The ghost tumour revisited. Corticosteroids in primary central nervous system lymphoma: diagnostic, prognostic and therapeutic implications.

OBJECTIVE: The cytolytic effect of corticosteroids on primary central nervous system lymphoma (PCNSL) has established the clinical dogma of avoiding steroid therapy prior to surgery for diagnostic purposes. However, since steroids are very useful during the initial management of intracranial lesions with vasogenic oedema, it was our aim to determine whether they cause a drawback in the diagnosis and prognosis of PCNSL. METHODS: A retrospective cohort study of patients diagnosed with PCNSL between 2000 and 2020 in our tertiary neurosurgical centre. Data on steroid administration, surgery type and complications, haematopathological findings and prognostic factors were compiled. A second cohort was used as a control group to compare the ratio of non-diagnostic biopsies; this series comprised patients who underwent stereotactic brain biopsy for any reason between 2019 and 2020. RESULTS: Forty patients with PCNSL were included in the study, of which 28 (70%) had received steroids before surgery. The use of steroids was more prevalent in patients with poorer performance status at diagnosis. No relevant differences were found in the diagnostic accuracy regardless of steroid exposure (93% under steroids vs 100% without steroids) or type of surgery performed. Furthermore, steroid withdrawal did not seem to augment the diagnostic ratio. The notable diagnostic delay was not influenced by the use of steroids. CONCLUSIONS: Novel imaging and surgical techniques might obviate the need to withhold corticosteroids from patients suffering from PCNSL prior to biopsy. Moreover, when steroids have been given, tapering them and delaying the surgery might not be justified. This could hold relevant therapeutic implications in the early clinical stages.

Clinicopathological and Neuroimaging Features of Primary Gliosarcoma: A Case Series and Review of Literature.

BACKGROUND: Gliosarcoma (GS) is a rare primary high-grade brain neoplasm with a poor prognosis and challenging surgical resection. Although it is now considered a morphologic variant of IDH-wildtype glioblastoma (World Health Organization Classification of Tumours 2021), GS may display peculiarities that hamper both surgical and oncological management. METHODS: In this retrospective study, we searched our registry for histologically confirmed GS patients between 2006 and 2020. Cases were reviewed for clinical information, pathologic characteristics, imaging findings, management, and outcome. RESULTS: 21 patients with histologically confirmed GS were identified with a median age of 62 years. Twelve were men and 9 women. The temporal lobe was the most common location (9 patients, 42.9%). Nineteen patients underwent surgical resection, and only 4 (19%) demonstrated gross total resection on postsurgical MRI, with an overall median survival of 7 months (range, 0.5-37). Diagnostic MRI demonstrated heterogenous lesions with necrotic-cystic areas and a ring-enhancement pattern. Only 1 case of extracranial extension was seen in our sample, and no patient showed distant metastases. CONCLUSIONS: The rarity of primary GS and the absence of specific therapeutic guidelines represent a significant clinical challenge. Our study provides a comprehensive analysis of clinical and neuroimaging characteristics in a real-world patient cohort and compares our findings with the available literature.

Texture Analysis of the Apparent Diffusion Coefficient Focused on Contrast-Enhancing Lesions in Predicting Survival for Bevacizumab-Treated Patients with Recurrent Glioblastoma.

PURPOSE: Glioblastoma often recurs after treatment. Bevacizumab increases progression-free survival in some patients with recurrent glioblastoma. Identifying pretreatment predictors of survival can help clinical decision making. Magnetic resonance texture analysis (MRTA) quantifies macroscopic tissue heterogeneity indirectly linked to microscopic tissue properties. We investigated the usefulness of MRTA in predicting survival in patients with recurrent glioblastoma treated with bevacizumab. METHODS: We evaluated retrospective longitudinal data from 33 patients (20 men; mean age 56 ± 13 years) who received bevacizumab on the first recurrence of glioblastoma. Volumes of contrast-enhancing lesions segmented on postcontrast T1-weighted sequences were co-registered on apparent diffusion coefficient maps to extract 107 radiomic features. To assess the performance of textural parameters in predicting progression-free survival and overall survival, we used receiver operating characteristic curves, univariate and multivariate regression analysis, and Kaplan-Meier plots. RESULTS: Longer progression-free survival (>6 months) and overall survival (>1 year) were associated with lower values of major axis length (MAL), a lower maximum 2D diameter row (m2Ddr), and higher skewness values. Longer progression-free survival was also associated with higher kurtosis, and longer overall survival with higher elongation values. The model combining MAL, m2Ddr, and skewness best predicted progression-free survival at 6 months (AUC 0.886, 100% sensitivity, 77.8% specificity, 50% PPV, 100% NPV), and the model combining m2Ddr, elongation, and skewness best predicted overall survival (AUC 0.895, 83.3% sensitivity, 85.2% specificity, 55.6% PPV, 95.8% NPV). CONCLUSIONS: Our preliminary analyses suggest that in patients with recurrent glioblastoma pretreatment, MRTA helps to predict survival after bevacizumab treatment.

