Cognitive reserve in bipolar disorder: relation to cognition, psychosocial functioning and quality of life.

OBJECTIVE: Cognitive reserve (CR) is a concept that was postulated as a protective factor for some clinical symptoms after the observation that there is not a direct relationship between the degree of brain damage and its clinical manifestation. This study aimed to explore the association between CR and the main outcomes in bipolar disorder (BD): cognitive functions, psychosocial functioning and perceived quality of life. METHOD: A sample of 224 euthymic bipolar patients was assessed with a neuropsychological battery, the Functioning Assessment Short Test and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). CR was calculated through three proxies: estimated premorbid Intelligent Quotient, educational level and occupational attainment. Relationships between CR and cognitive functions, psychosocial functioning and quality of life were assessed by multiple linear regression models. RESULTS: Higher CR was associated with better cognitive functioning (P < 0.001 in processing speed, working memory, verbal and visual memory, and executive function; P = 0.026 in attention) and better psychosocial functioning (P = 0.008). For quality of life, CR was positively associated with the physical component of the SF-36 (P = 0.016) but negatively associated with the mental component (P = 0.004). CONCLUSION: The results suggest that CR may play an important role in the course and prognosis of bipolar patients and it should be considered in both clinical and research settings related to BD.

Treatment of carotid cavernous fistulas using covered stents: midterm results in seven patients.

BACKGROUND AND PURPOSE: Carotid cavernous fistulas (CCF) can be effectively treated by using different therapeutic alternatives such as detachable balloons and detachable coils, alone or in combination with N-butyl-2-cyanoacrylate (n-BCA) or Onyx. Stents have also been used in an attempt to improve preservation of the parent artery while still occluding the fistula. We present our experience using balloon-expandable covered stents to treat CCF, focusing on arterial wall reconstruction. To our knowledge, this is the first series with midterm follow-up between 3 months and 3.5 years. MATERIALS AND METHODS: From the 46 CCF treated at our institution between November 1998 and September 2006, a total of 7 posttraumatic direct CCF were treated using polytetrafluoroethylene (PTFE)-covered stents between April 2003 and September 2006. Five were treated with covered stents alone. One patient with transection of the internal carotid artery (ICA) first underwent bare stent placement to provide support for the covered stent. One patient had to be treated with coils and n-BCA. RESULTS: Control angiograms obtained in the 7 patients demonstrated occlusion of the fistula and preservation of the ICA in all cases. There was no mortality and no immediate postprocedural morbidity. There was 1 case of morbidity identified at 1-month follow-up with asymptomatic occlusion of the ICA; the other 6 patients had angiographic follow-up between 3 and 42 months (mean, 18.4 months), with persistent occlusion of the fistulas, patent stent grafts, and no significant intimal hyperplasia. CONCLUSIONS: PTFE-covered stents are evolving as a promising intracranial therapeutic alternative to treat CCF and preserve the parent artery by reconstructing the arterial wall. They should be considered in patients in whom fistulas cannot be successfully occluded with detachable balloons or detachable coils. More investigation is required to further develop their specifications and indications.

Acción Insulinica y resistencia a la insulina: aspectos moleculares / Action of insulin and insulin resistance

Las patologías asociadas a alteraciones metabólicas crónicas, como la obesidad, la diabetes y las dislipidemias; constituyen una fuente de enfermedad, muerte y discapacidad que cobra cada vez mayor relevancia en el mundo. Varios de estos problemas son consecuencia directa o indirecta de una acción insuficiente de la insulina, lo cual origina una constelación de factores de riesgo que potencian la aparición de enfermedad cardiovascular aterosclerótica en el largo plazo. En esta revisión se abordan de manera concisa los mecanismos de acción de la insulina a nivel molecular, así como la forma en que se pueden ver afectados por factores diferentes a la constitución genética de cada individuo

Hemoglobina glucosilada A1c (A1c): Variación etárea y determinantes clínicos y para clínicos en población sana / Glycated hemoglobin A1c: Clinical and laboratory variations in a selected population

