Searching for a prognostic index in lupus nephritis.

BACKGROUND: Currently we do not have an ideal biomarker in lupus nephritis (LN) that should help us to identify those patients with SLE at risk of developing LN or to determine those patients at risk of renal progression. We aimed to evaluate the development of a prognostic index for LN, through the evaluation of clinical, analytical and histological factors used in a cohort of lupus. We have proposed to determine which factors, 6 months after the diagnosis of LN, could help us to define which patients will have a worse evolution of the disease and may be, more aggressive treatment and closer follow-up. METHODS: A retrospective study to identify prognostic factors was carried out. We have included patients over 18 years of age with a clinical diagnosis of systemic lupus erythematosus (SLE) and kidney involvement confirmed by biopsy, who are followed up in our centre during the last 20 years. A multi-step statistical approach will be used in order to obtain a limited set of parameters, optimally selected and weighted, that show a satisfactory ability to discriminate between patients with different levels of prognosis. RESULTS: We analysed 92 patients with LN, although only 73 have been able to be classified according to whether or not they have presented poor renal evolution. The age of onset (44 vs. 32; p = 0.024), the value of serum creatinine (1.41 vs. 1.04; p = 0.041), greater frequency of thrombocytopenia (30 vs. 7%; p = 0.038), higher score in the renal chronicity index (2.47 vs. 1.04; p = 0.015), proliferative histological type (100%) and higher frequency of interstitial fibrosis (67 vs. 32%; p = 0.017) and tubular atrophy (67 vs. 32%; p = 0.018) was observed between two groups. The multivariate analysis allowed us to select the best predictive model for poor outcome at 6 months based on different adjustment and discrimination parameters. CONCLUSION: We have developed a prognostic index of poor renal evolution in patients with LN that combines demographic, clinical, analytical and histopathological factors, easy to use in routine clinical practice and that could be an effective tool in the early detection and management.

Complicaciones de los pacientes con uveítis en un estudio poblacional español: proyecto UveCAM / Complications of uveitis in a Spanish population, UveCAM study

Objetivo Estimar la frecuencia poblacional de complicaciones de uveítis y evaluar sus principales factores de riesgo en los pacientes con uveítis del estudio UveCAM. Pacientes y método Desarrollo de complicaciones de los 386 pacientes con uveítis de toda el área sanitaria de la provincia de Toledo (estudio UveCAM) durante el periodo de un año. Descripción de complicaciones y estudio de los posibles determinantes mediante modelos de regresión multivariante. Resultados Se dispuso de información sobre el desarrollo de complicaciones en 371 de los 386 pacientes del estudio. El 45,8% de los pacientes presentó al menos una complicación, siendo las más frecuentes las sinequias posteriores (19,0%), la hipertensión ocular (14,0%), el edema macular (7,5%), la membrana epirretiniana (6,9%), el glaucoma (6,6%), la atrofia iridiana (5,6%) y las cataratas (5,5%). El riesgo de complicaciones aumenta con la edad, las formas intermedias y panuveítis, y las de evolución crónica o recurrente. Conclusión Las uveítis se asocian con una elevada frecuencia de complicaciones, especialmente en pacientes de edad avanzada, con localización intermedia o posterior del proceso inflamatorio y con evolución crónica o recurrente (AU)

Objective To estimate the population frequency of uveitis complications and to evaluate their main risk factors in the patients with uveitis from the UveCAM study. Patients and methods Development of complications in 386 patients with uveitis in the whole health area of the province of Toledo (UveCAM study) during a period of one year. Description of complications and study of their possible determinants by means of multivariate regression models. Results Information on the development of complications was available in 371 of the 386 patients of the UveCAM study. 45.8% of patients had at least one complication, the most frequent were posterior synechiae (19.0%), ocular hypertension (14.0%), macular oedema (7.5%), epiretinal membrane (6.9%), glaucoma (6.6%), iridian atrophy (5.6%), and atrophy (5.6%) and cataracts (5.5%). The risk of complications increases with age, intermediate and panuveitis locations, and those of chronic or recurrent evolution. Conclusion Uveitis is associated with a high frequency of complications, especially in older patients, with intermediate or posterior localization of the inflammatory process, and chronic or recurrent evolution (AU)

Complications of uveitis in a Spanish population, UveCAM study.

