Barriers and facilitators to adherence to walking group exercise in older people living with dementia in the community: a systematic review.

BACKGROUND & AIMS: Evidence suggests that targeted exercise is important for people living with dementia. The aim of this review was to collect and synthesize evidence on the known barriers and facilitators to adherence to walking group exercise of older people living with dementia in the community. METHODS: We have searched appropriate electronic databases between January 1990 until September 2019, in any language. Additionally, we searched trial registries (clinicaltrial.gov and WHO ICTRP) for ongoing studies. We included all study designs. Studies were excluded when participants were either healthy older people or people suffering from dementia but living in residential care. Narrative synthesis was used. FINDINGS: 10 papers met the inclusion criteria. The narrative analysis focused on barriers, facilitators, and adherence. All studies reported on barriers and facilitators. Barriers included: bio-medical reasons (including mental wellbeing and physical ability); relationship dynamics; and socio-economic reasons and environmental issues. Facilitators included: bio-medical benefits & benefits related to physical ability; staff, group relationship dynamics and social aspect of walking group; environmental issues and individual tailoring; and participants perceptions about the walks & the program. Most studies did not provide data about adherence or attendance; where reported, adherence ranged from 47 to 89%. CONCLUSIONS: This systematic review of literature has highlighted known barriers and facilitators to adherence to walking groups type of exercise for people living with dementia in community. Carers' willingness to engage, their circumstances, perspectives and previous experiences of exercise seem to play a key role in facilitating adherence but there is little research that explores these. Also, the design, location and organisation of walking groups facilitate adherence. This reflects the need for such activities to be part of a wider 'program of care', tailored to the needs of the individual, flexible and convenient. Knowledgeable and well-trained instructors or healthcare professionals are recommended as group exercise leaders.

Sintomatología depresiva en el post parto y factores psicosociales asociados / Postpartum depressive symptomatology and its associated psychosocial factors

Introducción: La sintomatología depresiva en el postparto impacta negativamente en el sistema familiar. En México existe poca investigación al respecto por ello es primordial su estudio. Objetivo: Conocer la frecuencia de sintomatología depresiva postparto y los factores psicosociales que se le asocian. Material y métodos. Se entrevistaron 154 mujeres con 0 a 12 meses de postparto que acudieron a dos hospitales públicos de un estado del noreste México. Se aplicó el Cuestionario de Depresión Postparto de Edimburgo (EPDS) para medir la sintomatología depresiva y un Cuestionario de Factores Psicosociales diseñado por los investigadores. Resultados. El 16% de la muestra presentó sintomatología depresiva. Los factores que se le asociaron fueron estado civil de unión libre, familiar con depresión, tristeza en embarazo, acontecimiento vital estresante en embarazo, consumo de alcohol en embarazo, ansiedad, consumo de alcohol actual, insatisfacción con los cambios corporales, percibir mayor atención de la familia al bebé y haber experimentado tristeza en embarazos anteriores. Conclusiones. Existen factores psicosociales que se asocian a sintomatología depresiva en el postparto que es de relevancia conocer en la atención primaria con el fin de crear estrategias preventivas en las instituciones de salud.

Background. Postpartum depressive symptomatology has a negative impact on the nuclear family. Research on this topic is scarce in Mexico, therefore conducting more studies in this field is of upmost importance. Objective. Finding out the frequency of postpartum depressive symptomatology and its associated psychosocial factors. Material and methods. 154 women at 0-12 months postpartum that attended two public hospitals in a northeast state of the Mexico were interviewed. They answered the Edinburgh Postpartum Depression Scale (EPDS), measuring depressive symptomatology, and a Psychosocial Factors questionnaire designed by the researchers. Results. 16% of women in the cohort presented depressive symptomatology. The factors associated were out-of-wedlock cohabitation, having relatives that suffer from depression, feelings of sadness during pregnancy, stressful life event during pregnancy, alcohol consumption during pregnancy, anxiety, current alcohol consumption, dissatisfaction regarding body changes caused by pregnancy, feeling that family attention is focused on the baby and having feelings of sadness during previous pregnancies. Conclusions. There are psychosocial factors that are associated to postpartum depressive symptomatology, which should be taken into consideration to create preventive strategies in health institutes.