Secuelas post COVID-19 como causa de estado de invalidez / Post-covid-19 sequelae as a cause of disability

Introducción: Existe un alto impacto económico secundario a incapacidades prolongadas y secuelas invalidantes post-COVID-19 en trabajadores. Objetivo: Identificar las secuelas post-COVID como causa de estado de invalidez. Material y Métodos: Estudio transversal y retrolectivo. Mediante los registros de los dictámenes de invalidez emitidos en los sistemas de información de salud en el trabajo de octubre 2020 a enero 2022 en delegación Querétaro del instituto mexicano del seguro social (IMSS). Resultados: Se incluyeron 32 dictámenes, masculinos 88% femenino 12%. Edad media 44.5 años (DE±9). El 71% cursaron con enfermedad critica. El 77% tenía una o más comorbilidades. Las secuelas predominantes fueron estenosis traqueal y neuropatías. Días de estancia intrahospitalaria media 41.4 (DE±37.6). Días previos de incapacidad al dictamen media 236.6 (DE±96.5). El 46.8% fueron trabajadores del área industrial. Conclusión: Predominó trabajadores masculinos, con una o más comorbilidades, enfermedad crítica y secuelas por estancias intrahospitalarias prolongadas en trabajadores con invalidez secundario a COVID 19. (AU)

Introduction: There is a high economic impact secondary to prolonged disabilities and disabling sequelae post-COVID-19 in workers. Objective: Identify post-COVID sequelae as a cause of disability status Material and Methods: Cross-sectional and retrolective study. Through the records of the disability opinions issued in the occupational health information systems from October 2020 to January 2022 in the Querétaro delegation of the Mexican Social Security Institute (IMSS). Results: 32 opinions were included, male 88% female 12%. Mean age 44.5 years (SD±9). 71% attended with critical illness. 77% had one or more comorbidities. The predominant sequelae were tracheal stenosis and neuropathies. Mean days of hospital stay 41.4 (SD±37.6). Mean days of disability prior to the opinion 236.6 (SD±96.5). 46.8% were workers in the industrial area. Conclusion: Male workers predominate, with one or more comorbidities, critical illness and sequelae from prolonged hospital stays in workers with disability secondary to COVID 19. (AU)

Is intraoperative ultrasound more efficient than magnetic resonance in neurosurgical oncology? An exploratory cost-effectiveness analysis.

Objective: Intraoperative imaging is a chief asset in neurosurgical oncology, it improves the extent of resection and postoperative outcomes. Imaging devices have evolved considerably, in particular ultrasound (iUS) and magnetic resonance (iMR). Although iUS is regarded as a more economically convenient and yet effective asset, no formal comparison between the efficiency of iUS and iMR in neurosurgical oncology has been performed. Methods: A cost-effectiveness analysis comparing two single-center prospectively collected surgical cohorts, classified according to the intraoperative imaging used. iMR (2013-2016) and iUS (2021-2022) groups comprised low- and high-grade gliomas, with a maximal safe resection intention. Units of health gain were gross total resection and equal or increased Karnofsky performance status. Surgical and health costs were considered for analysis. The incremental cost-effectiveness ratio (ICER) was calculated for the two intervention alternatives. The cost-utility graphic and the evolution of surgical duration with the gained experience were also analyzed. Results: 50 patients followed an iMR-assisted operation, while 17 underwent an iUS-guided surgery. Gross total resection was achieved in 70% with iMR and in 60% with iUS. Median postoperative Karnofsky was similar in both group (KPS 90). Health costs were € 3,220 higher with iMR, and so were surgical-related costs (€ 1,976 higher). The ICER was € 322 per complete resection obtained with iMR, and € 644 per KPS gained or maintained with iMR. When only surgical-related costs were analyzed, ICER was € 198 per complete resection with iMR and € 395 per KPS gained or maintained. Conclusion: This is an unprecedented but preliminary cost-effectiveness analysis of the two most common intraoperative imaging devices in neurosurgical oncology. iMR, although being costlier and time-consuming, seems cost-effective in terms of complete resection rates and postoperative performance status. However, the differences between both techniques are small. Possibly, iMR and iUS are complementary aids during the resection: iUS real-time images assist while advancing towards the tumor limits, informing about the distance to relevant landmarks and correcting neuronavigation inaccuracy due to brain shift. Yet, at the end of resection, it is the iMR that reliably corroborates whether residual tumor remains.

