Profiling cognitive-motor interference in a large sample of persons with progressive multiple sclerosis and impaired processing speed: results from the CogEx study.

BACKGROUND: Performing cognitive-motor dual tasks (DTs) may result in reduced walking speed and cognitive performance. The effect in persons with progressive multiple sclerosis (pwPMS) having cognitive dysfunction is unknown. OBJECTIVE: To profile DT-performance during walking in cognitively impaired pwPMS and examine DT-performance by disability level. METHODS: Secondary analyses were conducted on baseline data from the CogEx-study. Participants, enrolled with Symbol Digit Modalities Test 1.282 standard deviations below normative value, performed a cognitive single task ([ST], alternating alphabet), motor ST (walking) and DT (both). Outcomes were number of correct answers on the alternating alphabet task, walking speed, and DT-cost (DTC: decline in performance relative to the ST). Outcomes were compared between EDSS subgroups (≤ 4, 4.5-5.5, ≥ 6). Spearman correlations were conducted between the DTCmotor with clinical measures. Adjusted significance level was 0.01. RESULTS: Overall, participants (n = 307) walked slower and had fewer correct answers on the DT versus ST (both p < 0.001), with a DTCmotor of 15.8% and DTCcognitive of 2.7%. All three subgroups walked slower during the DT versus ST, with DTCmotor different from zero (p's < 0.001). Only the EDSS ≥ 6 group had fewer correct answers on the DT versus ST (p < 0.001), but the DTCcognitive did not differ from zero for any of the groups (p ≥ 0.039). CONCLUSION: Dual tasking substantially affects walking performance in cognitively impaired pwPMS, to a similar degree for EDSS subgroups.

Cefalea por abuso de medicamentos y sus marcadores clínicos / Medication overuse headache and its specific clinical markers

Resumen Introducción: Los marcadores clínicos de la cefalea por uso excesivo de medicación (CMA) se basan en la clasificación de las cefaleas desarrollada por la Sociedad Internacional de Cefaleas (IHS). Esta clasificación incluye sólo dos criterios: la frecuencia de los días de cefalea debe ser de 15 o más días al mes durante al menos tres o más meses; - y el número de días de uso excesivo de la medicación debe ser de 10 o 15 días al mes dependiendo del tipo de medicación. Sin embargo, los pacientes suelen tener otros marcadores clínicos asociados distintos, que la mayoría de los médicos pasan por alto durante la evaluación inicial. Metodología: Este estudio es un estudio prospectivo, longitudinal y observacional de 76 pacientes ingresados en la Unidad de Cefaleas del hospital DIPRECA. Todos ellos fueron diagnosticados de HMO según los criterios establecidos por su ICHD III beta.(1) Los pacientes recibieron un tratamiento estándar que incluía desintoxicación y medicación preventiva y fueron seguidos durante 6 meses. Se registraron los síntomas de interés en cada visita de seguimiento clínico y se administraron escalas de evaluación como Zung, MIDAS, HIT-6. Resultados: Los medicamentos sobreutilizados incluyeron antiinflamatorios no esteroideos (AINE), triptanes y cornezuelos. Los síntomas clínicos más significativos asociados fueron: despertar por la mañana con dolor de cabeza, despertar al paciente al amanecer por dolor de cabeza, dificultades de atención, depresión, dolor cervical y síndrome de dolor miofascial. Todos los síntomas mejoraron significativamente al iniciar el tratamiento, al igual que la calidad de vida medida por las escalas MIDAS y HIT-6. Discusión: Al evaluar a los pacientes con HMO, hay que tener en cuenta tanto los criterios diagnósticos de la ICHD III beta como los síntomas comunes y específicos que se observan en la mayoría de los casos de HMO.