Synthesis and functionalization of dextran-based single-chain nanoparticles in aqueous media.

Water-dispersible dextran-based single-chain polymer nanoparticles (SCPNs) were prepared in aqueous media and under mild conditions. Radiolabeling of the resulting biocompatible materials allowed the study of lung deposition of aqueous aerosols after intratracheal nebulization by means of single-photon emission computed tomography (SPECT), demonstrating their potential use as imaging contrast agents.

Faecal Escherichia coli isolates from healthy dogs harbour CTX-M-15 and CMY-2 ß-lactamases.

The presence of extended spectrum ß-lactamase (ESBL) and plasmid-mediated AmpC ß-lactamase (pAmpC) producing Escherichia coli, along with the mechanisms of antimicrobial resistance and the molecular types of isolates, was investigated in faecal samples from 53 healthy dogs in Mexico. Samples were inoculated on Levine agar plates with 2 µg/mL cefotaxime for recovery of cefotaxime-resistant (CTX(R)) E. coli. CTX(R)E. coli isolates were recovered from 9/53 (17%) samples; one isolate was characterised from each positive sample. ESBL producing E. coli isolates were detected in 3/53 (6%) samples; these isolates carried the blaCTX-M-15 gene and one isolate also carried blaSHV-2. These three ESBL-positive E. coli isolates belonged to phylogroup A and sequence types ST617, ST410 or ST3944. The remaining 6/53 (11%) samples contained pAmpC positive isolates; these isolates carried the blaCMY-2 gene, which encodes CMY-2 ß-lactamase. These six isolates belonged to phylogroups A (n = 2), B1 (n = 1) and D (n = 3), and sequences types ST1431, ST57, ST93 and ST4565. One CMY-2 ß-lactamase positive E. coli isolate of lineage ST93 had the -32 mutation in the chromosomal ampC promoter/attenuator region. Five ESBL/pAmpC positive E. coli isolates carried class 1 integrons (dfrA17-aadA5, aadA and aadA/aadB arrays were detected in three isolates) and one isolate carried a class 2 integron (dfrA12-sat2-aadA1). The aac(6')Ib-cr, aac(3)-II, qnrB19, tet(A), tet(B), cmlA, and sul3 genes were also detected. All studied isolates showed unrelated PFGE-patterns. To our knowledge, this is the first description of ESBL-producing E. coli and the second of pAmpC-producing E. coli from healthy dogs in America. Our results suggest the potential zoonotic role of dogs in the transmission to humans of ESBL and pAmpC E. coli in the household environment.

Usefulness of intravenous lacosamide in status epilepticus.

Lacosamide (LCM) is a treatment option for status epilepticus (SE) described in several series. We therefore proposed to describe its use in status epilepticus patients in our hospital. All patients admitted to our hospital for SE from September 2010 to April 2012 were evaluated. We collected related variables including the type of SE, etiology, antiepileptic drugs (AEDs) used, loading dose of AEDs, cessation of SE after AEDs, ICU admission and mortality. In those patients receiving LCM, we reviewed the infusion rate and time to response. We compared patients receiving LCM with patients in whom it was not used. This was a retrospective and uncontrolled study. A total of 92 patients were included; 67.7 % of SE patients who received LCM responded to treatment. The vast majority of the patients presented non-convulsive and motor focal SE. When we selected patients to receive four or more AEDs, the LCM efficacy was 55.6 %, a very similar result compared to when it was not used. Subsequently, we analyzed the sample regarding the AED administered as the second or third line of treatment, and the responder rate was significantly higher when LCM was used (84.6 vs. 47.8 %, p 0.041). After an adjusted regression analysis, the use of LCM was independently associated with cessation of SE. The total percentage of undesirable effects was very low (12 %), and they were all mild. No relationship was found between a specific etiology and better response. LCM is a useful drug that represents an alternative in the treatment of non-convulsive or focal motor SE. Its efficacy might be more important when it is administered as a second or third option after benzodiazepines. A randomized trial is required to confirm these results.

Phase diagram and tie-line determination for the ternary mixture DOPC/eSM/cholesterol.