The Vascular Microenvironment in Glioblastoma: A Comprehensive Review.

Glioblastoma multiforme, the deadliest primary brain tumor, is characterized by an excessive and aberrant neovascularization. The initial expectations raised by anti-angiogenic drugs were soon tempered due to their limited efficacy in improving the overall survival. Intrinsic resistance and escape mechanisms against anti-VEGF therapies evidenced that tumor angiogenesis is an intricate multifaceted phenomenon and that vessels not only support the tumor but exert indispensable interactions for resistance and spreading. This holistic review covers the essentials of the vascular microenvironment of glioblastoma, including the perivascular niche components, the vascular generation patterns and the implicated signaling pathways, the endothelial-tumor interrelation, and the interconnection between vessel aberrancies and immune disarrangement. The revised concepts provide novel insights into the preclinical models and the potential explanations for the failure of conventional anti-angiogenic therapies, leading to an era of new and combined anti-angiogenic-based approaches.

Synchrotron-Based Fourier-Transform Infrared Micro-Spectroscopy (SR-FTIRM) Fingerprint of the Small Anionic Molecule Cobaltabis(dicarbollide) Uptake in Glioma Stem Cells.

The anionic cobaltabis (dicarbollide) [3,3'-Co(1,2-C2B9H11)2]-, [o-COSAN]-, is the most studied icosahedral metallacarborane. The sodium salts of [o-COSAN]- could be an ideal candidate for the anti-cancer treatment Boron Neutron Capture Therapy (BNCT) as it possesses the ability to readily cross biological membranes thereby producing cell cycle arrest in cancer cells. BNCT is a cancer therapy based on the potential of 10B atoms to produce α particles that cross tissues in which the 10B is accumulated without damaging the surrounding healthy tissues, after being irradiated with low energy thermal neutrons. Since Na[o-COSAN] displays a strong and characteristic ν(B-H) frequency in the infrared range 2.600-2.500 cm-1, we studied the uptake of Na[o-COSAN] followed by its interaction with biomolecules and its cellular biodistribution in two different glioma initiating cells (GICs), mesenchymal and proneural respectively, by using Synchrotron Radiation-Fourier Transform Infrared (FTIR) micro-spectroscopy (SR-FTIRM) facilities at the MIRAS Beamline of ALBA synchrotron light source. The spectroscopic data analysis from the bands in the regions of DNA, proteins, and lipids permitted to suggest that after its cellular uptake, Na[o-COSAN] strongly interacts with DNA strings, modifies proteins secondary structure and also leads to lipid saturation. The mapping suggests the nuclear localization of [o-COSAN]-, which according to reported Monte Carlo simulations may result in a more efficient cell-killing effect compared to that in a uniform distribution within the entire cell. In conclusion, we show pieces of evidence that at low doses, [o-COSAN]- translocates GIC cells' membranes and it alters the physiology of the cells, suggesting that Na[o-COSAN] is a promising agent to BNCT for glioblastoma cells.

