The Impact of Delirium on Recovery in Geriatric Rehabilitation after Acute Infection.

OBJECTIVES: Delirium is common during acute infection in older patients and is associated with functional decline. Geriatric rehabilitation (GR) can help older patients to return to their premorbid functional level. It is unknown whether delirium affects GR outcomes in patients with acute infection. We evaluated whether delirium affects trajectories of activities of daily living (ADL) and quality of life (QoL) recovery in GR after COVID-19 infection. DESIGN: This study was part of the EU-COGER study, a multicenter cohort study conducted between October 2020 and October 2021. SETTING AND PARTICIPANTS: Participants were recruited after COVID-19 infection from 59 GR centers in 10 European countries. METHODS: Data were collected at GR admission, discharge, and at the 6-week and 6-month follow-ups. Trajectories of ADL [using the Barthel index (BI)] and QoL [using the EuroQol-5 Dimensions-5 Level (EQ-5D-5L)] recovery were examined using linear mixed models. RESULTS: Of the 723 patients included (mean age 75.5 ± 9.9 years; 52.4% male), 28.9% had delirium before or during GR admission. Participants with delirium recovered in ADL at approximately the same rate as those without (linear slope effect = -0.13, SE 0.16, P = .427) up to an estimated BI score of 16.1 at 6 months. Similarly, participants with delirium recovered in QoL at approximately the same rate as those without (linear slope effect = -0.017, SE 0.015, P = .248), up to an estimated EQ-5D-5L score of 0.8 at 6 months. CONCLUSIONS AND IMPLICATIONS: Presence of delirium during the acute phase of infection or subsequent GR did not influence the recovery trajectory of ADL functioning and QoL.

Effect of the chemical structure of an equatorial ligand on the spin crossover properties of the Fe(III) complex with 4-styrylpyridine axial ligands.

In order to study the effect of the chemical structure of the equatorial ligand on the spin state of the Fe(iii) ion in complexes with invariable photoisomerizable 4-styrylpyridine axial ligands and different tetradentate Schiff bases, several new Fe(iii) complexes have been first synthesized, characterized, and studied by UV-vis, NMR, and EPR spectroscopies. The general chemical formula of the complexes is [Fe(SB)Sp2]BPh4·MeOH, where Sp is trans-4-styrylpyridine and SB are dianions of Schiff bases: salen, bzacen, and acen [salen = N,N'-ethylenebis(salicylaldimine) 1, acen = N,N'-ethylenebis(acetylacetonylideneimine) 2, and H2bzacen = N,N'-ethylenebis(benzoylacetonylideneimine) 3]. The results of the EPR and NMR measurements of the complexes both in the solid state and in solutions showed that the more methyl groups and less aromatic rings in the equatorial ligand, the more abrupt spin-crossover was observed in the complex. The dependence of the magnetic properties of the complexes on the state of matter and the presence of a solvent (powder, liquid solutions, and vitrified solutions) are noted.

25(OH) vitamin D and functional outcomes in older adults admitted to rehabilitation units: the safari study.

