Associations of Race-Ethnicity and History of Traumatic Brain Injury With Age at Onset of Alzheimer's Disease.

OBJECTIVE: This study examined whether a history of traumatic brain injury (TBI) is associated with age at onset of Alzheimer's disease (AD) in three racial-ethnic groups. METHODS: Data from 7,577 non-Hispanic Caucasian, 792 African American, and 870 Hispanic participants with clinically diagnosed AD were obtained from the National Alzheimer's Coordinating Center. Participants were categorized by the presence or absence of self-reported remote history of TBI (>1 year before diagnosis of AD) with loss of consciousness (LOC) (TBI+) or no history of TBI with LOC (TBI-). Any group differences in education; sex; APOE ε4 alleles; family history of dementia; or history of depression, stroke, hypertension, hypercholesterolemia, and diabetes were included in analyses of covariance comparing clinician-estimated age at AD symptom onset for the TBI+ and TBI- groups. RESULTS: AD onset occurred 2.3 years earlier for non-Hispanic Caucasians (F=30.49, df=1, 7,572, p<0.001) and 3.4 years earlier for African Americans (F=5.17, df=1, 772, p=0.023) in the TBI+ group. In the Hispanic cohort, females in the TBI+ group had AD onset 5.6 years earlier, compared with females in the TBI- group (F=6.96, df=1, 865, p=0.008); little difference in age at AD onset was observed for Hispanic males with and without a TBI history. CONCLUSIONS: A history of TBI with LOC was associated with AD onset 2-3 years earlier in non-Hispanic Caucasians and African Americans and an onset nearly 6 years earlier in Hispanic females; no association was observed in Hispanic males. Further work in underserved populations is needed to understand possible underlying mechanisms for these differences.

Sucesso no tratamento conservador da gravidez ectópica em cicatriz de cesárea / Successful conservative management of ectopic pregnancy in cesarean scar

A implantação da gravidez na cicatriz de cesárea é considerada uma forma rara de gestação ectópica com uma alta morbidade e mortalidade. Esse tipo de gestação ectópica pode causar complicações graves que pode resultar em histerectomia e comprometimento do futuro reprodutivo da mulher. Reportamos um caso de um tratamento conservador com sucesso.

Implantation of a pregnancy with in a cesarean delivery scar is considered to be the rarest form of ectopic pregnancy. with a high morbidity and mortality. Pregnancy in a cesarean delivery scar may cause catastrophic complications which may result in hysterectomy and compromise the reproductive future of a woman. We report a case that was treated conservatively with success.