Jorge clinical study: 10-year outcomes of risk-adapted radiotherapy defined by multiparametric MRI for prostate cancer.

PURPOSE: To analyze the 10-year biochemical relapse-free survival (BRFS), locoregional relapse-free survival (LRFS), metastasis-free survival (MFS), and overall survival (OS) in patients diagnosed with localized prostate adenocarcinoma treated with radiotherapy (RT) ± androgen deprivation therapy (ADT), according to the risk groups based on multiparametric magnetic resonance imaging (mpMRI) instead of digital rectal exam (DRE). METHODS: We retrospectively evaluated 140 consecutive patients diagnosed with localized prostate adenocarcinoma, stratified into different risk groups-low (LR), intermediate (IR), and high (HR) by mpMRI results. RESULTS: After a median follow-up of 104 months, in LR group (n = 15), 10-year BRFS was 86.7%, 10-year LRFS was 86.7%, 10-year MFS was 93.3%, and 10-year OS was 100%. In IR group (n = 80), 10-year BRFS was 80.5%, 10-year LRFS was 86.1%, 10-year MFS was 92.6%, and 10-year OS was 76%. In HR group (n = 45), 10-year BRFS was 72.8%, 10-year LRFS was 78.7%, 10-year MFS was 82.1%, and 10-year OS was 77% (2 deaths from prostate cancer). According to mpMRI results, 36 (25.7%) patients change the risk group and 125 (89.28%) patients change the TNM stage. There was a trend for higher metastatic relapse in patients who switched from IR to HR (due to mpMRI) versus the patients who remained in the IR (20%, vs. 1.81% p = 0.059). Multivariate analysis showed that locoregional relapse was strongly associated with distant relapse (OR = 9.28; 95%CI: 2.60-33.31). There were no cases of acute grade 3 toxicity. Late grade 3 genitourinary, gastrointestinal, and sexual toxicity were 2.8%, 0.7%, and 1.2%, respectively. CONCLUSION: This is the first study with a 10-year median follow-up of patients diagnosed with localized prostate cancer treated with radiotherapy according to the risk groups established by mpMRI. Our findings show that mpMRI is a key tool to diagnose and establish risk groups in these patients, to optimize their treatment.

Prediction of serious complications in patients with pulmonary thromboembolism and solid cancer: Validation of the EPIPHANY Index in a prospective cohort of patients from the PERSEO study.

INTRODUCTION: There is currently no validated score capable of classifying cancer-associated pulmonary embolism (PE) in its full spectrum of severity. This study has validated the EPIPHANY Index, a new tool to predict serious complications in cancer patients with suspected or unsuspected PE. METHOD: The PERSEO Study prospectively recruited individuals with PE and active cancer or receiving antineoplastic therapy from 22 Spanish hospitals. The estimation of the relative frequency θ of complications based on the EPIPHANY Index categories was made using the Bayesian alternative for the binomial test. RESULTS: A total of 900 patients, who were diagnosed with PE between October 2017 and January 2020, were enrolled. The rate of serious complications at 15 days was 11.8%, 95% highest density interval [HDI], 9.8-14.1%. Of the EPIPHANY low-risk patients, 2.4% (95% HDI, 0.8-4.6%) had serious complications, as did 5.5% (95% HDI, 2.9-8.7%) of the moderate-risk participants and 21.0% (95% HDI, 17.0-24.0%) of those with high-risk episodes. The EPIPHANY Index was associated with overall survival (OS) in patients with different risk levels: median OS was 16.5, 14.4, and 4.4 months for those at low, intermediate, and high risk, respectively. Both the EPIPHANY Index and the Hestia criteria exhibited greater negative predictive value and a lower negative likelihood ratio than the remaining models. The incidence of bleeding at 6 months was 6.2% (95% HDI, 2.9-9.5%) in low/moderate-risk vs 12.7% (95% HDI, 10.1-15.4%) in high-risk (p-value = 0.037) episodes. Of the outpatients, serious complications at 15 days were recorded in 2.1% (95% HDI, 0.7-4.0%) of the cases with EPIPHANY low/intermediate-risk vs 5.3% (95% HDI, 1.7-11.8%) in high-risk cases. CONCLUSION: We have validated the EPIPHANY Index in patients with incidental or symptomatic cancer-related PE. This model can contribute to standardize decision-making in a scenario lacking quality evidence.

Pilot Study for the Assessment of the Best Radiomic Features for Bosniak Cyst Classification Using Phantom and Radiologist Inter-Observer Selection.

Since the Bosniak cysts classification is highly reader-dependent, automated tools based on radiomics could help in the diagnosis of the lesion. This study is an initial step in the search for radiomic features that may be good classifiers of benign-malignant Bosniak cysts in machine learning models. A CCR phantom was used through five CT scanners. Registration was performed with ARIA software, while Quibim Precision was used for feature extraction. R software was used for the statistical analysis. Robust radiomic features based on repeatability and reproducibility criteria were chosen. Excellent correlation criteria between different radiologists during lesion segmentation were imposed. With the selected features, their classification ability in benignity-malignity terms was assessed. From the phantom study, 25.3% of the features were robust. For the study of inter-observer correlation (ICC) in the segmentation of cystic masses, 82 subjects were prospectively selected, finding 48.4% of the features as excellent regarding concordance. Comparing both datasets, 12 features were established as repeatable, reproducible, and useful for the classification of Bosniak cysts and could serve as initial candidates for the elaboration of a classification model. With those features, the Linear Discriminant Analysis model classified the Bosniak cysts in terms of benignity or malignancy with 88.2% accuracy.

