ABSTRACT
The seasonal dynamics and distribution of ticks play a pivotal role in the epidemiology of tick-borne diseases. The objective of this study was to establish the seasonal abundance and species richness of questing ixodid ticks on Amathole Montane Grassland camps grazed by sheep. Ticks questing for hosts were collected monthly for a period of three years by dragging flannel strips attached to a wooden spar over the vegetation. At each occasion, six replicate drag-samples were made in camps grazed by sheep. Of the questing ticks (n = 14 891) collected from the vegetation, the most abundant larvae were those of Rhipicephalus microplus (95.04%) followed by Rhipicephalus appendiculatus (2.32%), Rhipicephalus evertsi (1.56%), Rhipicephalus decoloratus (1.03%), Rhipicephalus simus (0.03) and Amblyomma hebraeum (0.02%). Comparing the two Rhipicephalus (Boophilus) spp., R. microplus (98.9%) outcompete the indigenous tick, R. decoloratus (1.1%). The R. microplus larvae were significantly higher (P < 0.05) in 2015 (2.11±0.108), 2016 (2.02 ± 0.076) and 2017 (1.94±0.075) during spring than any other season. There were no significant differences (P Ë 0.05) from R. appendiculatus questing ticks collected in autumn (0.27±0.007; 0.30±0.052) and spring (0.33±0.007; 0.20±0.052) for 2015 and 2016, respectively. The study showed that the cattle tick, R. microplus adapted very well on host species, in this case sheep, and encroached to areas that were too cold for its adaptation.
Subject(s)
Cattle Diseases , Ixodidae , Rhipicephalus , Tick Infestations , Animals , Sheep , Cattle , South Africa/epidemiology , Tick Infestations/epidemiology , Tick Infestations/veterinary , Cattle Diseases/epidemiology , LarvaABSTRACT
OBJECTIVE: To compare the effectiveness and safety of Foley catheter and oral misoprostol for induction of labor (IOL). METHODS: The Cochrane Review on Mechanical Methods for Induction of Labour and Ovid MEDLINE, EMBASE via Ovid, Ovid Emcare, CINAHL Plus, ClinicalTrials.gov and Scopus, from inception to April 2019, were searched for randomized controlled trials (RCTs) comparing Foley catheter to oral misoprostol for IOL in viable singleton gestations. Eligible trials for which raw data were obtained were included and individual participant data meta-analysis was performed. Primary outcomes were vaginal birth, a composite of adverse perinatal outcome (including stillbirth, neonatal death, neonatal seizures, admission to the neonatal intensive care unit, severe respiratory compromise or meconium aspiration syndrome) and a composite of adverse maternal outcome (including admission to the intensive care unit, maternal infection, severe postpartum hemorrhage, maternal death or uterine rupture). The quality of the included RCTs was assessed using the Cochrane Risk of Bias 2 tool and the certainty of evidence was evaluated using the GRADE approach. A two-stage random-effects model was used for meta-analysis according to the intention-to-treat principle and interactions between treatment and baseline characteristics were assessed. RESULTS: Of seven eligible trials, four provided individual participant data for a total of 2815 participants undergoing IOL, of whom 1399 were assigned to Foley catheter and 1416 to oral misoprostol. All four trials provided data for each of the primary outcomes in all 2815 women. Compared with those receiving oral misoprostol, Foley catheter recipients had a slightly decreased chance of vaginal birth (risk ratio (RR), 0.95 (95% CI, 0.91-0.99); I2 , 2.0%; moderate-certainty evidence). A trend towards a lower rate of composite adverse perinatal outcome was found in women undergoing IOL using a Foley catheter compared with oral misoprostol (RR, 0.71 (95% CI, 0.48-1.05); I2 , 14.9%; low-certainty evidence). Composite adverse maternal outcome did not differ between the groups (RR, 1.00 (95% CI, 0.97-1.03); I2 , 0%; moderate-certainty evidence). Meta-analyses of effect modifications did not show significant interactions between intervention and parity or gestational age for any of the primary outcomes. CONCLUSIONS: For women undergoing IOL, Foley catheter is less effective than oral misoprostol, as it was associated with fewer vaginal births. However, while we found no significant difference in maternal safety, Foley catheter induction may reduce adverse perinatal outcomes. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
Subject(s)
