White Matter Abnormalities in Late Onset First Episode Mania: A Diffusion Tensor Imaging Study.

INTRODUCTION: A first manic episode after 50 years of age is uncommon. Late Onset Mania might be indicative of abnormalities in white matter, probably related to vascular, degenerative, or inflammatory processes. OBJECTIVE: To determine if patients with late onset mania have reduced white matter integrity according to Magnetic Resonance Diffusion Tensor Imaging (DTI) and structural MRI. METHODS: Twenty-two patients with late onset mania (>50 years old) and 22 age-paired healthy subjects were included in the study. Fractional anisotropy (FA) was used as a quantitative measure of white matter integrity. Fazekas scale was assessed also to measure white matter abnormalities in the FLAIR sequence. The Frontal Assessment Battery, COGNISTAT and Trail making test A and B were used as cognitive measurements. RESULTS: According to DTI, commissural connections (left corpus callosum), and limbic connections (right and left uncinate fasciculus) were different between the patients and the comparison group. Fractional anisotropy values in the left corpus callosum showed significant correlations with neuropsychological measures, and with the Fazekas scale score. According to Fazekas scale, a pathological score in the FLAIR sequence was significantly more frequent in the patients as compared to the comparison group. CONCLUSIONS: Patients with first episode mania in late life have relevant white matter abnormalities not explained by age, affecting interhemispheric and fronto-limbic networks probably related to executive functioning and emotional processing, at the level of the corpus callosum and the uncinate fasciculus. The etiology of this white matter loss of integrity in patients with late-onset mania is yet to be explored.

[White matter hyperintensities and cognitive function in patients with late onset mania]. / Lesiones hiperintensas de la sustancia blanca y función cognoscitiva en pacientes con manía de inicio tardío.

Bipolar disorder is characterized by affective episodes in the mania-depression spectrum. Ninety per cent of the cases have an onset before age 50. In the patients with late onset mania, white matter hyperintensities (WMH) may be seen in the MRI FLAIR sequence, although these are of uncertain significance. A case-control study was done, including patients with late onset mania attended at the National Institute of Neurology and Neurosurgery, as well as healthy controls which were paired by age, sex, and academic level. Sagital FLAIR CUBE volumetric images were obtained, and later on assessed by an expert neuroradiologist, blinded to the diagnostic category. Neuropsychological measures were obtained. The patients with late onset mania showed statistically significant deficiencies (p < 0.05) in motor programming tasks, and inhibitory control tasks, according to the Frontal Assessment Battery, as well as a significant increase in the number of WMH in the right third frontal gyrus, the left first temporal gyrus, and the left second temporal gyrus. The total number of WMH and the Frontal Assessment Battery total score showed a significant inverse correlation.

[Paraplegia due to adhesive arachnoiditis. A case report]. / Paraplejía por aracnoiditis adhesiva. Reporte de un caso.

Various conditions of the spinal column occur at the lumbar level and new therapeutic surgical techniques have been applied to reduce the length of hospital stay, contribute to a quick return of patients to their activities of daily living, and reduce the postoperative limitations. However, a silent complication, adhesive arachnoiditis, has been reported with a frequency of 6-16% in cases undergoing lumbar surgery or with a history of revision surgery, and thus a second complication may occur, paraplegia, since the common symptom of arachnoiditis is persistent low back pain. The case of a 40-year-old patient is presented herein, who underwent lumbar spine surgery for herniated discs, and developed adhesive arachnoiditis involving the cauda equina, which was diagnosed with MRI. He had irreversible paraplegia with diffuse involvement of the cauda equina despite the mechanical lavage and surgical debridement performed due to the persistence of serous fluid discharge from the wound. The interbody implant placed during the first surgery was removed and the treatment was completed with posterior stabilization reinstrumentation; the patient had persistent neurologic impairment. There are few reports in the world literature of paraplegia due to non-infectious adhesive arachnoiditis. The remaining reports of paraplegia have been in patients with spinal infection, such as HIV-TB, mycosis, brucellosis or meningeal hemorrhage. It is not easy for patients to understand the very likely irreversible neurologic lesion of his complication. However, it is important for the spine surgeon to bear in mind the occurrence and frequency of adhesive arachnoiditis which could lead to irreversible neurologic deficit in patients undergoing lumbar spine surgery.