Vitamin D (25(OH)D) deficiency is associated with poor physical performance; little is known about its impact on geriatric rehabilitation. We found a positive non-linear relationship between 25(OH)D and functional gain, stronger in levels < 16 ng/ml (below the cutoff for "deficiency"). An early 25(OH)D dosage may be advisable for this population. INTRODUCTION: Vitamin D (25(OH)D) deficiency is highly prevalent in older people, and it is associated with poor muscular strength and physical performance. Its impact on functional outcomes during geriatric rehabilitation has been poorly studied. We aim to analyze the association between 25(OH)D and functional recovery in geriatric rehabilitation units. METHODS: We conducted a prospective multi-center cohort study including patients ≥ 65 years old admitted to 3 geriatric rehabilitation units in Italy and Spain, after orthopedic events or stroke. Outcomes were absolute functional gain (AFG, discharge-admission Barthel index) and ability to walk (AW) at 3 months after admission. The association between 25(OH)D quartiles (Q1-Q2-Q3-Q4) and outcomes was explored using linear or logistic regression models. RESULTS: We included 420 patients (mean age = 81.2 years [SD = 7.7], 66.4% females, mean 25(OH)D concentration = 13.5 ng/ml [SD = 8.7]) (to convert to nmol/l multiply by 2.496). A non-linear relationship between 25(OH)D and AFG was found, with a stronger association for 25(OH)D levels < 16 ng/ml. Compared to Q1 (25(OH)D ≤ 6 ng/ml), participants in Q3 (25(OH)D 11.5-18.2 ng/ml) had the best AFG and AW (mean AFG [SD], Q1 = 28.9 [27.8], Q2 = 32.5 [23.5], Q3 = 43.1 [21.9], Q4 = 34.5 [29.3], R2 = 7.3%; AW, Q1-Q2 = 80%, Q3 = 91%, Q4 = 86%). Regression models adjusted for potential confounders confirmed these results (AGF Q2, ß = 2.614, p = 0.49; Q3, ß = 9.723, p < 0.01; Q4, ß = 4.406, p = 0.22; AW Q2, OR [95% CI] = 1.84 [0.67-5.33]; Q3, OR [95% CI] = 4.01 [1.35-13.48]; Q4, OR [95% CI] = 2.18 [0.81-6.21]). CONCLUSIONS: In our study, 25(OH)D concentration showed a positive association with functional outcomes at 3 months. The association is stronger below the usual cutoff for "deficiency." Dosage of 25(OH)D concentration may help identify geriatric rehabilitation patients at risk for a worse functional recovery.

Maloclusión, trastorno temporomandibular y su asociación a la cervicalgia / Malocclusion, temporomandibular disorder and their association with neck pain

Objetivo: Estimar la asociación entre la maloclusión y el trastorno temporomandibular (TTM) con la cervicalgia en los pacientes que asistían al área odontológica de una clínica de Odontología. Materiales y métodos: Se realizó un estudio de corte transversal en Lima, Perú. La población fue conformada por pacientes que asistían a una clínica odontológica, a quienes se evaluó el autorreporte de cervicalgia en los últimos 3 meses, el TTM con el índice de Fonseca, los tipos de maloclusión con la evaluación odontológica registrada en su historia clínica, así como hábitos orales y falta de piezas dentarias. Se evaluó la asociación calculando las razones de prevalencia ajustadas (RPa). Resultados: Se incluyó a 215 personas, cuya edad media ± desviación estándar fue de 33,1 ± 12,4 años y la mayoría fueron mujeres (69,3%). La prevalencia de cervicalgia fue del 64,2; el 79,1% tuvo algún grado de TTM y el 97,7% maloclusión. Tener TTM estuvo asociado a cervicalgia, tanto moderada como severa (RPa: 6,65; IC del 95%, 3,17-13,95), como leve (RPa: 4,88; IC del 95%, 2,29-10,41). No se halló asociación entre maloclusión y cervicalgia (RPa: 0,89; IC del 95%, 0,71-1,13). Otro factor asociado fue la ausencia de 3 o más dientes (RPa: 1,25; IC del 95%, 1,01-1,56). Conclusiones: La cervicalgia está asociada al TTM pero no a la maloclusión, por lo que se recomienda un trabajo coordinado entre odontólogos y fisioterapeutas en el manejo de la TTM y cervicalgia para tratar integralmente a estos pacientes