Catheters , Labor, Induced , Misoprostol , Oxytocics , Administration, Oral , Female , Humans , Pregnancy , Randomized Controlled Trials as Topic , Urinary CatheterizationABSTRACT
INTRODUCTION: accurate preoperative localization of colorectal cancer (CRC) is very important, with a wide range of published error rates. AIMS: to determine accuracy of endoscopic localization of CRC in comparison with preoperative computed tomography (CT). To analyse variables that could be associated with a wrong endoscopic localization. PATIENTS AND METHODS: endoscopic and CT localization of a series of CRC without previous surgery were reviewed. We studied the concordance between endoscopic and radiologic localization against operative findings comparing accuracy of endoscopy and CT. We analysed the frequency of wrong endoscopic diagnoses with regard to a series of patient, endoscopy and tumor variables. RESULTS: two hundred thirty seven CRC in 223 patients were studied. Concordance with surgical localization was: colonoscopy = 0.87 and CT = 0.69. Endoscopic localization accuracy was:91.1%; CT: 76.2%: p = 0.00001; OR = 3.22 (1.82-5.72). Obstructive cancer presented a higher rate of wrong localization: 18 vs. 5.7% in non-obstructive tumors (p = 0.0034; OR = 3.65 (1.35-9.96). Endoscopic localization mistakes varied depending on tumor location, being more frequent in descending colon: 36.3%, p = 0.014; OR = 6.23 (1.38-26.87) and cecum: 23.1%, p = 0.007; OR = 3.92 (1.20-12.43). CONCLUSIONS: endoscopic accuracy for CRC localization was very high and significantly better than CT accuracy. Obstructive tumor and those located in the descending colon or cecum wereassociated with a significant increase of the error risk of CRC endoscopic localization.
Subject(s)
Colorectal Neoplasms/diagnosis , Endoscopy, Digestive System/statistics & numerical data , Adult , Aged , Cecum/diagnostic imaging , Colon/diagnostic imaging , Colonoscopy , Colorectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/surgery , Diagnostic Errors , Female , Humans , Male , Middle Aged , Reproducibility of Results , Tomography, X-Ray ComputedABSTRACT
La hemorragia digestiva baja se define como la que tiene su origen por debajo del ligamento de Treitz. La etiología de la misma varía dependiendo de la edad de los pacientes. Excluida la patología anorrectal benigna, en niños y jóvenes las causas más habituales son el divertículo de Meckel, los pólipos juveniles y la enfermedad inflamatoria intestinal. El divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal, estando presente en el 2% de la población general. La mayoría de los divertículos de Meckel son asintomáticos y se diagnostican de forma incidental. Aproximadamente, el riesgo de presentar complicaciones es del 4-6%, siendo la hemorragia una de ellas. Presentamos el caso de un paciente de 25 años, que acudió a nuestro servicio con un cuadro de molestias abdominales inespecíficas y rectorregia. Tras estudio endoscópico completo, el diagnóstico de divertículo de Meckel se realizó intraoperatoriamente. Se realizó resección ileal incluyendo el divertículo, con evolución posterior satisfactoria(AU)
Lower gastrointestinal bleeding refers to blood loss originating from a site distal to the ligament of Treitz. The aetiology varies depending on the age of patients. Excluding benign anorectal pathology in children and young people, Meckels diverticulum, juvenile polyps and inflammatory bowel disease are the main causes. Meckels diverticulum is the most common congenital anomaly of the gastrointestinal tract, being present in about 2% of the general population. Most Meckels diverticulum are asymptomatic and are diagnosed incidentally. The risk of complications is 4-6%, with bleeding as one of them(AU)
Subject(s)
Humans , Male , Adult , Gastrointestinal Hemorrhage/diagnosis , Meckel Diverticulum/complications , Gastrointestinal Hemorrhage/etiology , Meckel Diverticulum/surgery , LaparotomyABSTRACT
Lower gastrointestinal bleeding refers to blood loss originating from a site distal to the ligament of Treitz. The aetiology varies depending on the age of patients. Excluding benign anorectal pathology in children and young people, Meckel's diverticulum, juvenile polyps and inflammatory bowel disease are the main causes. Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract, being present in about 2% of the general population. Most Meckel's diverticulum are asymptomatic and are diagnosed incidentally. The risk of complications is 4-6%, with bleeding as one of them.