Introduction: Clinical markers of medication overuse headache (MOH) are based on headache classification developed by the International Headache Society (IHS). This classification include only two criteria: frequency of headache days must be 15 or more days per month for at least three or more months; - and the number of days of overuse medication must be either 10 or 15 days per month depending on the type of medication. However, patients often have others distinct associated clinical markers, which are overlooked by most physicians during the initial evaluation. Methodology: This study is a prospective, longitudinal and observational study of 76 patients admitted to DIPRECA´s hospital Headache Unit. They were all diagnosed with, MOH according to the criteria established by the his ICHD III beta.(1) Patients were given standard treatment including detoxification and preventive medications and followed for 6 months. Symptoms of interest were recorded in at each clinical monitoring visit and assessment scales such as Zung, MIDAS, HIT-6 were administered. Results: Overused medications included nonsteroidal anti-inflammatory drugs (NSAIDs), triptans and ergots. The most significant clinical symptoms associated were: awaking in the morning with headache, awaking the patient at dawn by headache, attention difficulties, depression, cervical pain and myofascial pain syndrome. All symptoms significantly improved when treatment began, as did quality of life as measured by MIDAS and HIT-6 scales. Discussion: In evaluating patients with MOH consider both the ICHD III beta diagnostic criteria and the common and specific symptoms seen in most cases of MOH.

Neuroprotective effects of EpoL against oxidative stress induced by soluble oligomers of Aß peptide.

Erythropoietin is a glycoproteic hormone that regulates hematopoiesis by acting on its specific receptor (EpoR). The expression of EpoR in the central nervous system (CNS) suggests a role for this hormone in the brain. Recently, we developed a new Epo variant without hematopoietic activity called EpoL, which showed marked neuroprotective effects against oxidative stress in brain ischemia related models. In this study, we have evaluated the neuroprotective effects of EpoL against oxidative stress induced by chronic treatment with Aß. Our results show that EpoL was neuroprotective against Aß-induced toxicity by a mechanism that implicates EpoR, reduction in reactive oxygen species, and reduction in astrogliosis. Furthermore, EpoL treatment improved calcium handling and SV2 levels. Interestingly, the neuroprotective effect of EpoL against oxidative stress induced by chronic Aß treatment was achieved at a concentration 10 times lower than that of Epo. In conclusion, EpoL, a new variant of Epo without hematopoietic activity, is of potential interest for the treatment of diseases related to oxidative stress in the CNS such as Alzheimer disease.

Obesity in laparoscopic surgery.

Since the 1980s, minimally invasive techniques have been applied to an increasing number and variety of surgical procedures with a gradual increase in the complexity of procedures being successfully performed laparoscopically. In the past, obesity was considered a contraindication to laparoscopy due to the higher risk of co-morbid conditions such as diabetes, hypertension, coronary artery disease and venous thromboembolism. Performing laparoscopic gynaecological procedures in morbidly obese patients is no longer a rare phenomenon; however, it does necessitate changes in clinical practice patterns. Understanding of the physiological changes induced by laparoscopy, particularly in obese patients, is important so that these may be counteracted and adverse outcomes avoided. Laparoscopy in obese patients confers certain advantages such as shorter hospital stay, less post-operative pain and fewer wound infections. In addition to these benefits, minimal-access surgery has been demonstrated as safe and effective in obese patients; however, specific surgical strategies and operative techniques may need to be adopted.

INCLUSIÓN DE HARINAS DE FOLLAJES ARBÓREOS Y ARBUSTIVOS TROPICALES (Morus alba, Erythrina poeppigiana, Tithonia diversifolia E Hibiscus rosa-sinensis) EN LA ALIMENTACIÓN DE CUYES (Cavia porcellus Linnaeus) / LEAF MEALS AND TROPICAL SHRUBBY FOLIAGE (Morus alba, Erythrina poeppigiana, Tithonia diversifolia AND Hibiscus rosa-sinensis) IN FEEDING GUINEA PIGS (Cavia porcellus Linnaeus)