We propose a novel, to our knowledge, method for the determination of tie lines in a phase diagram of ternary lipid mixtures. The method was applied to a system consisting of dioleoylphosphatidylcholine (DOPC), egg sphingomyelin (eSM), and cholesterol (Chol). The approach is based on electrofusion of single- or two-component homogeneous giant vesicles in the fluid phase and analyses of the domain areas of the fused vesicle. The electrofusion approach enables us to create three-component vesicles with precisely controlled composition, in contrast to conventional methods for giant vesicle formation. The tie lines determined in the two-liquid-phase coexistence region are found to be not parallel, suggesting that the dominant mechanism of lipid phase separation in this region changes with the membrane composition. We provide a phase diagram of the DOPC/eSM/Chol mixture and predict the location of the critical point. Finally, we evaluate the Gibbs free energy of transfer of individual lipid components from one phase to the other.

Ten novel mutations in the NR5A1 gene cause disordered sex development in 46,XY and ovarian insufficiency in 46,XX individuals.

CONTEXT: Steroidogenic factor-1 (SF-1/NR5A1) is a nuclear receptor that regulates adrenal and reproductive development and function. NR5A1 mutations have been detected in 46,XY individuals with disorders of sexual development (DSD) but apparently normal adrenal function and in 46,XX women with normal sexual development yet primary ovarian insufficiency (POI). OBJECTIVE: A group of 100 46,XY DSD and two POI was studied for NR5A1 mutations and their impact. DESIGN: Clinical, biochemical, histological, genetic, and functional characteristics of the patients with NR5A1 mutations are reported. SETTING: Patients were referred from different centers in Spain, Switzerland, and Turkey. Histological and genetic studies were performed in Barcelona, Spain. In vitro studies were performed in Bern, Switzerland. PATIENTS: A total of 65 Spanish and 35 Turkish patients with 46,XY DSD and two Swiss 46,XX patients with POI were investigated. MAIN OUTCOME: Ten novel heterozygote NR5A1 mutations were detected and characterized (five missense, one nonsense, three frameshift mutations, and one duplication). RESULTS: The novel NR5A1 mutations were tested in vitro by promoter transactivation assays showing grossly reduced activity for mutations in the DNA binding domain and variably reduced activity for other mutations. Dominant negative effect of the mutations was excluded. We found high variability and thus no apparent genotype-structure-function-phenotype correlation. Histological studies of testes revealed vacuolization of Leydig cells due to fat accumulation. CONCLUSIONS: SF-1/NR5A1 mutations are frequently found in 46,XY DSD individuals (9%) and manifest with a broad phenotype. Testes histology is characteristic for fat accumulation and degeneration over time, similar to findings observed in patients with lipoid congenital adrenal hyperplasia (due to StAR mutations). Genotype-structure-function-phenotype correlation remains elusive.

Clinical and molecular evaluation of SHOX/PAR1 duplications in Leri-Weill dyschondrosteosis (LWD) and idiopathic short stature (ISS).

CONTEXT: Léri-Weill dyschondrosteosis (LWD) is a skeletal dysplasia characterized by disproportionate short stature and the Madelung deformity of the forearm. SHOX mutations and pseudoautosomal region 1 deletions encompassing SHOX or its enhancers have been identified in approximately 60% of LWD and approximately 15% of idiopathic short stature (ISS) individuals. Recently SHOX duplications have been described in LWD/ISS but also in individuals with other clinical manifestations, thus questioning their pathogenicity. OBJECTIVE: The objective of the study was to investigate the pathogenicity of SHOX duplications in LWD and ISS. DESIGN AND METHODS: Multiplex ligation-dependent probe amplification is routinely used in our unit to analyze for SHOX/pseudoautosomal region 1 copy number changes in LWD/ISS referrals. Quantitative PCR, microsatellite marker, and fluorescence in situ hybridization analysis were undertaken to confirm all identified duplications. RESULTS: During the routine analysis of 122 LWD and 613 ISS referrals, a total of four complete and 10 partial SHOX duplications or multiple copy number (n > 3) as well as one duplication of the SHOX 5' flanking region were identified in nine LWD and six ISS cases. Partial SHOX duplications appeared to have a more deleterious effect on skeletal dysplasia and height gain than complete SHOX duplications. Importantly, no increase in SHOX copy number was identified in 340 individuals with normal stature or 104 overgrowth referrals. CONCLUSION: MLPA analysis of SHOX/PAR1 led to the identification of partial and complete SHOX duplications or multiple copies associated with LWD or ISS, suggesting that they may represent an additional class of mutations implicated in the molecular etiology of these clinical entities.