Subject(s)
Gastrointestinal Hemorrhage/etiology , Meckel Diverticulum/complications , Adult , Humans , Male , Severity of Illness IndexABSTRACT
Objectivo. Descripción de la experiencia organizativa de gestión de la demanda en nuestro centro de salud. Valoración de la utilidad, grado de satisfacción y percepción de mejora por parte de los profesionales del centro mediante una encuesta de valoración. Material y métodos. DISEÑO: Estudio descriptivo de la experiencia y de una encuesta de valoración. EMPLAZAMIENTO: Área urbana con 29.674 pacientes asignados. PARTICIPANTES: Todo el equipo de profesionales sanitarios y no sanitarios del centro de salud. INTERVENCIONES: Disminución de la cita previa en las agendas de los facultativos con aumento de las visitas del día y creación de un circuito nuevo de atención a los pacientes con una enfermera de triaje y un médico de guardia. Aplicación de una encuesta de valoración a todos los «profesionales del centro». MEDICIONES PRINCIPALES: Análisis de las visitas de la enfermera de triaje así como del porcentaje de resolución y análisis de los resultados de la encuesta por estamentos. Resultados. La media de visitas por parte de la enfermera de triaje es de 30 con un 41% de resolución por parte de la misma. Encuesta cumplimentada por el 93,8% de los profesionales del centro. Conclusiones. Valoración elevada por parte de todo el personal de la consulta de triaje. Las mejoras y la disminución de carga de trabajo lo refieren principalmente administrativos y médicos (AU)
Objectives. Description of the experience of organizational management of demand in our health centre. Assessment of the usefulness, level of satisfaction and perception of improvement on the part of the professionals of the centre using an evaluation survey. Material and methods. DESIGN: Descriptive Study of the experience and an evaluation survey. SETTING: Urban Area with 29,674 patients assigned. PARTICIPANTS: The team of health and non-health professionals of the health centre. INTERVENTIONS: Decrease in previous appointments in the lists of the physicians, with an increase in the visits on the day and creation of a new circuit of patient care using a triage nurse and an emergency physician. Implementation of an evaluation survey of all professionals of the centre. MAIN MEASUREMENTS: Analysis of triage nurse visits, as well as the percentage of resolution and analysis of the results of the survey by profession. Results. The average of visits to the nurse triage was 30, with 41% of them being resolved there. The survey was completed by 93.8% of professionals of the centre. Conclusions. There were high appraisals for the triage clinic by all the staff. The improvements and the decrease in workload were mainly administrative and medical (AU)
Subject(s)
Humans , Male , Female , Health Services Needs and Demand/organization & administration , Primary Health Care/methods , Triage/organization & administration , Triage/trends , Health Services Needs and Demand/standards , Health Services Needs and Demand/trends , Primary Health Care/organization & administration , Primary Health Care/trends , Triage/methods , Socioeconomic SurveyABSTRACT
El cistoadenoma seroso es el segundo tumor quísticomás frecuente del páncreas y representa el 1-2% detodas las neoplasias exocrinas pancreáticas. Recientemente,gracias a las mejoras en las técnicas de imagen,la identificación de las lesiones quísticas pancreáticases cada vez más frecuente. El diagnóstico diferencial hade hacerse con el cistoadenoma mucinoso, debido alpotencial maligno de esta última entidad. En esta notaclínica describimos el caso de una paciente con ictericiaindolora y colestasis, con diagnóstico final de cistoadenomaseroso pancreático (AU)