Objetivos. El objetivo principal de este estudio era determinar si existía alguna tendencia o patrón de comportamiento de los niveles de A1c a diferentes edades, en personas sanas. Otros objetivos eran encontrar los determinantes clìnicos y paraclínicos mas importantes del nivel de A1c en personas sanas, modelar el comportamiento de la A1c en función de la edad, y comparar los niveles de A1c entre ambos sexos. Métodos. Se estudiaron 130 personas aparentemente sanas distribuidas en 5 grupos etáreos: 7 a 12 años (n=35), 13 a 18 años (n=34), 19 a 26 años (n=20), 27 a 45 años (n=19) y 46 a 60 años (n=22). Se practicó examen físico completo y determinación de glucemia de ayuno, perfil de lípidos, ácido úrico y cuadro hemático. Los niveles de A1c se determinaron por inmunoturbidimetría. Se realizaron comparaciones múltiples entre grupos de edad, así como regresión polinomial con los grupos de edad como variable independiente y A1c como variable dependiente. Para establecer los determinantes de la A1c se realizó regresión lineal múltiple. Conclusiones. Nuestros datos sustentan la hipótesis de que los niveles de A1c varían con la edad y el sexo en población no diabética. Hacia el futuro sería recomendable ajustar las metas de A1c en el tratamiento de los pacientes con diabetes según la edad y el sexo

Outbreak of nosocomial sepsis and pneumonia in a newborn intensive care unit by multiresistant extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: high impact on mortality.

We describe a case-control study of a small outbreak of nosocomial sepsis and pneumonia with high mortality due to clonal dissemination of a multiresistant Klebsiella pneumoniae in the neonatal intensive care unit of a Mexican institution. Our study helped to change nosocomial infection control policy in this hospital.

Characteristics of frequent pediatric emergency department users.

The purpose of this study was to examine the medical and demographic characteristics of patients who frequently seek emergency care at a pediatric emergency department (ED). Registration information of ED visits during the study period from 11/1/87 to 5/31/92 (4.6 years) was stored in a data base. Patients with 10 or more ED visits during this study period were considered to be "frequent" ED users. Outpatient and inpatient medical records of these patients were manually reviewed. Demographics, chronic conditions, and the acute conditions for each ED visit were coded and analyzed. During the study period, there were 79,049 ED patient visits under 21 years of age. Of the patients born after 1970, there were 47,451 visits by patients seen one or two times, 25,883 visits by patients seen three to nine times, and 5178 visits by 357 patients seen in the ED ten times or more. Ninety-nine patients were seen more than 15 times, 39 patients were seen more than 20 times, 17 patients were seen more than 25 times, and 10 patients were seen more than 30 times. Two hundred sixty-five of the 357 frequent ED users (74%) had chronic disease conditions. Two hundred and twenty-three of them had good functional status, 25 had mild or moderate impairment in carrying out activities of daily living, and 17 had severe impairment of function. The most common chronic medical conditions were recurrent wheezing (226), neurologic conditions (33), gastrointestinal conditions (13), cardiac conditions (12), and endocrine conditions (9). The other 92 were assessed as healthy children. Patients' immunization status were up to date as of the last ED visit during the study period in 329 patients (92%). Pediatricians were the primary care providers in 339 patients (95%). Medical insurance status of patients follows: private insurance (38%), military (0.3%), Medicaid or state assistance (60%), and no insurance (1.4%). Polynesian ethnic groups were over-represented in the cohort of frequent ED users. We conclude that cultural differences appeared to be an important factor associated with frequent ED use by healthy persons. Medical care resources as measured by immunizations, insurance, and identification of a primary care physician did not appear to be deficient in this cohort of frequent ED users. Since recurrent wheezing is a dominant chronic condition among frequent ED users, pediatric emergency medicine training programs may consider the inclusion of the chronic management of wheezing in their curriculum.

Production and characterization of monoclonal antibodies to plum pox virus and their use in differentiation of Mediterranean isolates.