[Ethics of the cardiopulmonary resuscitation decisions]. / Ética de las decisiones en resucitación cardiopulmonar.

Cardiopulmonary Resuscitation (CPR) must be attempted if indicated, not done if it is not indicated or if the patient does not accept or has previously rejected it and withdrawn it if it is ineffective. If CPR is considered futile, a Do-Not-Resuscitate Order (DNR) will be recorded. This should be made known to all physicians and nurses involved in patient care. It may be appropriate to limit life-sustaining-treatments for patients with severe anoxic encephalopathy, if the possibility of clinical evolution to brain death is ruled out. After CPR it is necessary to inform and support families and then review the process in order to make future improvements. After limitation of vital support, certain type of non-heart-beating-organ donation can be proposed. In order to acquire CPR skills, it is necessary to practice with simulators and, sometimes, with recently deceased, always with the consent of the family. Research on CPR is essential and must be conducted according to ethical rules and legal frameworks.

Total serum cholesterol levels and suicide attempts in child and adolescent psychiatric inpatients.

Associations between cholesterol and suicidal behavior in adolescent patients have not been explored in depth. In this study, 66 patients consecutively admitted to a psychiatric inpatient unit following attempted suicide were compared with a control group of 54 patients with no history of suicide attempts. The age range of the sample was from 8 to 18 years old. Cholesterol levels were significantly lower in attempted suicide patients than in controls (p < 0.02), supporting the hypothesis that lower cholesterol levels might be associated with suicidal behavior in patients with similar acute phase of their disorder.

Chorionic gonadotropin hormone receptors on Taenia solium and Taenia crassiceps cysticerci in culture.

Hormones play a significant role in murine Taenia crassiceps cysticercosis, and they may also participate in the susceptibility to Taenia solium cysticercosis. In the present study, in vitro effects are reported for human chorionic gonadotropin (hCG) on the larval stages of T. crassiceps (WFU strain) and T. solium. Our results reveal the presence of receptors for hCG in different developmental phases of both cultured parasites. On day 30, both taeniid species had the highest percentage of receptors in the neck, strobila, and suckers, but these receptors decreased by day 60, delimiting the segments and the exterior of the developing proglottids in T. solium. At the same time, there was a large number of hCG receptors in the area of the presumptive cirrus organ and in calcareous corpuscles within the parenchyma. This is the first report detecting receptors for hCG on different larval stages of T. crassiceps and T. solium. A direct effect of hCG could be recognized by the cysticerci as a factor contributing to the growth and development of T. crassiceps and T. solium cysticerci, respectively.

Fibroma ovárico en mujer joven: reporte de un caso / Ovarian fibroma in a young woman: a case report

El presente caso ocurre en una mujer joven, inicialmente sin síntomas, a la que únicamente le llamó la atención algo de estreñimiento y el aumento del perímetro abdominal, a expensas de protrusión predominantemente desde la fosa y el flanco derechos. Vale destacar la percepción del crecimiento rápido de esta masa. Sin embargo, luego de ser evaluada exhaustivamente, se estima la probabilidad de que se trate de un tumor benigno. Por lo que se practica laparotomía simple...

CDKN1C mutations in HELLP/preeclamptic mothers of Beckwith-Wiedemann Syndrome (BWS) patients.

Preeclampsia is the development of new-onset hypertension with proteinuria after 20 weeks of gestation. HELLP syndrome (haemolysis, elevated liver enzymes, and low platelet count) is a severe form of preeclampsia with high rates of neonatal and maternal morbidity. In recent years, loss of function of cdkn1c (a tight-binding inhibitor of G1 cyclin/cyclin-dependent kinase complexes and a negative regulator of cell proliferation) has been observed in several mouse models of preeclampsia. In this paper, we report on three women with HELLP/preeclampsia who had children with Beckwith Wiedemann syndrome, a complex genetic disorder characterised, among other findings, by overgrowth, omphalocele and macroglossia. All three children displayed mutations in CDKN1C predicted to generate truncated proteins. Two of the mutations were maternally inherited while the third was de novo. This finding suggests a fetal contribution to the maternal disease. To the best of our knowledge this is the first report of CDKN1C mutations in children born to women with preeclampsia/HELLP syndrome, thus suggesting the involvement of an imprinted gene in the pathophysiology of preeclampsia.