Serous cystadenoma is the second most frequentpancreatic cystic neoplasm and accounts for 1-2% ofexocrine neoplasms of the pancreas. Recently, theyhave been identified more frequently, due to the improvementin imaging techniques. Differential diagnosisshould be performed with mucinous cystoadenoma,due to the latter´s potential for malignant transformation.We present the case of a female patient whounderwent examination for painless jaundice and cholestasis,with a final diagnosis of pancreatic serous cystoadenoma (AU)
Subject(s)
Humans , Female , Aged, 80 and over , Cystadenoma/complications , Cystadenoma/diagnosis , Jaundice/complications , Jaundice/diagnosis , Cholestasis/complications , Cholestasis , Pancreatic Neoplasms/complications , Pancreatic Neoplasms , Cystadenoma/physiopathology , Jaundice/physiopathology , Jaundice , Pancreas/pathology , Pancreas , Pancreatic Neoplasms/physiopathology , EndoscopyABSTRACT
Arenaviridae comprises 23 recognized virus species with a bipartite ssRNA genome and an ambisense coding strategy. The virions are enveloped and include nonequimolar amounts of each genomic RNA species, designated L and S, coding for four ORFs (N, GPC, L, and Z). The arenavirus Junín (JUNV) is the etiological agent of Argentine Hemorrhagic Fever, an acute disease with high mortality rate. It has been proposed that Z is the functional counterpart of the matrix proteins found in other negative-stranded enveloped RNA viruses. Here we report the optimized expression of a synthetic gene of Z protein, using three expression systems (two bacterial and a baculoviral one). One of these recombinant proteins was used to generate antibodies. A bioinformatic analysis was made where Z was subdivided into three domains. The data presented contributes methodologies for Z recombinant production and provides the basis for the development of new experiments to test its function.
Subject(s)
Junin virus/genetics , Recombinant Fusion Proteins/isolation & purification , Viral Matrix Proteins/isolation & purification , Amino Acid Sequence , Animals , Antibodies, Viral/metabolism , Arenaviridae Infections/virology , Blotting, Western , Escherichia coli/genetics , Humans , Molecular Sequence Data , Protein Structure, Tertiary/genetics , Rabbits , Recombinant Fusion Proteins/chemistry , Recombinant Fusion Proteins/genetics , Recombinant Fusion Proteins/metabolism , Sequence Alignment , Spodoptera/genetics , Viral Matrix Proteins/chemistry , Viral Matrix Proteins/genetics , Viral Matrix Proteins/metabolismABSTRACT
Activation of the epidermal growth factor receptor (EGFR) plays an important role in liver regeneration and resistance to acute injury. However its chronic activation participates in the progression of liver disease, including fibrogenesis and malignant transformation. Hepatobiliary disease represents a constant feature in the clinically relevant Fechm1pas/Fechm1pas genetic model of erythropoietic protoporphyria (EPP). Similarly, chronic administration of griseofulvin to mice induces pathological changes similar to those found in patients with EPP-associated liver injury. We investigated the hepatic expression of the EGFR and its seven most relevant ligands in Fechm1pas/Fechm1pas mice bred in three different backgrounds, and in griseofulvin-induced protoporphyria. We observed that the expression of amphiregulin, betacellulin and epiregulin was significantly increased in young EPP mice when compared to aged-matched controls in all genetic backgrounds. The expression of these ligands was also tested in older (11 months) BALB/cJ EPP mice, and it was found to remain induced, while that of the EGFR was downregulated. Griseofulvin feeding also increased the expression of amphiregulin, betacellulin and epiregulin. Interestingly, protoporphyrin accumulation in cultured hepatic AML-12 cells readily elicited the expression of these three EGFR ligands. Our findings suggest that protoporphyrin could directly induce the hepatic expression of EGFR ligands, and that their chronic upregulation might participate in the pathogenesis of EPP-associated liver disease.
