Adaptation and validation of the semi-structured interview for Psychological Autopsy (SSIPA) in Spanish.

OBJECTIVES: The aim of this work was to adapt and validate into Spanish the Semi-Structured Interview for Psychological Autopsy (SSIPA). METHOD: The SSIPA consists of 69 items distributed into four modules: precipitants and/or stressors, motivation, lethality, and intentionality. The original instrument was translated from Portuguese into Spanish and backtranslated by bilinguals persons. The resulting questionnaire was compared with the original and discussed by an expert panel. The adapted instrument was then applied to the relatives of 26 presumed suicide cases in Ourense (Spain) who voluntarily accepted to participate. Interviews were digitally recorded and evaluated using a decision-making algorithm by the interviewer and two independent judges blind to the results of the others. RESULTS: Interrater agreement was measured using Kappa statistics. Participation in the study (27.6%) was similar to that obtained in the original study in Brazil >(20%). The Kappa values obtained were statistically significant. Correlation index was considered good (k>0.60) or very good (k> 0.80) in 15 steps including 3 out of 4 final steps of each module and the final result of the autopsy; moderate (k> 0.40) in 8 steps, 3 of them located in the motivation's module; and weak (k> 0.20) just in 2 steps. CONCLUSIONS: The Spanish version of the SSIPA is a reliable instrument for psychological autopsy studies. Low correlation in two of the algorithm steps for decision making may be due to the lack of accuracy of the questionnaire and should be improved.

The tropicamide test in patients with dementia of Alzheimer type and frontotemporal dementia.

The tropicamide test was applied to 30 patients with probable Alzheimer's disease (pAD), 12 with frontotemporal dementia (FTD) and 46 healthy subjects. One drop of 0.01% tropicamide was instilled in one eye and one drop of saline solution in the other. The pupil diameter was measured with a Goldmann pupillometer in its basal condition and 10, 15, 20, 25, 30, 35, 45 and 55 minutes afterwards. The results do not show differences between pupil dilation observed in pAD and in FTD; in both groups, from the beginning of the test, the pupil dilated more than in healthy people. A high interindividual variability was observed. The best cutoff point is 38% of interpupillary difference at minute 25 (sensitivity = 63%, specificity = 80%). If we consider the prevalence of AD in a population over 40 years old to be 1.4%, the adjusted positive predictive value of the test would be 4.2%. According to these results, the test is not a true diagnostic marker of AD.

Repair of scleral perforation with preserved scleral and amniotic membrane in Marfan's syndrome.

To describe the surgical technique used in the repair of a large scleral perforation in a patient with Marfan's syndrome and a past history of various surgical interventions in both eyes. Scleral homograft and amniotic membrane transplant were used to reconstruct the large scleral defect present in his left eye. One month after surgical intervention, the patient showed excellent restoration of the scleral perforation without signs of inflammation or infection. The combination of scleral homograft and amniotic membrane transplant constitute an effective alternative to autologous scleral and conjunctival grafts when these cannot be used.

[Experience with pupil tropicamide test in Alzheimer's disease]. / Experiencia con el test pupilar de tropicamida en la enfermedad de Alzheimer.

Scinto et al (Science 1994; 266: 1051-4) observed that a single drop of 0.01% tropicamide elicited more than a 13% pupil dilatation in 19 individuals with probable or possible Alzheimer's disease (AD) and 3 cognitive abnormal elderly without dementia, but not in 30 out of 32 normal elderly and 3 out of 4 patients suffering from other dementias. It could be an easy and bloodless test to help in diagnosing AD. We have administered the same test to 10 patients with probable AD (NINCDS-ADRDA criteria) and twenty 40-90 year-old control subjects (10 of whom were sons or daughters of AD patients and 10 without a family history of dementia). The researcher does not know which group the subject belongs to. He administers a single drop of 0.01% tropicamide in eye and one drop of 0.45% normal saline solution in the other (without knowing the contents of either vial) and measures the pupil diameter by means of a Goldmann pupilometer in basal condition and 10, 15, 25, 30, 35, 45, and 55 minutes after. The results show that it is necessary to measure the pupils at least between the minutes 25 and 55 to detect tha maximum pupil dilation in every case. The cutoff point to consider the result positive must be located between 43 and 50%. If we establish the cutoff point in 50% of pupil dilation, 90% of AD patients and 35% of control subjects show a positive response. There was not a statistically significant difference between both control groups. Our results from this test show a sensitivity of 90% and a specificity of 65%. The positive responses of some control subjects may express a weak specificity, or perhaps they mean that we have a marker of the pre-clinical stage of the disease before us.

Ocular echography in the prognosis of vitreous haemorrhage in type II diabetes mellitus.

PURPOSE: In this study, we have attempted to demonstrate the presence of various echographic parameters which could be associated with a non-spontaneous resorption of vitreous haemorrhage in type II diabetes mellitus and correlate these parameters with clinical outcome. SUBJECTS AND METHODS: We studied 297 eyes of 257 patients with diabetic retinopathy and vitreous haemorrhage without tractional macular retinal detachment ophthalmoscopically and echographically. Of the total eyes studied, a 3-month follow-up visit (including ultrasound) was available in 208 eyes. We retrospectively reviewed the medical records of each patient. RESULTS: The echographic parameters associated with non-resorption of the vitreous haemorrhage were: extramacular tractional retinal detachment, fibrovascular membranes and location of the haemorrhage within the subhyaloidal space (in contrast to within the intragel space). In addition, the duration of the vitreous haemorrhage and the presence of panretinal laser photocoagulation at the time of presentation with a vitreous haemorrhage influenced the resolution of the vitreous haemorrhage. We were also able to construct a logarithmic function that could be used to predict the prognosis of a vitreous haemorrhage in type II diabetes mellitus. CONCLUSIONS: When employed to evaluate vitreous haemorrhages in non-insulin-dependent diabetes mellitus, ocular ultrasound can provide useful prognostic information regarding the lack of resorption of vitreous haemorrhages in type II diabetics.