Multi-domain cognitive screening test for neuropsychological assessment for cognitive decline in acclimatized lowlanders staying at high altitude.

Background & objectives: Ascent to high altitude has been reported to cause hippocampal atrophy and cognitive impairment in mountaineers. We assessed the cognitive performance and probable occurrence of mild cognitive impairment (MCI) in acclimatized lowlanders (ALL) staying at altitudes above 4,300 m for duration above 12 months and validated a multi-domain cognitive screening test (MDCST) for future demographic studies on MCI. Methods: Following evaluation of sensitivity and correlation of the newly developed MDCST battery with Mini Mental State Examination (MMSE) and Clinical Dementia Rating (CDR) scores on a group of 28 individuals, the MDCST battery was validated on a population of 843 ALL staying at high altitude MSL >4,300 m and 862 subjects staying at MSL <230 m. EEG recordings were performed on 840 ALL staying at altitudes above 4,300 m and 743 control subjects staying at MSL <230 m. Results: Percentage prevalence of MCI was 4.18 per cent in the ALL population as assessed by MMSE while that of the LL population was <0.42 per cent. The percentage prevalence of MCI based on calculations from the MDCST scores was 12.4 per cent in the ALL population as compared to 1.19 per cent in the LL population. Decrease in alpha wave amplitude at the T3 and T4 sources in MCI subjects was observed in LL group while there was an increase in amplitude for alpha wave in these regions in the ALL groups. Domain specific MDCST showed decline in immediate recall, procedural memory and mind body co-ordination which was negligible in the LL population. Interpretation & conclusions: MDCST exhibited excellent psychometric properties in terms of sensitivity, and test-retest reliability qualifying it to be used as a more effective cognitive measure for assessment of MCI in demographic studies in comparison to traditional measures. Our findings also showed increased prevalence of MCI in ALL population staying for longer durations at high altitude which is neurophysiologically distinct from MCI leading to Alzheimer's disease.

Coronary artery disease and T wave inversions in electrocardiogram at high altitude

To find out the role of coronary artery disease [CAD] as a cause of T wave inversions in electrocardiogram [ECG] in otherwise healthy soldiers who were evacuated from high altitude because of chest pain. A prospective observational study. The study was carried out at CMH Skardu from September 2003 to September 2004 fifty-four consecutive patients evacuated from height > 4000 meters [13123 feet] with symptoms of chest pain and electrocardiographic changes of T-wave inversions in a group of leads were included in the study. Echocardiography and Exercise tolerance test [ETT] was performed on all the patients. All of the patients with indeterminate or inconclusive results on ETT underwent coronary angiography at Armed Forces Institute of Cardiology, Rawalpindi. Out of 54 patients, 36 [66.7%] patients had normal exercise tolerance test. In the rest 18 [33.34%] patients coronary angiogram was done and in 04 patients it was reported abnormal. In 02 [3.70%] patients coronary angiogram confirmed coronary artery disease. In 02 patients coronary angiograms were abnormal but there was no evidence of coronary artery disease. T wave inversions at high altitude suggestive of IHD are not true indicators of underlying coronary artery disease

Ecocardiografia modo "M" y bidimensional en cardiopatias congenitas en la altura (3.500 m) / Echocardiography mode \"M\" and bidimensional in heart defects, congenital in height (3.500 m)

Para evaluar la experiencia, alcances y limitaciones de la ecocardiografia en la valoracion de las cardiopatias congenitas, se reviso la casuistica de los ultimos 5 anos (1982-87) en el IBBA. De un total de 1736 ecocardiografias efectuadas 137 correspondieron a pacientes con diagnostico clinico de cardiopatia congenita. Grupo I (menores de 15 anos) 102 pacientes con cardiopatia congenita siendo la mas frecuentes CIV-CIA-PCA entre las cardiopatias acianoticas y la enfermedad de Ebstein(13 casos -76%). Grupo II (mayores de 15 años) 35 pacientes con cardiopatias congenitas siendo la mas frecuente la CIA (22%) entre las acianoticas y la enfermedad de Ebstein (8%) entre las cianoticas. Se discuten las aportaciones y las limitaciones que la ecocardiografia modo "M" presenta en la evaluacion de las alteraciones anatomicas de las cardiopatias congenitas asi como las ventajas sobre la misma de la acocardiografia bidimensional. Se analizan los hallazgos ecocardiograficos en las cardiopatias congenitas mas frecuentesl. Se concluye que la ecocardiografia constituye un adelanto significativo en la evaluacion y diagnostico de las cardiopatias.

Estudios en recién nacidos de gestantes añosas de Cerro de Pasco (4,340 m.) / Newborn infants from aged pregnant women of Cerro de Pasco (4,340 m.)

Se han estudiado los partos ocurridos en madres mayores de 35 años atendidos entre 1982 y 1985 en Cerro de Pasco (4340m) cuyos datos son comparados con un número similar de partos ocurridos en madres menores de 35 años. Se encuentra que la edad materna tardía produce un mayor número de óbitos fetales masculinos que en el grupo control y que en RN mujeres de madres añosas. La tasa de RNBP, prematuridad y asfixia neonatal es alta en Cerro de Pasco comparado a lo observado a nivel del mar por otros autores

Rabia: presentacion de un caso y revision retrospectiva de casuistica en el hospital del niño

Se presenta un paciente con cuadro de rabia confirmada por medio de examen de laboratorio y cinco casos mas con clinica compatible y de antecedente de agresion por can, a traves de revision retrospectiva del periodo entre 1972 y 1983. Se pretende enfatizando las caracteristicas clinicas, llamar la atencion respecto a la incidencia de esta enfermedad en nuestro medio y, mediante una actualizacion, efectuar un recordatorio de esta enfermedad mortal. Finalmente, se esbozan algunas recomendaciones aplicables a nuestro medio.