Subject(s)
ErbB Receptors/agonists , ErbB Receptors/metabolism , Liver/drug effects , Liver/metabolism , Protoporphyria, Erythropoietic/metabolism , Amphiregulin , Animals , Betacellulin , Cell Line , EGF Family of Proteins , Epidermal Growth Factor/genetics , Epigen , Epiregulin , Glycoproteins/genetics , Griseofulvin/pharmacology , Heparin-binding EGF-like Growth Factor , Intercellular Signaling Peptides and Proteins/genetics , Liver Diseases/genetics , Liver Diseases/metabolism , Male , Mice , Mice, Inbred C57BL , Mice, Mutant Strains , Protoporphyria, Erythropoietic/genetics , Protoporphyrins/metabolism , Reverse Transcriptase Polymerase Chain Reaction , Transforming Growth Factor alpha/geneticsABSTRACT
No disponible
Subject(s)
Humans , Liver Diseases/immunology , Hepatocytes/immunology , Hepatic Insufficiency/immunology , Liver Regeneration/immunology , Ischemia/physiopathology , Inflammation/physiopathology , Reperfusion Injury/physiopathology , Amphiregulin/pharmacokinetics , Liver Cirrhosis/physiopathologyABSTRACT
This work is a continuation of a previous durability study of class C fly ash belite cement (FABC-2-W) in simulated radioactive liquid waste (SRLW) that is very rich in sulphate salts. The same experimental methodology was applied in the present case, but with a SRLW rich in sodium chloride. The study was carried out by testing the flexural strength of mortars immersed in simulated radioactive liquid waste that was rich in chloride (0.5M), and demineralised water as a reference, at 20 and 40 degrees C over a period of 180 days. The reaction mechanism of chloride ions with the mortar was evaluated by scanning electron microscopy (SEM), porosity and pore-size distribution, and X-ray diffraction (XRD). The results showed that the FABC mortar was stable against simulated chloride radioactive liquid waste (SCRLW) attack at the two chosen temperatures. The enhancement of mechanical properties was a result of the formation of non-expansive Friedel's salt inside the pores; accordingly, the microstructure was refined.
Subject(s)
Carbon/chemistry , Construction Materials , Particulate Matter/chemistry , Radioisotopes/chemistry , Sodium Chloride/chemistry , Coal Ash , Microscopy, Electron, Scanning , Temperature , X-Ray DiffractionABSTRACT
The resistance of class C fly ash belite cement (FABC-2-W) to concentrated sodium sulphate salts associated with low level wastes (LLW) and medium level wastes (MLW) is discussed. This study was carried out according to the Koch and Steinegger methodology by testing the flexural strength of mortars immersed in simulated radioactive liquid waste rich in sulphate (48,000 ppm) and demineralised water (used as a reference), at 20 degrees C and 40 degrees C over a period of 180 days. The reaction mechanisms of sulphate ion with the mortar was carried out through a microstructure study, which included the use of Scanning electron microscopy (SEM), porosity and pore-size distribution and X-ray diffraction (XRD). The results showed that the FABC mortar was stable against simulated sulphate radioactive liquid waste (SSRLW) attack at the two chosen temperatures. The enhancement of mechanical properties was a result of the formation of non-expansive ettringite inside the pores and an alkaline activation of the hydraulic activity of cement promoted by the ingress of sulphate. Accordingly, the microstructure was strongly refined.