Objective: This study has aimed to estimate the association between malocclusion and temporomandibular disorder with neck pain in patients seen in the area of odontology in an Odontology clinic. Materials and methods: A cross-sectional was performed in Lima, Peru. The population was composed of patients attending a dental clinic. During the last three months, assessment was made of self-reported neck pain, the temporomandibular disorder (TMD) with the index of Fonseca, types of malocclusion with dental assessment recorded in their medical history, oral habits and lack of teeth. The association was evaluated by estimating the established prevalence reasons (RPa). Results: The study included 215 people, whose mean age was 33.1 ± 12.4 years old. Most of the subjects were women (69.3%). Prevalence of neck pain was 64.2%, 79.1% had some degree of TMD and 97.7% malocclusion. Having TMD was associated with neck pain, both moderate as severe (OR: 6.65, 95% CI: 3.17-3.95) and mild (OR: 4.88 95%, 95% CI: 2.29-10.41). No association between malocclusion and neck pain (95% CI: 0, 71-1, 13 OR 0.89) was found. Another associated factor was the absence of 3 or more teeth (OR: 1.25, 95% CI 1.01-1.56). Conclusions: Neck pain is associated with TMD but not with malocclusion. Therefore, a coordinated work between dentists and physiotherapists in the management of TMD and neck pain is recommended in order to comprehensively treat these patients

¿Activación o estiramiento muscular para el alivio del dolor? / Muscle activation or stretching for pain relief?

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Identification and analysis of the first 2009 pandemic H1N1 influenza virus from U.S. feral swine.

The first case of pandemic H1N1 influenza (pH1N1) virus in feral swine in the United States was identified in Texas through the United States Department of Agriculture (USDA) Wildlife Services' surveillance program. Two samples were identified as pandemic influenza by reverse transcriptase quantitative PCR (RT-qPCR). Full-genome Sanger sequencing of all eight influenza segments was performed. In addition, Illumina deep sequencing of the original diagnostic samples and their respective virus isolation cultures were performed to assess the feasibility of using an unbiased whole-genome linear target amplification method and multiple sample sequencing in a single Illumina GAIIx lane. Identical sequences were obtained using both techniques. Phylogenetic analysis indicated that all gene segments belonged to the pH1N1 (2009) lineage. In conclusion, we have identified the first pH1N1 isolate in feral swine in the United States and have demonstrated the use of an easy unbiased linear amplification method for deep sequencing of multiple samples.

Indorenate modifies a1-adrenergic and benzodiazepine receptor binding in the rat brain: an autoradiography study.

Indorenate (5-methoxytryptamine-beta-methylcarboxylate) is a 5-HT1A receptor agonist that produces antihypertensive, anxiolytic, antidepressant and anticonvulsant effects. However, there is evidence suggesting that these effects could involve the activation of benzodiazepine (BZD) receptors but not the activation of a1-adrenergic receptors. The goal of this study was to analyse the effect of indorenate on a1-adrenergic and BZD receptor binding in specific rat brain areas by using in-vitro autoradiography. Coronal brain sections from male Wistar rats were used for labelling 5-HT1A (3H-8-OH-DPAT, 2 nM), a1-adrenergic (3H-prazosin, 2 nM) and BZD (3H-flunitrazepam, 2 nM) receptor binding in the presence or absence of indorenate (1 microM). Indorenate totally displaced 3H-8-OH-DPAT binding in all the brain areas evaluated. It decreased 3H-prazosin binding just in the frontal (30%) and sensorimotor (32%) cortices and in the thalamus (21%). Additionally, indorenate diminished 3H-flunitrazepam binding only in the cingulate (16%) and piriform (18%) cortices as well as in the dorsal raphe nucleus (18%). These results confirm that indorenate is a 5-HT1A ligand and suggest the possible participation of a1-adrenergic and BZD receptors in its pharmacological properties.

Low frequency stimulation modifies receptor binding in rat brain.