Intervención educativa sobre Diabetes Mellitus en pacientes portadores de la enfermedad / Educational intervention on diabetes mellitus in patients carriers of the disease

La diabetes mellitus es un problema de salud mundial cuya prevalencia e incidencia aumenta vertiginosamente. En Cuba constituye la octava causa de muerte, contribuye en gran medida a la discapacidad y repercute en el aumento de hospitalizaciones y uso de los servicios de urgencia. Objetivo: evaluar los conocimientos sobre factores de riesgo y su influencia en el control metabólico de la Diabetes Mellitus en pacientes portadores de la enfermedad. Método: se realizó una intervención educativa en pacientes con diagnóstico de Diabetes Mellitus tipo 2 desde el inicio de la enfermedad, mayores de 45 años y según el orden cronológico de su asistencia a la consulta de medicina en el policlínico Comunitario Florida Norte desde enero a junio de 2007. La muestra se conformó por 82 pacientes, para la recolección de los datos se confeccionó una encuesta, la cual se aplicó antes y después de la intervención educativa. Resultados: predominaron los pacientes entre los 55 y 64 años de edad, así como el sexo femenino, se identificaron factores de riesgos como: inactividad física, obesidad y hábito de fumar. El control metabólico de dichos pacientes fue predominantemente regular, sin embargo, después de la intervención se elevó a la categoría de bueno. Conclusiones: la intervención educativa resultó muy provechosa, pues se logró mayor conocimiento sobre los factores de riesgo y un mejor control metabólico, la reducción de los ingresos hospitalarios implicaron una mayor calidad de vida en la población de estudio (AU)

Diabetes mellitus is a health worldwide problem whose prevalence and incidence increases vertiginously. It constitutes the eighth cause of death in Cuba, it contributes in great measure to disability and it has repercussions in the increase of hospitalizations and use of the urgency services. Objective: to evaluate knowledge on risk factors and their influence in the metabolic control of diabetes mellitus in patients carriers of the disease. Method: an educational intervention was performed in patients with diagnostic of type II diabetes mellitus since the beginning of the disease, older than 45 years and according to the chronological order of their attendance in the medicine consultation at the North Community polyclinic of Florida from January to June 2007. The sample was constituted by 82 patients, for data collecting a survey was made, which was applied before and after the educational intervention. Results: patients between 55 and 64 years prevailed, as well as the female sex, were identified as risk factors: physical inactivity, obesity and smoking. The metabolic control of these patients was mainly regular, however, after the intervention increased to the category of good. Conclusions: the educational intervention proved to be very profitable, since a greater knowledge with regard to risk factors and a better metabolic control was achieved, the reduction of the hospital admittance implied a better quality of life in the population under study (AU)

Intervención educativa sobre conocimientos de los factores de riesgos y su influencia en pacientes con episodio de urgencia hipertensiva / Educational intervention on knowledge of risk factors and their influence in patients with hypertensive urgency episode