Subject(s)
Carbon , Glass Ionomer Cements/chemistry , Particulate Matter , Sulfates/pharmacology , Zeolites/chemistry , Coal Ash , Construction Materials , Hydrogen-Ion Concentration , Microscopy, Electron, Scanning , Models, Chemical , Particle Size , Refuse Disposal/methods , Stress, Mechanical , Sulfates/chemistry , Temperature , Time Factors , Water/chemistry , X-Ray DiffractionABSTRACT
The durability of class C fly ash belite cement (FABC-2-W) in simulated radioactive liquid waste (SRLW) rich in a mixed sodium chloride and sulphate solution is presented here. The effect of the temperature and potential synergic effect of chloride and sulfate ions are discussed. This study has been carried out according to the Koch-Steinegger test, at the temperature of 20 degrees C and 40 degrees C during a period of 180 days. The durability has been evaluated by the changes of the flexural strength of mortar, fabricated with this cement, immersed in a simulated radioactive liquid waste rich in sulfate (0.5M), chloride (0.5M) and sodium (1.5M) ions--catalogued like severely aggressive for the traditional Portland cement--and demineralised water, which was used as reference. The reaction mechanism of sulphate, chloride and sodium ions with the mortar was evaluated by scanning electron microscopy (SEM), porosity and pore-size distribution, and X-ray diffraction (XRD). The results showed that the chloride binding and formation of Friedel's salt was inhibited by the presence of sulphate. Sulphate ion reacts preferentially with the calcium aluminate hydrates forming non-expansive ettringite which precipitated inside the pores; the microstructure was refined and the mechanical properties enhanced. This process was faster and more marked at 40 degrees C.
Subject(s)
Glass Ionomer Cements/chemistry , Models, Chemical , Radioactive Waste , Temperature , Water Pollutants, Radioactive/isolation & purification , Zeolites/chemistry , Carbon , Chemical Precipitation , Chlorides , Coal Ash , Construction Materials , Minerals , Particulate Matter , Sodium , Sulfates , Waste Disposal, Fluid/methodsSubject(s)
Antidepressive Agents/therapeutic use , Depressive Disorder/drug therapy , Drug Industry , Gender Identity , Adult , Age Factors , Aged , Antidepressive Agents/adverse effects , Cross-Sectional Studies , Depressive Disorder/epidemiology , Depressive Disorder/psychology , Drug Interactions , Female , France , Humans , Middle Aged , Patient Education as Topic , Research , Risk AssessmentABSTRACT
The efficiency of innovative matrices for immobilizing cesium is presented in this work. The matrix formulation included the use of fly ash belite cement (FABC-2-W) and gismondine-type Na-P1 zeolite, both of which are synthesized from fly ash of coal combustion. The efficiency for immobilizing cesium is evaluated from the leaching test ANSI/ANS 16.1-1986 at the temperature of 40 degrees C, from which the apparent diffusion coefficient of cesium is obtained. Matrices with 100% of FABC-2-W are used as a reference. The integrity of matrices is evaluated by porosity and pore-size distribution from mercury intrusion porosimetry, X-ray diffraction and nitrogen adsorption analyses. Both matrices can be classified as good solidify systems for cesium, specially the FABC-2-W/zeolite matrix in which the replacement of 50% of belite cement by the gismondine-type Na-P1 zeolite caused a decrease of two orders of magnitude of cesium mean Effective Diffusion Coefficient (D(e)) (2.8e-09 cm(2)/s versus 2.2e-07 cm(2)/s, for FABC-2-W/zeolite and FABC-2-W matrices, respectively).