Experiments were designed to reproduce the antiepileptic effects of low frequency stimulation (LFS) during the amygdala kindling process and to examine LFS-induced changes in receptor binding levels of different neurotransmitters in normal brain. Male Wistar rats were stereotactically implanted in the right amygdala with a bipolar electrode. Rats (n = 14) received twice daily LFS (15 min train of 1Hz, 0.1 ms at an intensity of 100 to 400 microA) immediately after amygdala kindling stimulation (1s train of 60 Hz biphasic square waves, each 1 ms at amplitude of 200-500 microA) during 20 days. The LFS suppressed epileptogenesis (full attainment of stage V kindling) but not the presence of partial seizures (lower stages of kindling) in 85.7% of the rats. Thereafter, normal rats (n = 7) received amygdala LFS twice daily for 40 trials. Animals were sacrificed 24 h after last stimulation and their brain used for labeling mu opioid, benzodiazepine (BZD), alpha(1)-adrenergic, and adenylyl cyclase binding. Autoradiography experiments revealed increased BZD receptor binding in basolateral amygdala (20.5%) and thalamus (29.3%) ipsilateral to the place of stimulation and in contralateral temporal cortex (18%) as well as decreased values in ipsilateral frontal cortex (24.2%). Concerning mu receptors, LFS decreased binding values in ipsilateral sensorimotor (7.2%) and temporal (5.6%) cortices, dentate gyrus (5.8% ipsi and 6.8% contralateral, respectively), and contralateral CA1 area of dorsal hippocampus (5.5%). LFS did not modify alpha(1) receptor and adenylyl cyclase binding values. These findings suggest that the antiepileptic effects of LFS may involve activation of GABA-BZD and endogenous opioid systems.

Cry1Ac protoxin from Bacillus thuringiensis sp. kurstaki HD73 binds to surface proteins in the mouse small intestine.

Bacillus thuringiensis (Bt), considered a safe insecticide, produces insecticidal proteins named Cry during sporulation, which possess exceptional immunological properties. In this work using an immunohistochemical test we demonstrated that Cry1Ac protoxin (pCry1Ac) binds to the mucosal surface of the mouse small intestine. Ligand blot assay allowed us to detect, under denaturing conditions, six pCry1Ac-binding polypeptides present in brush border membrane vesicles isolated from the small intestine. Moreover, this protein induced in situ temporal changes in the electrophysiological properties of the mouse jejunum. The data obtained indicate a possible interaction in vivo of Cry proteins with the animal bowel which could induce changes in the physiological status of the intestine.

Characterization of the mucosal and systemic immune response induced by Cry1Ac protein from Bacillus thuringiensis HD 73 in mice.

The present paper describes important features of the immune response induced by the Cry1Ac protein from Bacillus thuringiensis in mice. The kinetics of induction of serum and mucosal antibodies showed an immediate production of anti-Cry1Ac IgM and IgG antibodies in serum after the first immunization with the protoxin by either the intraperitoneal or intragastric route. The antibody fraction in serum and intestinal fluids consisted mainly of IgG1. In addition, plasma cells producing anti-Cry1Ac IgG antibodies in Peyer's patches were observed using the solid-phase enzyme-linked immunospot (ELISPOT). Cry1Ac toxin administration induced a strong immune response in serum but in the small intestinal fluids only anti-Cry1Ac IgA antibodies were detected. The data obtained in the present study confirm that the Cry1Ac protoxin is a potent immunogen able to induce a specific immune response in the mucosal tissue, which has not been observed in response to most other proteins.

Characterization of the mucosal and systemic immune response induced by Cry1Ac protein from Bacillus thuringiensis HD 73 in mice

The present paper describes important features of the immune response induced by the Cry1Ac protein from Bacillus thuringiensis in mice. The kinetics of induction of serum and mucosal antibodies showed an immediate production of anti-Cry1Ac IgM and IgG antibodies in serum after the first immunization with the protoxin by either the intraperitoneal or intragastric route. The antibody fraction in serum and intestinal fluids consisted mainly of IgG1. In addition, plasma cells producing anti-Cry1Ac IgG antibodies in Peyer's patches were observed using the solid-phase enzyme-linked immunospot (ELISPOT). Cry1Ac toxin administration induced a strong immune response in serum but in the small intestinal fluids only anti-Cry1Ac IgA antibodies were detected. The data obtained in the present study confirm that the Cry1Ac protoxin is a potent immunogen able to induce a specific immune response in the mucosal tissue, which has not been observed in response to most other proteins

Intragastric and intraperitoneal administration of Cry1Ac protoxin from Bacillus thuringiensis induces systemic and mucosal antibody responses in mice.