La hipertensión Arterial es un problema sanitario extraordinario, permanece asintomática hasta etapas tardías de su evolución (asesina silenciosa), existen cerca de un billón de hipertensos a nivel mundial, con una mortalidad de 15 millones por año. Objetivo: evaluar el conocimiento de los factores de riesgo y su influencia en pacientes con episodio de urgencia hipertensiva. Método: se realizó una intervención educativa en pacientes que presentaron episodio de urgencia hipertensiva que se atendieron en el cuerpo de guardia del Policlínico Universitario Norte Florida desde enero a junio de 2007. El universo se constituyó por todos los pacientes mayores de 45 años con este diagnóstico, la muestra se conformó por 48 pacientes, para la recolección de los datos se confeccionó una encuesta, la misma se aplicó antes y después de la intervención educativa. Resultados: el grupo de edades más afectado correspondió al de 65-74 años, predominó el sexo femenino, los principales factores de riesgo fueron: el hábito de fumar, obesidad e hipercolesterolemia. Después de la intervención educativa se lograron incrementar los conocimientos sobre factores de riesgo en la población, aspectos relacionados con la hipercolesterolemia, la inactividad física, obesidad y hábito de fumar. Conclusiones: la frecuencia de urgencia hipertensiva aumentó con la edad, con predominio en el sexo femenino. La intervención educativa resultó factible y efectiva para el conocimiento de los factores de riesgo de la hipertensión arterial, se elevaron los niveles de comprensión y se logró mayor calidad de vida de los pacientes estudiados (AU)

Arterial hypertension is an extraordinary sanitary problem, it remains asymptomatic until late stages of its evolution (silent murderer), and there are nearly a trillion of hypertensive people worldwide, with a mortality of 15 millions per year. Objective: to evaluate knowledge on risk factors and their influence in patients with hypertensive urgency episode. Method: an educational intervention in patients that presented hypertensive urgency episode was conducted, who were attended in the Emergency-room at the North University Polyclinic of Florida from January to June 2007. The universe was constituted by all patients older than 45 years with this diagnosis, the sample was conformed to 48 patients, for data collecting a survey was designed, the said survey was applied before and after the educational intervention. Results: the most affected age group corresponded to 65-74 years, the female sex prevailed, and the main risk factors were: smoking, obesity and hypercholesterolemia. After the educational intervention was possible to increase knowledge on risk factors in the population, aspects related with hypercholesterolemia, physical inactivity, obesity and smoking. Conclusions: the frequency of hypertensive urgency increased with the age, with prevalence in the female sex. The educational intervention proved to be feasible and effective for the knowledge on hypertension risk factors, comprehension levels were increased and a better quality of life was achieved in the studied patients (AU)

Intervención educativa sobre conocimientos de los factores de riesgos y su influencia en pacientes con episodio de urgencia hipertensiva / Educational intervention on knowledge of risk factors and their influence in patients with hypertensive urgency episode

La hipertensión Arterial es un problema sanitario extraordinario, permanece asintomática hasta etapas tardías de su evolución (asesina silenciosa), existen cerca de un billón de hipertensos a nivel mundial, con una mortalidad de 15 millones por año. Objetivo: evaluar el conocimiento de los factores de riesgo y su influencia en pacientes con episodio de urgencia hipertensiva. Método: se realizó una intervención educativa en pacientes que presentaron episodio de urgencia hipertensiva que se atendieron en el cuerpo de guardia del Policlínico Universitario Norte Florida desde enero a junio de 2007. El universo se constituyó por todos los pacientes mayores de 45 años con este diagnóstico, la muestra se conformó por 48 pacientes, para la recolección de los datos se confeccionó una encuesta, la misma se aplicó antes y después de la intervención educativa. Resultados: el grupo de edades más afectado correspondió al de 65-74 años, predominó el sexo femenino, los principales factores de riesgo fueron: el hábito de fumar, obesidad e hipercolesterolemia. Después de la intervención educativa se lograron incrementar los conocimientos sobre factores de riesgo en la población, aspectos relacionados con la hipercolesterolemia, la inactividad física, obesidad y hábito de fumar. Conclusiones: la frecuencia de urgencia hipertensiva aumentó con la edad, con predominio en el sexo femenino. La intervención educativa resultó factible y efectiva para el conocimiento de los factores de riesgo de la hipertensión arterial, se elevaron los niveles de comprensión y se logró mayor calidad de vida de los pacientes estudiados