Subject(s)
Carbon/chemistry , Cesium/chemistry , Glass Ionomer Cements/chemistry , Particulate Matter/chemistry , Zeolites/chemistry , Coal Ash , Microscopy, Electron, Scanning , Porosity , X-Ray DiffractionABSTRACT
The optimization of parameters of synthesis of belite cement clinker from coal fly ash of high Ca content is presented in this paper. The synthesis process is based on the hydrothermal-calcination-route of the fly ash without extra additions. The hydrothermal treatment was carried out in demineralized water and a 1 M NaOH solution for 4 h at the temperatures of 100 degrees C, 150 degrees C, and 200 degrees C. The precursors obtained during the hydrothermal treatmentwere heated at temperatures of 700 degrees C, 800 degrees C, 900 degrees C, and 1000 degrees C. The changes of fly ash composition after the different treatments were characterized by X-ray diffraction (XRD), FT infrared (FTIR) spectroscopy, surface area (BET-N2), and thermal analyses. From the results obtained we concluded that the optimum temperature of the hydrothermal treatment was 200 degrees C, and the optimum temperature for obtaining the belite cement clinker was 800 degrees C.
Subject(s)
Calcium/chemistry , Carbon , Construction Materials , Coal , Coal Ash , Conservation of Natural Resources , Industrial Waste , Particulate Matter , Spectroscopy, Fourier Transform Infrared , Temperature , X-Ray DiffractionABSTRACT
The durability, of mixtures of two kinds of Spanish fly ashes from coal combustion (ASTM class F) with 0, 15 and 35% replacement of Portland cement by fly ash, in a simulated marine environment (Na(2)SO(4)+NaCl solution of equivalent concentration to that of sea water: 0.03 and 0.45 M for sulphate and chloride, respectively), has been studied for a period of 90 days. The resistance of the different mixtures to the attack was evaluated by means of the Koch-Steinegger test. The results showed that all the mixtures were resistant, in spite of the great amount of Al(2)O(3) content of the fly ash. The diffusion of SO(4)(2-), Na+ and Cl- ions through the pore solution activated the pozzolanic reactivity of the fly ashes causing the corresponding microstructure changes, which were characterized by X-ray diffraction (XRD), mercury intrusion porosimetry (MIP) and scanning electron microscopy (SEM). As a result, the flexural strength of the mixtures increased, principally for the fly ash of a lower particle size and 35% of addition.
Subject(s)
Construction Materials , Refuse Disposal , Water Pollutants/analysis , Coal , Incineration , Materials Testing , Mercury/analysis , Microscopy, Electron, Scanning , Particle Size , Seawater/chemistry , X-Ray DiffractionABSTRACT
UNLABELLED: Alzheimer's disease (AD) is a major healthcare challenge due to the increasing longevity of the population. Clinically prominent neuropsychological and neurological impairments, together with behavioral disorders characterize Alzheimer's disease (AD). In the past, behavioural and emotional disturbances received less attention than cognitive symptoms in studies of dementia. The association between cognitive and behavioural symptoms is complicated by the fact that such association could also occur with different patterns during depressive episode without dementia. Because Alzheimer's disease (AD) tends to be under diagnosed, there is an increasing need for accurate neuropsychological screening tools that are easy to administer by psychiatrists. The aim of the present study was to validate, in French, a sensitive and specific screening battery (B2C) designed to improve the discrimination between patients with AD, patients with depression, and healthy elderly subjects. POPULATION AND METHOD: The B2C was administered to 123 ambulatory subjects (mean age 76.4 2.3 years): divided in three groups of subjects. AD subjects were included (n=49) with a Mini-Mental Status Examination (MMSE) score of between 18 and 26, and a confirmed diagnosis (DSM IV) of mild to moderate AD. Subjects were not included if they were receiving treatment with an acetylcholinesterase inhibitor. The depressive group comprised elderly subjects (n=27) with at least two DSM IV criteria for a major depressive episode including the depressive mood criterion and a score of more than 17 on the Montgomery-Asberg Depression Rating Scale (MADRS). The healthy control group (n=47) comprised age-matched subjects with no neurological or psychiatric pathology. The B2C consists of four individual tasks derived from classical neuropsychological tests. Tasks were presented in the following order: temporal orientation test (knowledge of month, date, year, day of the week