Monoclonal antibodies (MAbs) specific to plum pox virus (PPV) were prepared by fusing myeloma cell lines to spleen cells of mice immunized with purified virus, including virus prepared with protease inhibitors to preserve the integrity of the coat protein (CP). The characterized MAbs could be used in ELISA to differentiate several Mediterranean PPV isolates differing in their geographical origin and CP size. At least seven antigenic sites could be established based on the recognition pattern and competition binding analysis, and the epitopes could be classified in three groups by Western blot analysis of intact and trypsin digested virus particles. By means of electron microscopy the epitopes could be seen to be located on the surface of the virus particles.

Pulse oximetry and peak flow as indicators of wheezing severity in children and improvement following bronchodilator treatments.

This study examined the changes from the initial peak flows and oxygen saturations (OSAT) of wheezing children at presentation to the emergency department through their treatment in the emergency department. Data was collected prospectively on 785 patients 5 to 20 years of age during an 11-month period from November 1, 1990, to September 30, 1991. Both the initial OSAT and peak flows were correlated with the number of bronchodilator treatments required in the emergency department and with the need for hospitalization. Both the initial OSAT and the peak flows had a limited ability to predict the need for hospitalization. Oxygen saturation appears to be a valid measure of wheezing severity and is more easily obtained in children of all ages. Following bronchodilator treatment, peak flow results in a larger quantitative improvement than OSAT; however, this difference does not appear to have any significant advantage. Aerosolized albuterol and subcutaneous epinephrine resulted in a similar degree of improvement as measured by peak flow and by oxygen saturation, with clinically similar changes in heart rate.

Diagnostic methods for African horsesickness virus using monoclonal antibodies to structural and non-structural proteins.

A panel of 32 hybridoma cell lines secreting monoclonal antibodies (MAbs) reactive with African horsesickness virus serotype 4 (AHSV-4) has been developed. Four of the MAbs recognized the major core antigen VP7, twenty recognized the outer capsid protein VP2 and eight reacted with the non-structural protein NS1. With the VP7-specific MAbs a rapid and sensitive double antibody sandwich immunoassay has been developed to detect viral antigen in infected Vero cells and in spleen tissue from AHSV-infected horses. The sensitivity of the assay is 10 ng viral antigen per 100 microliters. The NS1-specific MAbs allowed visualization by immunofluorescence of tubule-like structures in the cytoplasm of infected Vero cells. This can be very useful as a confirmatory diagnostic procedure. The antigenic map of the outer capsid VP2 protein with MAbs is also reported.

[Latero-protrusive checkbites and setting of a semi-adjustable articulator]. / Mordus de latéro-propulsion et réglage d'un articulateur semi-adaptable.

The authors propose an original method for the setting of a semi-adjustable articulator based on latero-protrusive check-bites. This study compares two setting methods. The first was used as a control. It makes use of protrusion and lateral check-bites for the adjustment of the condylar path angle and Bennett's angle. The second method, adjusts the two parameters using only latero-protrusion check-bites. Recordings were taken on 15 young patients aged from 24 to 32 years old, having a healthy and complete dentition without any subjective symptomatology of T.M.J. The recordings were always made by the same operator. According to a strict methodology, the same protocole was used for the recording of the check-bites with both methods, mounting of the models on the articulator and adjustment of the angles. For the first method, the check-bites were taken with a 5 mm protrusion previously determined on the articulator. This position was reported and marked in the mouth using indelible ink. Likewise, a 5 mm lateral bites position on the working side was determined for both sides. With the second method, the lateroprotrusion bites were taken with a 3 mm displacement of the condyle on the working side and 5 mm on the non-working side. In both methods, the values of the condylar path angle and Bennett's angle were revealed and compared for all the patients. Subsequently to a statistical analysis, the authors concluded on the similarity of the results for the two methods, confirming the interest of a single latero-protrusion check-bite which is easier to obtain, is economical in terms of time, and entails a lesser number of bites to be made.