en sangre en población infantil de Morelos, México, y sus resultados son punto de partida para acciones futuras de control y prevención.