The spore-forming soil bacterium Bacillus thuringiensis produces parasporal inclusion bodies composed by delta-endotoxins also known as Cry proteins, whose resistance to proteolysis, stability in highly alkaline pH and innocuity to vertebrates make them an interesting candidate to carrier of relevant epitopes in vaccines. The purpose of this study was to determine the mucosal and systemic immunogenicity in mice of Cry1Ac protoxin from B. thuringiensis HD73. Crystalline and soluble forms of the protoxin were administered by intraperitoneal or intragastric route and anti-Cry1Ac antibodies of the major isotypes were determined in serum and intestinal fluids. The two forms of Cry1Ac protoxin administered by intraperitoneal route induced a high systemic antibody response, however, only soluble Cry1Ac induced a mucosal response via intragastric. Serum antibody levels were higher than those induced by cholera toxin. Systemic immune responses were attained with doses of soluble Cry1Ac ranging from 0.1 to 100 microg by both routes, and the maximal effect was obtained with the highest doses. High anti-Cry1Ac IgG antibody levels were detected in the large and small intestine fluids from mice receiving the antigen via i.p. These data indicate that Cry1Ac is a potent systemic and mucosal immunogen.

Bacillus thuringiensis Cry1Ac protoxin is a potent systemic and mucosal adjuvant.

Recently we demonstrated that recombinant Cry1Ac protoxin from Bacillus thuringiensis is a potent systemic and mucosal immunogen. In this study we compared the adjuvant effects of Cry1Ac and cholera toxin (CT) for the hepatitis B surface antigen (HBsAg) and bovine serum albumin (BSA). The antibody responses of intestinal secretions and serum were determined by ELISA in Balb/c mice immunized through the intragastric (IG) or intraperitoneal (IP) routes. When HBsAg was administered via IG, the anti-HBsAg intestinal response was not enhanced by either Cry1Ac or CT, whereas via IP Cry1Ac increased the anti-HBsAg intestinal immunoglobulin (Ig)G response and CT increased the intestinal IgA and IgM responses. Serum anti-BSA antibodies increased when BSA was co-administered with CT or Cry1Ac by both routes. Cholera toxin and Cry1Ac co-administered via IP increased the IgG anti-BSA response in fluid of the large intestine and CT also increased the IgA and IgM responses slightly. When co-administered via IP, CT and Cry1Ac did not affect the IgG anti-BSA response of the small intestine significantly. We conclude that Cry1Ac is a mucosal and systemic adjuvant as potent as CT which enhances mostly serum and intestinal IgG antibody responses, especially at the large intestine, and its effects depend on the route and antigen used. These features make Cry1Ac of potential use as carrier and/or adjuvant in mucosal and parenteral vaccines.

Estudio retrospectivo de pacientes hospitalizados por Herpes Zoster en el Hospital Nacional Cayetano Heredia entre los años 1980-1998 / Retrospective study of patients hospitalized by Herpes Zoster in the Hospital Nacional Cayetano Heredia between the years 1980-1998