Arterial hypertension is an extraordinary sanitary problem, it remains asymptomatic until late stages of its evolution (silent murderer), and there are nearly a trillion of hypertensive people worldwide, with a mortality of 15 millions per year. Objective: to evaluate knowledge on risk factors and their influence in patients with hypertensive urgency episode. Method: an educational intervention in patients that presented hypertensive urgency episode was conducted, who were attended in the Emergency-room at the North University Polyclinic of Florida from January to June 2007. The universe was constituted by all patients older than 45 years with this diagnosis, the sample was conformed to 48 patients, for data collecting a survey was designed, the said survey was applied before and after the educational intervention. Results: the most affected age group corresponded to 65-74 years, the female sex prevailed, and the main risk factors were: smoking, obesity and hypercholesterolemia. After the educational intervention was possible to increase knowledge on risk factors in the population, aspects related with hypercholesterolemia, physical inactivity, obesity and smoking. Conclusions: the frequency of hypertensive urgency increased with the age, with prevalence in the female sex. The educational intervention proved to be feasible and effective for the knowledge on hypertension risk factors, comprehension levels were increased and a better quality of life was achieved in the studied patients

Intervención educativa sobre Diabetes Mellitus en pacientes portadores de la enfermedad / Educational intervention on diabetes mellitus in patients carriers of the disease

La diabetes mellitus es un problema de salud mundial cuya prevalencia e incidencia aumenta vertiginosamente. En Cuba constituye la octava causa de muerte, contribuye en gran medida a la discapacidad y repercute en el aumento de hospitalizaciones y uso de los servicios de urgencia. Objetivo: evaluar los conocimientos sobre factores de riesgo y su influencia en el control metabólico de la Diabetes Mellitus en pacientes portadores de la enfermedad. Método: se realizó una intervención educativa en pacientes con diagnóstico de Diabetes Mellitus tipo 2 desde el inicio de la enfermedad, mayores de 45 años y según el orden cronológico de su asistencia a la consulta de medicina en el policlínico Comunitario Florida Norte desde enero a junio de 2007. La muestra se conformó por 82 pacientes, para la recolección de los datos se confeccionó una encuesta, la cual se aplicó antes y después de la intervención educativa. Resultados: predominaron los pacientes entre los 55 y 64 años de edad, así como el sexo femenino, se identificaron factores de riesgos como: inactividad física, obesidad y hábito de fumar. El control metabólico de dichos pacientes fue predominantemente regular, sin embargo, después de la intervención se elevó a la categoría de bueno. Conclusiones: la intervención educativa resultó muy provechosa, pues se logró mayor conocimiento sobre los factores de riesgo y un mejor control metabólico, la reducción de los ingresos hospitalarios implicaron una mayor calidad de vida en la población de estudio.

Diabetes mellitus is a health worldwide problem whose prevalence and incidence increases vertiginously. It constitutes the eighth cause of death in Cuba, it contributes in great measure to disability and it has repercussions in the increase of hospitalizations and use of the urgency services. Objective: to evaluate knowledge on risk factors and their influence in the metabolic control of diabetes mellitus in patients carriers of the disease. Method: an educational intervention was performed in patients with diagnostic of type II diabetes mellitus since the beginning of the disease, older than 45 years and according to the chronological order of their attendance in the medicine consultation at the North Community polyclinic of Florida from January to June 2007. The sample was constituted by 82 patients, for data collecting a survey was made, which was applied before and after the educational intervention. Results: patients between 55 and 64 years prevailed, as well as the female sex, were identified as risk factors: physical inactivity, obesity and smoking. The metabolic control of these patients was mainly regular, however, after the intervention increased to the category of good. Conclusions: the educational intervention proved to be very profitable, since a greater knowledge with regard to risk factors and a better metabolic control was achieved, the reduction of the hospital admittance implied a better quality of life in the population under study.