La investigación se ejecutó en la Finca Experimental "La María" propiedad de la Universidad Técnica Estatal de Quevedo (UTEQ) localizada en el km 7¹/2 de la vía Quevedo-Mocache; Provincia de Los Ríos cuya ubicación geográfica de 1º 6' 23" de latitud sur y 79º 29' 12" de longitud oeste y a una altura de 73 m.s.n.m. El objetivo principal fue evaluar el comportamiento productivo de cuyes con la inclusión del 20% de harinas derivadas de follajes arbustivos y arbóreos tropicales. Se utilizaron 40 cuyes macho de 30 días de edad. Se empleó un diseño completamente al azar con cinco tratamientos, cuatro réplicas y la unidad experimental estuvo conformado por dos cuyes. Para determinar las diferencias entre medias de tratamientos se aplicó la prueba de Tukey (P≤0.05). Se evaluaron cinco dietas-tratamientos: (T0) dieta 100% balanceado, (T1) 80% dieta y 20% harina de Morus alba, (T2) 80% dieta y 20% harina de Erythrina poeppigiana, (T3) 80% dieta y 20% harina de Tithonia diversifolia, (T4) 80% dieta y 20% harina de Hibiscus rosa-sinensis. Las variables bajo estudio fueron: consumo de alimento de balanceado en materia seca (CABMS, g), ganancia de peso (GP, g), índice de conversión alimenticia (ICA) y rendimiento en canal (RC, %). La rentabilidad de los tratamientos se determinó a través de la relación beneficio-costo (R b/c). Los mayores (P<0.01) CABMS, GP-ICA y RC-Rentabilidad, la registraron los tratamientos: T0 (48.34 g MS animal-1 d-1), T1 (8.80 g animal-1 d-1 y 5.04) y el T3 (77.67% y 26.20%), respectivamente.

The research was carried out at the Experimental farm "La María" property of the State Technical University of Quevedo located at km 7¹/2 in road Quevedo-Mocache; Los Ríos province, with a geographical location of 1° 6' 23" south latitude and 79º 29' 12" west longitude, at 73 meters altitude. The aim was to evaluate the productive effect of leaf meal and tropical shrubs with inclusion 20%. Were used 40 male guinea pigs of 30 days age and a completely randomized design with five treatments and four repetitions, two male guinea pigs was used to study. A 56-days experiment was conducted, and was applied the Tukey test (P≤0.05) to determine differences. Five treatments in diets were evaluated: (T0) 100% balanced diet; (T1) 80% and 20% leaf meal Morus alba flour (T2); 80% diet and 20% Erythrina poeppigiana flour; (T3) 80% diet and 20% Tithonia diversifolia flour; (T4) 80% diet and 20% Hibiscus rosa-sinensis flour. The following variables were used: Balanced feed consumption in dry matter (CABMS, g), weight obtained (GP, g), alimentary conversion index (ICA), performance distribution channel (RC, %). The profitability of the treatments was determined using the benefit-cost ratio (R b/c) ratio. The higher (P<0.01) CABMS, GP-ICA, RC- yield, assigned treatments: T0 (48.34 g DM animal-1 d-1), T1 (8.80 g animal-1 d-1 and 5.04) and T3 (77.67 % and 26.20%), respectively.

Effectiveness of the E2-classical swine fever virus recombinant vaccine produced and formulated within whey from genetically transformed goats.

Subunit recombinant vaccines against classical swine fever virus (CSFV) are a promising alternative to overcome practical and biosafety issues with inactivated vaccines. One of the strategies in evaluation under field conditions is the use of a new marker E2-based vaccine produced in the milk of adenovirally transduced goats. Previously we had demonstrated the efficacy of this antigen, which conferred early protection and long-lasting immunity in swine against CSFV infection. Here, we have used a simpler downstream process to obtain and formulate the recombinant E2 glycoprotein expressed in the mammary gland. The expression levels reached approximately 1.7 mg/ml, and instead of chromatographic separation of the antigen, we utilized a clarification process that eliminates the fat content, retains a minor amount of caseins, and includes an adenoviral inactivation step that improves the biosafety of the final formulation. In a vaccination and challenge experiment in swine, different doses of the E2 antigen contained within the clarified whey generated an effective immune response of neutralizing antibodies that protected all of the animals against a lethal challenge with CSFV. During the immunization and after challenge, the swine were monitored for adverse reactions related to the vaccine or symptoms of CSF, respectively. No adverse reactions or clinical signs of disease were observed in vaccinated animals, in which no replication of CSFV could be detected after challenge. Overall, we consider that the simplicity of the procedures proposed here is a further step toward the introduction and implementation of a commercial subunit vaccine against CSF.

A survey of beef carcass quality and quantity attributes in Mexico.