COVID-19, ACE -inhibitors and angiotensin receptor blockers: The need to differentiate between early infection and acute lung injury / COVID-19, y IECA -inhibidores y bloqueadores de los receptores de angiotensina: la necesidad de diferenciar entre una infección temprana y una lesión pulmonar aguda

SARS-CoV-2, along with SARS-CoV and MERS-CoV, forms part of the three highly pathogenic coronaviruses identified since the start of the millennium.1,2 While SARS-CoV was identified on 2003 and MERS-CoV on 2012, the initial reports of SARS-CoV-2 (the etiological agent of COVID-19) were first released at the end of December 2019.3,4 Now, after less than four months, the virus has distributed globally and has become the focus of extensive medical research, as the number of cases keeps rising.A significant part of the investigative effort has been directed to the search for an effective therapy or intervention that could stop the spread of the disease or be used to effectively treat infected patients. Likewise, potential predisposing factors to develop a more severe clinical presentation are progressively being identified. Some of the more relevant are older age and the presence of certain comorbidities, such as cerebrovascular and coronary heart disease, hypertension and diabetes.5­8 It is important to highlight that the last two are chronic conditions commonly treated with ACE-inhibitors and angiotensin II type-I receptor blockers.9­11 However, the evidence suggests that these medications can upregulate the expression of angiotensin converting enzyme 2 (ACE2), the cellular receptor for both SARS-CoV and SARS-CoV-2.11­16 Thus, a group of researchers hypothesized that ACE2-increasing drugs could raise the risk of infection and prompt a more severe clinical course or a fatal outcome in diabetic and hypertensive patients.

Detección de embolismo aéreo venoso y de foramen oval permeable en pacientes neuroquirúrgicos intervenidos en posición de sedestación / Detection of venous air embolism and patent foramen ovale in neurosurgery patients in sitting position

INTRODUCCIÓN: La detección precoz del embolismo aéreo venoso (EAV) durante las intervenciones neuroquirúrgicas en sedestación disminuye la gravedad de sus complicaciones. OBJETIVOS: Analizar la detección de EAV y sus repercusiones en pacientes intervenidos en sedestación. Comprobar la frecuencia de aspiración de aire a través de una vía venosa central. Valorar la viabilidad del uso del Doppler transcraneal (DTC) en quirófano para el diagnóstico del foramen oval permeable (FOP). MATERIAL Y MÉTODOS: Estudio prospectivo de intervenciones neuroquirúrgicas consecutivas realizadas durante 5 años en sedestación. Como método diagnóstico del EAV se empleó el Doppler precordial y el CO2 espirado. El FOP se exploró tras la inducción anestésica mediante DTC. RESULTADOS: Ciento treinta y seis pacientes fueron intervenidos en sedestación, 93 craneotomías y 43 cirugías de columna cervical. Veintidós pacientes (16,2%) fueron diagnosticados de EAV (21,5% de las craneotomías y 4,7% de las cirugías de columna; p = 0,013). En el 59% de los casos se aspiró aire a través del catéter venoso central. Hubo afectación hemodinámica en 3 pacientes, alteración de la oxigenación en 4 y neumoencéfalo clínicamente relevante en 5. Dos pacientes (1,4%) fueron diagnosticados de FOP, pero no presentaron episodios de EAV ni embolia aérea paradójica. CONCLUSIONES: Confirmamos una mayor incidencia de EAV en craneotomías que en cirugía de columna cervical en sedestación. Obtuvimos aire a través del catéter venoso central en más de la mitad de los casos. Con nuestra sistemática, ningún paciente presentó complicaciones críticas intraoperatorias. La baja incidencia de FOP detectada con DTC requerirá modificar nuestro protocolo realizado con el paciente anestesiado

INTRODUCTION: Early detection of venous air embolism (VAE) during neurosurgical procedures in sitting position decreases the severity of its complications. OBJECTIVES: our aim was to analyse the detection of VAE and its impact on patients operated in a sitting position, verify air aspiration through a central venous catheter and assess the feasibility of the routine use of transcranial Doppler (TCD) for intraoperative diagnosis of patent foramen ovale (PFO). MATERIAL AND METHODS: We performed a prospective study of consecutive neurosurgical procedures performed in the sitting position for 5 years. Precordial Doppler and end-tidal carbon dioxide were the diagnostic methods for VAE. PFO was explored by TCD after anaesthetic induction. RESULTS: 136 patients were operated in the sitting position, 93 craniotomies and 43 cervical spine procedures. Twenty-two patients (16.2%) were diagnosed with VAE (21.5% of craniotomies and 4.7% of spinal surgeries; p = .013). In 59% of cases, air was aspirated through the central venous catheter. There was haemodynamic involvement in 3 patients, impaired oxygenation in 4 and clinically relevant pneumocephalus in 5 of them. Two patients (1.4%) were diagnosed with PFO, but did not present episodes of VAE or paradoxical air embolism. CONCLUSIONS: The series analysed confirmed a higher incidence of VAE in craniotomies than in cervical spine surgery in a sitting position. We were able to aspirate air through the central venous catheter in more than half the cases. No patients suffered critical intraoperative complications following our approach. The low incidence of PFO detected with TCD will imply a modification of our protocol performed on anaesthetised patients