OBJECTIVE: To estimate the population frequency of uveitis complications and to evaluate their main risk factors in the patients with uveitis from the UVECAM study. PATIENTS AND METHODS: Development of complications in 386 patients with uveitis in the whole health area of the province of Toledo (UVECAM study) during a period of 1 year. Description of complications and study of their possible determinants by means of multivariate regression models. RESULTS: Information on the development of complications was available in 371 of the 386 patients of the UVECAM study. The most frequent complications were posterior synechiae (19.0%), ocular hypertension (14.0%), macular edema (7.5%), epirretinal membrane (6.9%), glaucoma (6.6%), iridian atrophy (5.6%) and cataract (5.5%). The risk of complications increases with age, intermediate and panuveitis locations, and those of chronic or recurrent evolution. CONCLUSION: Uveitis is associated with a high frequency of complications, especially in older patients, with intermediate or posterior localization of the inflammatory process and chronic or recurrent evolution.

[Spanish version of the 7 Minute screening neurocognitive battery. Normative data of an elderly population sample over 70]. / Versión española del Test de los 7 Minutos. Datos normativos de una muestra poblacional de ancianos de más de 70 años.

INTRODUCTION: To standardize the Spanish version of the 7 Minute screening neurocognitive battery (7MS) in a population sample of elderly over 70 years. METHODS: We examined 416 persons, living at home, participating in elderly the longitudinal study "Aging in Leganes", aged 71 to 99 years old (mean age: 79 +- 9.2 years; 51.7 % women; 10.6 illiterate, 25 % without formal education). In order to do so, we used an extensive clinical survey, general and neurological exam and extensive neuropsychological battery with several cognitive scales, attention, language, memory, visuomotor skill and reasoning tests, Jorm's IQCODE questionnaire, CES-D depression questionnaire and the 7MS including the Benton Orientation Test, Clock Drawing Test, Free and Cued Learning Test and Categorial Verbal Fluency. Dementia was diagnosed according to DSM-IV criteria but independently of the 7MS scores. Several methods to obtain the total score of the 7MS were analyzed and the normative parameters of the test were obtained in the subgroup of non-demented subjects. RESULTS: The easiest and most efficient method to obtain the total score of the 7MS was the sum of the z-scores of the four subtests. We present the mean values, -1 and -1.5 standard deviations, range and percentiles of the partial and total scores of the 7MS stratified by age (71-75, 76-80, 81-85 and > or = 86 years) and education (less than primary education and primary education or greater) in the subgroup of non-demented subjects. CONCLUSIONS: The normative data of the 7MS obtained in a representative sample of the general elderly population support its rigorous use in the Spanish clinical setting.

[Prevalence of urinary incontinence and linked factors in men and women over 65]. / Prevalencia de la incontinencia urinaria y factores asociados en varones y mujeres de más de 65 años.

OBJECTIVES: To calculate the prevalence of urinary incontinence and to identify linked factors in a population of elderly people living in their homes. DESIGN: Population survey. SETTING: Leganés (Madrid). PARTICIPANTS: Representative sample of people over 65 registered in Leganés (n=1560). Two interviews at home were conducted. The second interview included a medical examination. The reply rate was 75% (n=1150). MAIN MEASUREMENTS: Frequency of involuntary losses of urine and use of medication and absorbents, health status, use of diuretics and oxybutinin, and demographic and social variables. RESULTS: The prevalence of urinary incontinence was 14% (95% CI, 11%-17%) in men and 30% (95% CI, 26%-34%) in women. Advanced age was associated with greater prevalence in men but not in women. In the multivariate analysis, factors associated with urinary incontinence were comorbidity and cognitive deficit. In addition, in women, high Body Mass Index and seriously limited movement were added factors. 20% of women and 5% of men over 65 used absorbents. The use of diuretics and the low number of patients receiving specific treatment for urinary incontinence suggested that there was low detection of this problem. CONCLUSIONS: Urinary incontinence is common and could be better detected and treated in primary care. Prevention of urinary incontinence in women should begin before old age.