The objective of the present study was to evaluate quality and yield attributes of Mexican beef carcasses to serve as a benchmark for production in the Mexican beef cattle industry. Seven packing plants were surveyed nationwide. Carcass yield and quality traits were assessed in the cooler at approximately 24 h postmortem. Results indicated that around 90% of the beef slaughter population in Mexico has a strong Bos indicus genetic background. Moreover, 71.6% of the surveyed cattle are presented for slaughter at a BW between 400 and 500 kg. Chilled carcass weight was between 220 and 340 kg in 88.9% of the surveyed population. According to European beef carcass grading standards, carcass conformation varied from poor to good in 82% of the carcasses, whereas in 17.8% the conformation was very good or excellent. In 60.7% of the surveyed carcasses the KPH was 2% or less. The subcutaneous fat depth was 1 cm or less in 90% of the carcasses. In 71.8% of the carcasses the LMA was of 80 cm(2) or less, whereas only 8.6% had LMA values of 90 cm(2) or greater. Carcass maturity score USDA B(100) or less was found in 92.4% of the evaluated carcasses, whereas 28.5% were graded as USDA A(100)/B(00). A total of 93.6% of the sample had marbling scores of 300 or less, corresponding to the categories slight, practically devoid, or traces. Only 12.9% of the carcasses exhibited a yellow fat cover. In the remaining 87.1% the fat cover was white or beige. The backfat layer was uniform in 43.2% of the carcasses, whereas 55.9% had an uneven fat cover. Information from this survey provided data that could serve as a means to develop a yield and quality evaluation program that can be further developed into a value system for Mexican beef carcasses and live cattle.

Combined transurethral prostatectomy and mesh-based tension-free inguinal hernia repair.

Previous reports have recognized the benefits of combining prostatic resection and inguinal hernia repair. This study reports the surgical management of bladder-outlet obstruction with simultaneous transurethral prostatectomy and mesh-based tension-free inguinal hernia repair. A prospective study was undertaken of 31 consecutive patients seen from January 1993-December 1998 at the Western Medical Center. All surgery was performed electively under epidural anesthesia, and prophylactic antimicrobial agents were given routinely. Two hernia repair techniques were used: the mesh-plug technique and the Lichtenstein repair. Written informed consent was obtained from all patients. Over a 5-year period, in 31 consecutive patients without urinary tract infection, 36 groin hernias were diagnosed. The mean+/-SD age of patients was 65.9+/-6.3 years. Twenty-four (66.7%) hernias were direct, and 12 (33.3%) were indirect; 61.1% (22) were primary hernias, and 38.8% (14) were recurrent. The mesh-plug and Lichtenstein repair techniques were used to treat 22 (61.1%) and 14 (38.8%) hernias, respectively. Wound hematoma developed after three hernioplasties (8.3%) and wound infection in one (2.7%). Hospital stays ranged between 2 and 4 days. The mean follow-up period was 69 months. The recurrence rate was 2.7% (one hernia). Simultaneous mesh-based tension-free herniorrhaphy and transurethral prostatectomy is a reliable and safe alternative for patients with both prostate enlargement and groin hernia. Hospital stay is not affected by the combined procedure, and the infection rate is acceptably low.

[Serum retinol in urban Mexican women during the perinatal period]. / Retinol sérico en mujeres mexicanas urbanas durante el periodo perinatal.

OBJECTIVE: To establish the prevalence of vitamin A deficiency during pregnancy and lactation in a group of urban Mexican women. MATERIAL AND METHODS: A group of pregnant women who attended a prenatal care program were invited to participate. Subjects had no added pathologies and were less than 20 weeks pregnant. Evaluations were performed 3 times during pregnancy until 24 weeks post-partum. Vitamin A levels were determined in serum by high performance liquid chromatography (HPLC). The cut-off point to consider retinol deficiency was < 1.05 mumol/L. RESULTS: During the 3 gestational evaluations, vitamin A levels were 2.34 +/- 0.70, 2.41 +/- 1.03 and 1.86 +/- 0.66 mumol/L, respectively, which shows a significant decrease. However, only 1/30 was situated below the accepted cut-off point to consider risk of deficiency, and none for deficiency. During post-partum, concentrations remained relatively constant, approximately 2.10 mumol/L. Lactation had no impact on serum retinol levels, while weight loss did. CONCLUSIONS: No cases of vitamin A deficiency were found in the studied population during the perinatal period. Maternal weight loss affects post-partum retinol levels.