[Detection of venous air embolism and patent foramen ovale in neurosurgery patients in sitting position]. / Detección de embolismo aéreo venoso y de foramen oval permeable en pacientes neuroquirúrgicos intervenidos en posición de sedestación.

INTRODUCTION: Early detection of venous air embolism (VAE) during neurosurgical procedures in sitting position decreases the severity of its complications. OBJECTIVES: our aim was to analyse the detection of VAE and its impact on patients operated in a sitting position, verify air aspiration through a central venous catheter and assess the feasibility of the routine use of transcranial Doppler (TCD) for intraoperative diagnosis of patent foramen ovale (PFO). MATERIAL AND METHODS: We performed a prospective study of consecutive neurosurgical procedures performed in the sitting position for 5 years. Precordial Doppler and end-tidal carbon dioxide were the diagnostic methods for VAE. PFO was explored by TCD after anaesthetic induction. RESULTS: 136 patients were operated in the sitting position, 93 craniotomies and 43 cervical spine procedures. Twenty-two patients (16.2%) were diagnosed with VAE (21.5% of craniotomies and 4.7% of spinal surgeries; p=.013). In 59% of cases, air was aspirated through the central venous catheter. There was haemodynamic involvement in 3 patients, impaired oxygenation in 4 and clinically relevant pneumocephalus in 5 of them. Two patients (1.4%) were diagnosed with PFO, but did not present episodes of VAE or paradoxical air embolism. CONCLUSIONS: The series analysed confirmed a higher incidence of VAE in craniotomies than in cervical spine surgery in a sitting position. We were able to aspirate air through the central venous catheter in more than half the cases. No patients suffered critical intraoperative complications following our approach. The low incidence of PFO detected with TCD will imply a modification of our protocol performed on anaesthetised patients.

Economic burden to primary informal caregivers of hospitalized older adults in Mexico: a cohort study.

BACKGROUND: The burden of out of pocket spending for the Mexican population is high compared to other countries. Even patients insured by social security institutions have to face the cost of health goods, services or nonmedical expenses related to their illness. Primary caregivers, in addition, experience losses in productivity by taking up responsibilities in care giving activities. This situation represents a mayor economic burden in an acute care setting for elderly population. There is evidence that specialized geriatric services could represent lower overall costs in these circumstances and could help reduce these burdens.The aim of this study was to investigate economic burden differences in caregivers of elderly patients comparing two acute care services (Geriatric and Internal Medicine). Specifically, economic costs associated with hospitalization of older adults in these two settings by evaluating health care related out of pocket expenditures (OOPE), non-medical OOPE and indirect costs. METHODS: A comparative analysis of direct and indirect costs in hospitalised elderly patients (60-year or older) and their primary informal caregivers in two health care settings, using a prospective cohort was performed. Economic burden was measured by out of pocket expenses and indirect costs (productivity lost) due to care giving activities. The analysis included a two-part model, the first one allowing the estimation of the probability of observing any health care related and non-medical OOPE; and the second one, the positive observations or expenditures. RESULTS: A total of 210 subjects were followed during their hospital stay. Of the total number of subjects 95% reported at least one non-medical OOPE, being daily transportation the most common expense. Regarding medical OOPE, medicines were the most common expense, and the mean numbers of days without income were 4.12 days. Both OOPE and indirect costs were significantly different between type of services, with less overall economic burden to the caregivers of elderly hospitalized in the geriatric unit. The final model showed that type of service and satisfaction had the largest coefficients (-0.68 and 0.662 respectively, p<0.001). CONCLUSIONS: This study allowed us to identify associated factors of economic burden in elderly hospitalized in acute care units. It opens as well, an issue that should not be overlooked in framing public policies regarding elderly health care.