Se revisaron retrospectivamente las historias clínicas de 53 pacientes hospitalizados con diagnóstico de herpes zoster en el Hospital Nacional Cayetano Heredia entre 1980 y 1998. La mayoría de pacientes hospitalizados con diagnóstico de herpes zoster no presentan condiciones asociadas que lleven a inmunosupresión. Las condiciones asociadas más frecuentes fueron infección por Virus de Inmunosuficiencia Humana (VIH) en 15.1 por ciento y corticoterapia en 11.3 por ciento. Las áreas comprometidas en los pacientes estudiados en orden de frecuencia fueron: trigeminal (45.3 por ciento), torácica (32 por ciento), lumbosacra (17 por ciento) y difuso (5.7 por ciento). Con respecto al tratamiento recibido por los pacientes, 62 por ciento recibió aciclovir, de ellos el 19 por ciento inició tratamiento dentro de las primeras 72 horas de inicio de la enfermedad. El tratamiento completo con aciclovir, considerado igual o mayor a 7 días fue recibido por 36 por ciento de los pacientes. La complicación más frecuente fue la sobreinfección de las lesiones (32 por ciento). Dentro de las complicaciones neurológicas, la meningoencefalitis (7.5 por ciento) y encefalitis (3.8 por ciento) conforman un grupo importante y dentro de las oftalmológicas, la conjuntivitis inespecífica (30 por ciento) fue la más frecuente. La letalidad en nuestra serie fue de 7.5 por ciento. De ellos 75 por ciento (3) presentaban herpes zoster difuso y 25 por ciento (1) tenía diagnóstico de VIH Estadio IVC, herpes zoster torácico y meningitis criptococócica, aparentemente ésta última fue la causal de muerte. El 32 por ciento de los pacientes presentaron neuralgia postherpética (NPH), encontrándose esta complicación en 37.5 por ciento de los casos con herpes trigeminal, 41.7 por ciento de los casos con herpes torácico y 11.11 por ciento de los casos con herpes lumbosacro. Al analizar la presentación de NPH por grupos de edad encontró que 53 por ciento de los pacientes pertenecían al grupo de 70 a 87 años, 29.4 por ciento pertenecían al grupo de 52 a 69 años, 11.7 por ciento pertenecían al grupo de 16 a 33 años y 5.8 por ciento al grupo de 34 a 51 años, encontrándose diferencia significativa entre los grupos.

Mechanism for procaine-mediated hyperactivated motility in guinea pig spermatozoa.

Hyperactivated motility was studied in guinea pig spermatozoa. In the presence of the local anesthetic procaine, a high number of sperm cells (64%) showed hyperactivation when incubated in minimal culture medium with pyruvate, lactate, and glucose. Hyperactivated motility was dependent on glucose in the medium. Sperm ATP concentration was increased twofold in hyperactivated sperm when compared to procaine-treated non-hyperactivated cells. cAMP levels were also higher in hyperactivated cells than in control spermatozoa. Thus, in living spermatozoa high levels of ATP appear to be needed to generate hyperactivation. cAMP is present at a high concentration in hyperactivated spermatozoa, therefore a role of cAMP in hyperactivation cannot be excluded. Depletion of external Ca2+ did not inhibit procaine-induced hyperactivated motility. Hence, procaine canceled the requirement of external Ca2+ for sperm to express hyperactivated motility.

A method for measuring "primitive" and "advanced" elements in pleasures and aversions.

Subjects were asked to list pleasures and aversions actually experienced, and pleasures and aversions based on their "innermost fantasies." A 7-point rating scale was developed to rate "primitive" and "advanced" elements in these pleasure-aversion responses. The "primitive" pole of the scale was keyed with the phrase "gut-level experiencing" and the "advanced" pole with "detached objective thinking." Reality Pleasure, Fantasy Pleasure, Reality Aversive, Fantasy Aversive, and Total scores were derived by having trained raters rate each subject's response with the 7-point rating scale. In Study 1, 25 females and 25 males provided pleasure-aversion responses and the data analyzed in a mixed 2 (male-female) x 2 (reality-fantasy) x 2 (pleasure-aversive) ANOVA. The most important finding was a highly significant reality-fantasy x pleasure-aversive interaction: subjects tended to "progress" (give more advanced responses) going from reality to fantasy in their pleasure responses, while exactly the opposite occurred with the aversive responses. Also, as predicted, reality aversive responses tended to be more "advanced" than reality pleasure responses. Study 2 was similar in design, but several additional personality measures were administered to assess the construct validity of the pleasure-aversion scores. As in Study l, the reality-fantasy x pleasure-aversive interaction was highly significant and again reflected a pattern of "progression" going from reality to fantasy for pleasure responses and "regression" for aversive responses. The correlation analysis also produced several interesting findings with sex serving as a major moderator variable.