Why is asthma becoming more of a problem?

From antiquity to the 1920s, the frequency of asthma and especially death from asthma was considered to be rare. In fact, asthma was not considered a significant cause of death during the early years of the 20th century. The Frenchman Armand Trousseau declared in his Clinique Medicale that "asthma n'est pas fatale" ("asthma is not fatal"). In the United States, Oliver Wendell Holmes had described asthma as a "slight ailment that promotes longevity." Clearly this perception of asthma has changed for many reasons. It has been only in the past 10 years that death from asthma has received increased attention when evidence was obtained that the rate was increasing. Few reports of asthma death had appeared until the late 1950s. Mortality today is disproportionately high for asthmatic patients aged 5 through 34 years. Asthma mortality rates have increased worldwide. Substantial increases in the rates of death from asthma in patients aged 5 through 34 years between the mid-1970s and the mid-1980s had been reported. Although asthma is still a relatively infrequent cause of death, it is nonetheless important to emphasize that the rates of death from asthma have risen in England and Wales, Australia, Canada, the Netherlands, Sweden, France, West Germany, Israel, the United States, and Denmark. This review attempts to put this data in perspective and to highlight some features, including pollution and treatment, that may contribute to this alarming problem.

Variación mensual de las concentraciones de ácido ascórbico en leucocitos durante el embarazo / Monthly variation in the concentration of ascorbic and in leucocytes during pregnancy

El presente trabajo se reallizó para determinar las variaciones de la concentración del ácido ascórbico en leucocitos durante el embarazo. Se realizó un estudio prospectivo en que se evaluó mensualmente a 30 mujeres embarazadas sanas asistentes a al consulta externa del INPer, que no consumieron suplementos vitamínicos durante el periodo comprendido entre las 20 y 36 semanas de la gestación, con la finalidad de conocer las variaciones de la consentración de ácido ascórbico en leucocitos. Se determinó la ingestión de alimentos ricos en este nutrimiento mediante evaluaciones dietéticas. La menor concentración correspondió a la semana 28 y la diferencia con las concentraciones observadas en las semanas 32 y 36 fueron significativas con valores de p = 0.04 y 0.01 respectivamente. Las concentraciones tendieron a aumentar hacia el final de la gestación. Se observó un consumo irregular de frutas y verduras. Los resultados indican la necesidad de brindar orientación alimentaria oportuna a las gestantes a fin de que su estado de nutrición en vitamina C no se vea alterado.

Breath hydrogen test in children with giardiasis.

Respiratory hydrogen excretion was measured in 50 children with giardiasis in order to study lactose absorption. Samples of expired air were collected before and after the children drank 250 ml of whole cow's milk. The test was repeated after successful elimination of Giardia lamblia following treatment with tinidazol. The number of children showing a rise in breath hydrogen excretion greater than 20 ppm decreased from 33 (72%) before treatment to 20 (44%) after treatment. This study permits the conclusion that the presence of G. lamblia in the intestine might interfere with optimum lactose absorption.

Oligosacaridos en las heces de ninos desnutridos alimentados con una dieta elemental. / Oligosaccharides in feces of malnourished cildren fed with an elemental diet

Con el objeto de estudiar, en lactantes desnutritdos, la absorcion de los oligosarcaridos contenidos en una dieta elemental, diez ninos menores de un ano fueron alimentados con "dieta elemental" al 15% (peso/volumen) colectandose la materia fecal durante 24 horas. El estudio mostro que en todos los ninos las heces fecales contenian hidratos de carbono, en tres de ellos la excrecion fue de 21.2 g. 4.3 g y 18.0 g, acompanandose de un volumen importante de agua. Se discute la posible explicacion de los hallazgos, considerando el mecanismo alterno de digestion que se plantea cuando la actividad de la amilasa pancreatica es baja. Oligosacaridos en heces, dieta elemental, desnutricion