Drug-drug interactions at hospital admission in geriatric patients in a single facility: a retrospective study.

BACKGROUND: Individuals older than 60 years of age have multiple simultaneous diseases, for which the average number of medications is greater than five, leading up to 3% possibility of having an adverse reaction event. OBJECTIVE: To detect potential drug-drug interactions (PDDIs) and report the average hospital stay for severity potential PPIs, in adults 60 years of age and older in an Internal Medicine Service. METHODS: This was a retrospective analysis with a review of the clinical records of patients 60 years of age and older. The length of stay, number and type of prescribed daily medications, PDDIs, and number of admission diagnoses for each patient, were reviewed. RESULTS: This study included 342 patients with an average and standard deviation of 6 ± 3.0 medications per day. The PDDI levels were 27 (7.9%) severe, 94 (27.5%) moderate, and 61 (17.8%) had both types of interactions. Severe interactions, presented a hospital stay of 10 days, and moderate interaction a 13-day stay. CONCLUSION: The most common interactions and their average length of stay may be utilized for quality evaluation of the medication process of such a major patient population as that of the older adult in the hospital setting.

Comparison of a geriatric unit with a general ward in Mexican elders.

There is evidence that geriatric services may be more effective in handling problems of the elderly in acute care. We therefore studied a cohort of matched triplets (age, gender and admission diagnosis), to assess the effect of a geriatric service on elderly problems (falls, pressure ulcers, delirium and functional decline). This is a follow up study; comparing a geriatric unit with an internal medicine unit at two hospitals of the Mexican Institute of Social Security (IMSS) in Mexico City. Socio-demographic characteristics, functionality, emotional state, cognitive status, delirium, co-morbidities, diagnosis, number of medications, presence of pressure ulcers and falls, were assessed. We developed a composite variable as a global end-point, including: delirium, falls, mortality, pressure sores and functional decline. 70 patients were included in the geriatric services and 140 in the internal medicine unit. Mean age =72.5±7 years (±S.D.), and 52.9% were women. At baseline, only illiteracy, quality of life and the number of medications were statistically different between each group. Fully adjusted multiple logistic conditional regression model found an odds ratio of 0.27 (95% CI 0.1-0.7) for the presence of the composite variable, favoring the geriatric unit. Geriatric units in acute care may be beneficial in different frequent end points in elderly.

[Impact of the program Home Care for the Chronically Ill for elderly: quality of life and hospital readmissions]. / Impacto de un programa de Atención Domiciliaria al Enfermo Crónico en ancianos: calidad de vida y reingresos hospitalarios.

OBJECTIVE: To evaluate the impact of the ADEC program (acronym in Spanish) as compared with the typical care provided to disabled elderly affiliated with the Mexican Institute of Social Security (IMSS). MATERIAL AND METHODS: Prospective cohort at three months after discharge from two general hospitals in Mexico City. A total of 130 patients with functional dependency were studied, 70 in the ADEC program and 60 with typical care. Impact was measured using hospital readmissions and quality of life based on the Sickness Impact Profile (SIP). RESULTS: Average age was 74 (61/103) years and 60% were women. The main diagnosis was cerebrovascular disease (30.77%). The quality of life in the psychosocial dimension improved for the ADEC group (from 46.26 (±13.85) to 29.45(±16.48) as compared with 47.03 (±16.47) to 42.36 (±16.35) for those receiving typical care (p<0.05). No differences were found regarding hospital readmissions. (p>0.05). CONCLUSIONS: HC program improved the psychosocial dimension of quality of life.

