ABSTRACT
BACKGROUND: Delaying the transition from minimal cognitive impairment to Alzheimer's dementia is a major concern in Alzheimer's disease (AD) therapeutics. Pathological signs of AD occur years before the onset of clinical dementia. Thus, long-term therapeutic approaches, with safe, minimally invasive, and yet effective substances are recommended. There is a need to develop new drugs to delay Alzheimer's dementia. We have taken a nutritional supplement approach with genistein, a chemically defined polyphenol that acts by multimodal specific mechanisms. Our group previously showed that genistein supplementation is effective to treat the double transgenic (APP/PS1) AD animal model. METHODS: In this double-blind, placebo-controlled, bicentric clinical trial, we evaluated the effect of daily oral supplementation with 120 mg of genistein for 12 months on 24 prodromal Alzheimer's disease patients. The amyloid-beta deposition was analyzed using 18F-flutemetamol uptake. We used a battery of validated neurocognitive tests: Mini-Mental State Exam (MMSE), Memory Alteration Test (M@T), Clock Drawing Test, Complutense Verbal Learning Test (TAVEC), Barcelona Test-Revised (TBR), and Rey Complex Figure Test. RESULTS: We report that genistein treatment results in a significant improvement in two of the tests used (dichotomized direct TAVEC, p = 0.031; dichotomized delayed Centil REY copy p = 0.002 and a tendency to improve in all the rest of them. The amyloid-beta deposition analysis showed that genistein-treated patients did not increase their uptake in the anterior cingulate gyrus after treatment (p = 0.878), while placebo-treated did increase it (p = 0.036). We did not observe significant changes in other brain areas studied. CONCLUSIONS: This study shows that genistein may have a role in therapeutics to delay the onset of Alzheimer's dementia in patients with prodromal Alzheimer's disease. These encouraging results indicate that this should be followed up by a new study with more patients to further validate the conclusion that arises from this study. TRIAL REGISTRATION: NCT01982578, registered on November 13, 2013.
Subject(s)
Alzheimer Disease , Cognitive Dysfunction , Alzheimer Disease/diagnostic imaging , Alzheimer Disease/drug therapy , Alzheimer Disease/pathology , Amyloid beta-Peptides/pharmacology , Cognition , Genistein/therapeutic use , Genistein/pharmacology , HumansABSTRACT
En la Sección Clínica Médico Forense del Departamento de Medicina Legal se valoran pacientes enviados por la Sala Constitucional por interposición de Recursos de Hábeas Corpus, ésto, debido a las presuntas lesiones causadas por parte de funcionarios de alguna Autoridad Estatal. Este artículo pretende revisar qué es un Recurso de Hábeas Corpus y cómo se elabora, al unísono la relación directa con la valoración médico forense y las conclusiones médico legales respectivas, por lo que ejemplificamos un caso real de la Sección supra mencionada.
In Sección Clínica Médico Forense of Departamento de Medicina Legal we valued clients referred by the Constitutional Court by filing habeas corpus, this, because the alleged injuries caused by officials of any state authority. This article reviews what is a writ of habeas corpus and how it is produced, together with the direct and forensic evaluation forensic respective conclusions, so that exemplify a real case of above mentioned Section.
Subject(s)
Humans , Male , Female , Accidents, Occupational , Costa Rica , Forensic MedicineABSTRACT
Los accidentes de tránsito terrestres en Costa Rica se han convertido en un serio problema de salud pública, que derivan ya sea en lesiones graves o bien en muertes de personas de todas las edades. Estos eventos incluyen el atropellamiento, las colisiones y choques, y producen cuadros lesionológicos muy diversos de acuerdo a la participación de las personas, el tipo de vehículo y la forma en la que se produce el traumatismo. Así mismo, se debe tener en cuenta la participación de factores coadyuvantes como el uso del casco y el cinturón de seguridad, o bien el consumo de alcohol y el uso del teléfono móvil. La valoración médico legal de las víctimas, vivas o muertas de accidentes de tránsito, está a cargo del Departamento de Medicina Legal del Organismo de Investigación Judicial, y se hace por solicitud de una Autoridad Judicial competente.
Traffic accidents in Costa Rica have become a major public health threat, since they produce severe injuries o even death of people of all ages. These events include car run over, collisions and car crashes, which derive in a huge variety of injuries, regarding the roll that people play in the accident, the vehicle involved and the manner in which trauma is held. Nevertheless, out coming factors such as the use of helmet, the buckling of seat belts, alcohol drinking and mobile phone use must be considered an assessed. The medical examination of victims, living or death in traffic accidents might be requested by Costa Rican Court of Law, and is the task of the Departamento de Medicina Legal of the Organismo de Investigación Judicial, which is the government office in charge of crime investigation.
Subject(s)
Humans , Male , Female , Accidents, Traffic , Costa Rica , Forensic Medicine , Public HealthABSTRACT
BACKGROUND: Functional digestive disorders constitute a sizable proportion of gastroenterology and primary healthcare consultations, and have a negative impact on health-related quality of life. Dyspepsia and heartburn are often associated with irritable bowel syndrome (IBS); however, the incidence of these symptoms and their effect on IBS patients have not been evaluated. AIM: To investigate the clinical, psychological and health-related quality of life impact of upper digestive symptoms on IBS patients. METHODS: A prospective, observational, multicentered study was conducted in Spain: 517 IBS patients (Rome II criteria), grouped according to predominant symptoms of constipation (IBS-C), diarrhea (IBS-D) or alternating bowel habit (IBS-A) and 84 controls without IBS were recruited. Upper digestive symptoms were recorded in a 30-day diary. Health-related quality of life was evaluated by Irritable Bowel Syndrome Quality of Life and Euro-Quality of Life Five-Dimension Questionnaires; psychological well-being was evaluated by the Psychological General Well-Being Index. RESULTS: IBS patients had greater frequencies of upper digestive symptoms (72.3 vs. 6.0%), dyspepsia (21.1 vs. 4.8%) and heartburn (40.0 vs. 13.1%) (all P < 0.05) than controls. Prevalence of upper digestive symptoms was lower in patients with IBS-D than in those with IBS-C or IBS-A (P < 0.05). Health-related quality of life and psychological status were significantly worse in IBS patients with upper digestive symptoms than in those without. CONCLUSIONS: Upper digestive symptoms, frequently present in IBS patients, impair health-related quality of life and psychological status. This effect is greater in patients with IBS-C and IBS-A than in those with IBS-D. These data emphasize the importance of evaluating the presence of upper digestive symptoms in IBS patients.