Epithelial-to-mesenchymal transition of mesothelial cells is an early event during peritoneal dialysis and is associated with high peritoneal transport.

Ultrafiltration (UF) failure is a consequence of long-term peritoneal dialysis (PD). Fibrosis, angiogenesis, and vasculopathy are causes of this functional disorder after 3-8 years on PD. Epithelial-to-mesenchymal transition (EMT) of mesothelial cell (MC) is a key process leading to peritoneal fibrosis with functional deterioration. Our purpose was to study the peritoneal anatomical changes during the first months on PD, and to correlate them with peritoneal functional parameters. We studied 35 stable PD patients for up to 2 years on PD, with a mean age of 45.3+/-14.5 years. Seventy-four percent of patients presented loss of the mesothelial layer, 46% fibrosis (>150 microm) and 17% in situ evidence of EMT (submesothelial cytokeratin staining), which increased over time. All patients with EMT showed myofibroblasts, while only 36% of patients without EMT had myofibroblasts. The number of peritoneal vessels did not vary when we compared different times on PD. Vasculopathy was present in 17% of the samples. Functional studies were used to define the peritoneal transport status. Patients in the highest quartile of mass transfer area coefficient of creatinine (Cr-MTAC) (>11.8 ml min(-1)) showed significantly higher EMT prevalence (P=0.016) but similar number of peritoneal vessels. In the multivariate analysis, the highest quartile of Cr-MTAC remained as an independent factor predicting the presence of EMT (odds ratio 12.4; confidence interval: 1.6-92; P=0.013) after adjusting for fibrosis (P=0.018). We concluded that, during the first 2 PD years, EMT of MCs is a frequent morphological change in the peritoneal membrane. High solute transport status is associated with its presence but not with increased number of peritoneal vessels.

[Agoraphobia: combined treatment and virtual reality. Preliminary results]. / Agorafobia: tratamientos combinados y realidad virtual. Datos preliminares.

INTRODUCTION: Several validation studies have identified the use of certain psychodrugs, cognitive-behavioral therapy (CBT) and combined treatment as effective procedures for the treatment of agoraphobia. Recent findings suggest that agoraphobia can also be treated with virtual reality techniques (VRET) as an alternative exposure technique to virtual reality stimuli. METHODOLOGY: Twenty-seven patients with agoraphobia were distributed into two groups of psychoactive drugs (paroxetine and venlafaxine) and into two cognitive- behavioral procedures (with or without exposure to VRET). Seven virtual situations were used. RESULTS: Preliminary results show significant improvements in all the experimental groups. Regarding the psychodrugs (paroxetine and venlafaxine) both significantly improved the symptoms and in regards to the CBT, patients treated with VRET, especially the chronic patients, seem to obtain the best results. CONCLUSIONS: Agoraphobia combined treatments including paroxetine, venlafaxine and cognitive-behavioral therapy (with or without VRET) seem to have clear benefits for the patients. VRET seem to be a possible and effective treatment for agoraphobic patients, especially for those with chronic agoraphobia.

Pancreatic metastases from ductal and lobular carcinomas of the breast.

The pancreas is an uncommon target for metastases from other primary tumours. We discuss clinical, diagnostic and therapeutic aspects of pancreatic metastases through presentation of two surgically treated cases of metastases originating from breast cancer.

[Intravenous immunoglobulin: another therapeutic application]. / Inmunoglobulina intravenosa: una nueva aplicación terapéutica.

Intravenous immunoglobulin (IVIG) has immunoregulatory functions. In renal transplant, IVIG has been used as an immunosupressor agent only during short period of time and frequently associated to others immunosupressor drugs. In renal transplant IVIG has been used to treat refractory rejection but not as maintenance immunosupressor treatment. We report a case in which IVIG was used as principal immunosupressor agent close to low doses of iv methylprednisolone. The patient could not receive anything by oral way during three months, so she only could be treated by intravenous way. It is the first time that IVIG is used as maintenance immunosupressortreatment for a long time (three months) without secondary effects.