and time of day), 5 word test (task is originally derived from the Enhanced Cued Recall test), clock drawing test (In this widely used test, the subject had to draw a clock with all the numbers and then draw the clock hands at twenty minutes to four), and the semantic verbal fluency test (the subject was asked to generate as many words as possible from a given category in a fixed time period of 60 seconds). During the pre-study investigator meeting, the test procedure was adapted to ensure uniformity of practice in all centres. The B2C was administered one week to one month after the study inclusion date by a psychologist blinded to the patient groups and who had not participated in the subject's inclusion. Multivariate analysis was performed using a forced model of all four tests. Due to the nature of the dependent variable (AD vs controls and depressive vs control), the chosen discrimination model was a binary logistical regression model. Explanatory variables were limited to the variables of the test battery, and the dependent variable was the subject's status (AD, depressive or control). RESULTS: The mean results for each test are presented in Table II. The time taken to perform the tests was significantly higher (p=0.0001) for the AD group (11.2 minutes) when compared with both the control (7.6 minutes) and depressive group (8.2 minutes). In each of the four subtests, the AD subjects were significantly more impaired than the two other groups. Multivariate analysis was performed using a forced model of all four tests which provided correct classification of a high percentage of subjects (88.5%). The analysis followed a normal distribution and demonstrated that the AD patients were significantly impaired in all four tests of the B2C compared with controls. Depressive, elderly subjects were only impaired in verbal fluency. Multivariate analysis showed that, compared with controls, patients with mild AD were significantly impaired for all four tests. Response operating characteristics (ROC) analysis of the B2C showed: 93.8% sensitivity and 85% specificity for discriminating AD from control patients (table III), and 63% sensitivity and 96% specificity for discriminating AD from depressive patients (table IV). DISCUSSION: The main objective of this study was to demonstrate that the Short Cognitive Evaluation Battery developed in the French language is able to discriminate between patients suffering from AD and healthy elderly subjects. The results clearly demonstrate that AD patients were significantly impaired in all four tests of the B2C compared with the control group. The present study also supports the use of the screening battery for discriminating between AD and depressive subjects. The SCEB was less discriminatory for AD versus depressive patients than for AD versus controls. This could be due to the limited size of the depressive group. The verbal fluency test was the most sensitive for discriminating between AD and depression but this was at the expense of specificity. Other brief screening tests have already been developed in English speaking countries, In French language, the B2C appears to be a highly sensitive and specific tool for discriminating between patients with mild AD and healthy elderly individuals. Furthermore, in combination with clinical evaluation, the B2C could improve the specificity of the difficult discrimination between mild AD and depression. The next step of the validation process will include concurrent validity study and inclusion of a higher number of subjects with depressive symptoms.
Subject(s)
Alzheimer Disease/diagnosis , Cognition Disorders/diagnosis , Depressive Disorder, Major/diagnosis , Surveys and Questionnaires , Aged , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Male , Neuropsychological Tests , Perceptual Disorders/diagnosis , Severity of Illness Index , Time Perception/physiology , Verbal BehaviorSubject(s)
Preconception Care , Prenatal Care , Adult , Counseling , Female , Fetal Death/prevention & control , Folic Acid/administration & dosage , Folic Acid/therapeutic use , Humans , Infant Mortality/trends , Infant, Newborn , Male , Maternal Mortality/trends , Neural Tube Defects/prevention & control , Postpartum Period , Pregnancy , Pregnancy Complications/diagnosis , Pregnancy Complications/prevention & control , Risk FactorsABSTRACT
The hexane, ethylacetate and methanol extracts of Polygonum hydropiper whole plant administered to mice at doses of 250 and 500 mg/kg, showed a significant activity on acetic acid-induced writhing. Within the tested extracts, the ethylacetate one showed the most significant activity.