Impacto de un programa de atención domiciliaria al enfermo crónico en ancianos: calidad de vida y reingresos hospitalarios / Impact of the program home care for the chronically ill for elderly: quality of life and hospital readmissions

OBJETIVO: Evaluar el impacto del programa Atención Domiciliaria al Enfermo Crónico (ADEC) comparado con la atención habitual (AH) a ancianos con dependencia funcional, derechohabientes del Instituto Mexicano del Seguro Social (IMSS). MATERIAL Y MÉTODOS: Cohorte prospectiva a tres meses a partir del egreso hospitalario en dos hospitales de la Ciudad de México. Se ingresaron 130 ancianos con dependencia funcional, 70 insertados al programa ADEC y 60 con atención habitual. Se midió impacto en reingresos hospitalarios y calidad de vida a partir de la escala Perfil de Impacto de la Enfermedad (SIP, por sus siglas en inglés). RESULTADOS: La edad promedio de los ancianos fue de 74 años (61/103) y 60 por ciento fueron mujeres. El principal diagnóstico fue enfermedad vascular cerebral (EVC) (30.77 por ciento). El grupo de ADEC mejoró la calidad de vida en la dimensión psicosocial [46.26 (±13.85) comparado con 29.45 (±16.48) vs. 47.03 (±16.47) a 42.36 (±16.35) p<0.05 en grupo habitual]. No se presentaron diferencias en los reingresos (p>0.05). CONCLUSIONES: El programa mejoró la dimensión psicosocial de calidad de vida.

OBJECTIVE: To evaluate the impact of the ADEC program (acronym in Spanish) as compared with the typical care provided to disabled elderly affiliated with the Mexican Institute of Social Security (IMSS). MATERIAL AND METHODS: Prospective cohort at three months after discharge from two general hospitals in Mexico City. A total of 130 patients with functional dependency were studied, 70 in the ADEC program and 60 with typical care. Impact was measured using hospital readmissions and quality of life based on the Sickness Impact Profile (SIP). RESULTS: Average age was 74 (61/103) years and 60 percent were women. The main diagnosis was cerebrovascular disease (30.77 percent). The quality of life in the psychosocial dimension improved for the ADEC group (from 46.26 (±13.85) to 29.45(±16.48) as compared with 47.03 (±16.47) to 42.36 (±16.35) for those receiving typical care (p<0.05). No differences were found regarding hospital readmissions. (p>0.05). CONCLUSIONS: HC program improved the psychosocial dimension of quality of life.

[Treatment with imiquimod and surgical excision of a patient with extramammary Paget's disease. Case report]. / Tratamiento con imiquimod y escisión quirúrgica en un paciente con enfermedad extramamaria de Paget. Caso clínico.

Extramammary Paget's disease (EMPD) is a less common cutaneous type of cancer. It presents as erythematous plaques most frequently located in the genital region, perianal skin, and other cutaneous sites rich in apocrine glands, but it also may originate from keratinocytic stem cells. Recently, imiquimod has been used for the management of primary or relapsing extramammary Paget's disease. Complete healing, without recurrence, of extramammary Paget's disease in patients whom were treated topically with 5 % imiquimod cream was observed. We report a 78 year-old patient with scrotal and perianal extramammary Paget's disease treated with imiquimod cream in both lesions and subsequently with surgical excision in scrotum for the management of relapsing disease.

The Mini-mental State Examination revisited: ceiling and floor effects after score adjustment for educational level in an aging Mexican population.

BACKGROUND: The Mini-mental State Examination (MMSE) is the most widely used cognitive test, both in clinical settings and in epidemiological studies. However, correcting its score for education may create ceiling effects when used for poorly educated people and floor effects for those with higher education. METHODS: MMSE and a recent cognitive test, the seven minute screen (7MS), were serially administered to a community sample of Mexican elderly. 7MS test scores were equated to MMSE scores. MMSE-equated 7MS differences indicated ceiling or floor effects. An ordinal logistic regression model was fitted to identify predictors of such effects. RESULTS: Poorly educated persons were more prevalent on the side of MMSE ceiling effects. Concentration (serial-sevens), orientation and memory were the three MMSE subscales showing the strongest relationship to MMSE ceiling effects in the multivariate model. CONCLUSION: Even when MMSE scores are corrected for educational level they still have ceiling and floor effects. These effects should be considered when interpreting data from longitudinal studies of cognitive decline. When an education-adjusted MMSE test is used to screen for cognitive impairment, additional testing may be required to rule out the possibility of mild cognitive impairment.

A frailty index to predict the mortality risk in a population of senior Mexican adults.