Effects of calcium antagonists on the dopamine system.

Calcium channel antagonists are drugs currently used in the treatment of neurological and cardiovascular disorders and occasionally produce parkinsonism and movement disorders as a side effect. We investigated the effects of calcium channel antagonists on the pharmacology of dopamine systems in vivo and in vitro. Flunarizine, cinnarizine, and diltiazem reduce the viability of dopamine-rich human neuroblastoma cells in vitro. These compounds plus verapamil, nifedipine, and nicardipine reduce 3H-spiperone binding to bovine striatal membranes, 3H-dopamine uptake, K(+)-induced 3H-dopamine release, and apomorphine-induced rotation, but not amphetamine-induced rotation, in 6-OH-dopamine-lesioned rats. Therefore, all calcium channel antagonists tested reduce dopamine neurotransmission in vitro and in vivo, whereas the evidence of toxicity for dopamine cells in vitro is restricted to flunarizine, cinnarizine, and diltiazem. The clinical relevance of these toxic effects may depend on several factors, including age, penetration across the blood-brain barrier, and types of calcium channels present in the different neuronal subtypes. On the other hand, the finding of dopamine-regulating properties not associated to neurotoxic effects in the dihydropyridines and verapamil provides new putative therapeutics tools for the treatment of neurologic disorders associated with dopamine hyperactivity.

[Effect of a controlled low-protein diet on the pharmacological response to levodopa and on the plasma levels of L-dopa and amino acids in patients with Parkinson's disease]. / Efecto agudo de la dieta hipoproteica controlada sobre la respuesta farmacológica a la levodopa y sobre los niveles plasmáticos de L-dopa y aminoácidos en pacientes con enfermedad de Parkinson.

Levodopa is the treatment of choice in Parkinson's disease, but a high percentage of patients develop complications in the response, including fluctuations, after some years of treatment. Although the origin of fluctuations is unknown, these could be, at least partly, attributed to pharmacokinetic factors. Aromatic aminoacids interfere in the absorption and brain penetration of levodopa, and lowering protein intake improves the quality of the response. The continuation of a low-protein diet is difficult for some patients. In this way, to know if these diet effects are noticeable in an acute period would be interesting, in order to select groups of patients who were susceptible to improve with this treatment. In this report we have studied the acute effect of a low protein diet on the pharmacological response to levodopa, and the plasmatic levels of L-Dopa, 3-OM-Dopa and large neutral aminoacids. Protein restriction improves clinical response to levodopa, although the mechanisms of this improvement remain unknown.

Acute effects of 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine in a model of rat designated a poor metabolizer of debrisoquine.

The relationship between oxidative polymorphisms and the cause of Parkinson's disease is controversial. The drug 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP), which induces parkinsonism in humans and in some animal models, is metabolized by cytochrome P450 db1 isozyme (the same enzymatic system implicated in 4-hydroxylation of debrisoquine). In this study, we treated females of three rat species, which differ in their ability to hydroxylate debrisoquine, with MPTP (three doses of 30 mg/kg s.c. at 12-h intervals), and we measured their motor activity and brain monoamine levels. Female dark-adapted rats (poor metabolizers of debrisoquine) showed a more pronounced and more maintained reduction of their motor activity after treatment with MPTP. MPTP-treated, dark-adapted rats also had a depletion of noradrenaline in the diencephalon and a depletion of dopamine and serotonine and their respective metabolites in the limbic system when compared with the other two species. These results suggest that oxidative polymorphism of debrisoquine plays a role in the acute effects of MPTP.