BACKGROUND: Frailty in the elderly can be regarded as nonspecific vulnerability to adverse health outcomes, caused by multiple factors. The aim was to analyze the relationships between the frailty index, age and mortality in a two year follow up study of Mexican elderly. METHODS: A frailty index was developed using 34 variables. To obtain the index, the mean of the total score for each individual was obtained. Survival analyses techniques were used to examine the risk ratios for the different levels of the frailty index. Kaplan-Meier estimates were obtained, adjusted for age and gender. Cox proportional hazards models were also built to obtain hazard ratio estimates. RESULTS: A total of 4082 participants was analyzed. Participants had an average age of 73 years and 52.5% were women. On average, participants were followed-up for 710 days (standard deviation = 111 days) and 279 of them died. Mortality increased with the frailty index level, especially in those with levels between .21 to .65, reaching approximately 17% and 21%, respectively. Cox proportional hazards models showed that participants with frailty index levels associated to increased mortality (.21 and higher) represent 24.0% of those aged 65-69 years and 47.6% of those 85 and older. CONCLUSION: The frailty index shows the properties found in the other studies, it allows stratifying older Mexican into several groups different by the degree of the risk of mortality, and therefore the frailty index can be used in assessing health of elderly.

[Guideline for integrated geriatric assessment]. / Guía para la evaluación gerontológica integral.

A clinical practice guideline was developed as a response to the increasing of elderly in Mexican population due to the epidemiological transition; this instrument allows the assessment of health conditions for people from 60 years of age and older, and it can be a tool for helping family physicians and nurses in providing care for the main health problems of this group of age. The guideline for gerontologic assessment includes six principal health priorities in older people (loss of vision, difficulty to hear, falls or problems walking, nutritional disorders, memory difficulties, and sleep disorders); additionally, another four components for assessment are revised (medication use, physical functionality, quality of life, and social support). Simple recommendations for detection, diagnosis and management of these problems in primary care settings are presented.

Usefulness of two instruments in assessing depression among elderly Mexicans in population studies and for primary care / Utilidad de dos instrumentos para valorar depresión entre adultos mayores de México en estudios poblacionales y para la atención en el primer nivel de salud

OBJECTIVE: To determine the psychometric qualities of the CES-DR and GDS scales in the elderly and compare them to clinical psychiatric diagnoses. MATERIAL AND METHODS: The first phase consisted of home interviews for determining the psychometric qualities of the GDS and CES-DR scales. In the second phase, psychiatrists conducted diagnostic interviews. The sample consisted of 534 participants older than 60 years of age insured by the Mexican Institute of Social Security. RESULTS: First phase: Cronbach's alpha for the GDS was 0.87 and 0.86 for CES-DR. The GDS factorial analysis found eight factors that could explain 53.5 percent of the total variance and nine factors that explained 57.9 percent in the CES-DR. Second phase: Compared to the psychiatric diagnoses, CES-DR reported a sensitivity of 82 percent and a specificity of 49.2 percent; GDS reported 53.8 percent sensitivity and 78.9 percent specificity. CONCLUSIONS: CES-DR and GDS scales have high reliability and adequate validity but the CES-DR reports higher sensitivity.

RESUMEN OBJETIVO: Determinar las propiedades psicométricas de las escalas CES-DR y GDS para depresión en población anciana y compararlas con el diagnóstico clínico psiquiátrico. MATERIAL Y MÉTODOS: La primera fase consistió en entrevistas en casa para determinar las propiedades psicométricas. En la segunda fase, los psiquiatras condujeron entrevistas diagnósticas. La muestra consistió en 534 participantes de 60 años y más asegurados por el Instituto Mexicano del Seguro Social. RESULTADOS: Primera fase: Alfa de Cronbach para el GDS y CES-DR fue de 0.87 y 0.86, respectivamente. El análisis factorial del GDS reportó ocho factores que explicaron 53.5 por ciento de la varianza, comparado con nueve del CESDR que explicaron 57.9 por ciento. Segunda fase: Comparado con el diagnóstico psiquiátrico, el CES-DR reportó una sensibilidad de 82 por ciento y una especificidad de 49.2 por ciento comparado con 53.8 por ciento y 78.9 por ciento, respectivamente del GDS. CONCLUSIONES: Las escalas CES-DR y GDS tienen consistencia y adecuada validez pero el CES-DR reporta más alta sensibilidad.