Avaliação das informações sobre covid-19 disponíveis em sites populares e direcionadas às gestantes / Evaluación de la información sobre covid-19 disponible en sitios web populares dirigidos a mujeres embarazadas / Assessment of information on covid-19 available on popular websites aimed at pregnant women

RESUMO Objetivo: avaliar se as informações sobre a COVID-19 direcionadas às mulheres gestantes, disponíveis em sites populares, estão de acordo com as recomendações do Ministério da Saúde. Métodos: estudo descritivo/comparativo, realizado em sites populares mais acessados por mulheres leigas. Foi elaborado um checklist com informações relevantes sobre COVID-19 e gestação, com base nas recomendações do Ministério da Saúde e da literatura. O checklist apresentava os tópicos: pré-natal; gestante com suspeita ou diagnóstico de COVID-19; aleitamento materno; recomendações quanto à via de parto e interrupção da gestação; orientações para trabalho de parto e parto; orientações para cuidado no pós-parto; agentes farmacológicos, outros tratamentos e monitoramento da infecção por COVID-19; gestantes profissionais ou não da área da saúde; e risco de infecção por transmissão vertical e no pós-parto. Resultados: após aplicação do checklist, 210 sites foram selecionados para análise do seu conteúdo na íntegra. Observou-se que nenhum deles apresentou o conteúdo elencado de acordo com as evidências sobre gestação, parto/nascimento, pós-parto e COVID- 19 disponíveis até o presente momento. As informações mais negligenciadas sobre COVID-19 e gestação estavam no conjunto de informações sobre "Agentes farmacológicos, outros tratamentos e monitoramento da infecção COVID-19". As informações sobre o "pré-natal" foram as que mais apresentaram informações corretas nos sites analisados. Conclusão: os sites trouxeram informações importantes para as mulheres gestantes e puérperas; contudo, muitas vezes, essas informações estavam incompletas. Espera-se que as evidências deste estudo possam contribuir para o aprimoramento da educação em saúde, de modo a indicar novas possibilidades de comunicação com base em fontes confiáveis.

RESUMEN Objetivo: evaluar si la información sobre la COVID-19 dirigida a las mujeres embarazadas disponible en los sitios web populares se ajusta a las recomendaciones del Ministerio de Salud. Métodos: estudio descriptivo/comparativo, realizado con los sitios populares a los que más acceden las mujeres laicas. Se elaboró una checklist con información relevante sobre la COVID-19 y el embarazo, basándose en las recomendaciones del Ministerio de Salud y en la bibliografía. La checklist presentó los temas: cuidados prenatales, mujeres embarazadas con sospecha o diagnóstico de COVID-19, lactancia materna, recomendaciones para la vía del parto y la interrupción del embarazo, directrices para el trabajo de parto y el parto, directrices para la atención posparto, agentes farmacológicos, otros tratamientos y seguimiento de la infección por COVID-19, mujeres embarazadas o no en el área de la salud y riesgo de infección por transmisión vertical y posparto. Resultados: después de aplicar la checklist, se seleccionaron 210 sitios para el análisis completo de su contenido. Se observó que ninguno de ellos presentó el contenido listado de acuerdo con la evidencia sobre embarazo, parto/nacimiento, posparto y COVID-19 disponible hasta la fecha. La información más descuidada sobre COVID-19 y embarazo fue en el conjunto de información sobre "Agentes farmacológicos, otros tratamientos y seguimiento de la infección por COVID-19". La información sobre "Prenatal" fue la que presentó la información más correcta sobre los sitios analizados. Conclusión: los sitios aportaron información importante para las mujeres embarazadas y posparto, sin embargo, a menudo estaban incompletos. Se espera que la evidencia de este estudio pueda contribuir a la mejora de la educación para la salud, con el fin de indicar nuevas posibilidades de comunicación basadas en fuentes confiables.

ABSTRACT Objective: to assess whether information about COVID-19 aimed at pregnant women, available on popular websites, is in accordance with the recommendations of the Ministry of Health. Methods: descriptive/comparative study, carried out on popular websites most accessed by lay women. A checklist was prepared with relevant information about COVID-19 and pregnancy, based on the recommendations of the Ministry of Health and the literature. The checklist presented the topics: prenatal care; pregnant woman with suspected or diagnosed COVID-19; breastfeeding; recommendations regarding the mode of delivery and termination of pregnancy; guidelines for labor and delivery; guidelines for postpartum care; pharmacological agents, other treatments, and monitoring of COVID-19 infection; professional or non-professional pregnant women in the health area; and risk of infection by vertical and postpartum transmission. Results: after applying the checklist, 210 websites were selected for full content analysis. It was observed that none of them presented the content listed according to the evidence on pregnancy, delivery/birth, postpartum and COVID-19 available to date. The most neglected information about COVID-19 and pregnancy was in the information set on "Pharmacological agents, other treatments and monitoring of COVID-19 infection". Information about "prenatal care" was the one that most presented correct information on the analyzed websites. Conclusion: the websites provided important information for pregnant and postpartum women; however, this information was often incomplete. It is hoped that the evidence from this study can contribute to the improvement of health education, in order to indicate new possibilities of communication based on reliable sources.

Choroidal Melanoma with Ultrasound-Guided Episcleral Brachytherapy: Long-Term Results and Risk of Metastasis.

INTRODUCTION: The aim of this study was to elucidate the long-term outcomes in patients with choroidal melanoma who received episcleral brachytherapy with 125-I seeds; analyse cause-specific survival (CSS), metastasis-free survival (MFS), and local control; and establish the relationship between tumour size and metastases. METHODS: From May 2007 to February 2013, 88 patients classified according to the American Joint Committee on Cancer guidelines underwent ultrasound-guided episcleral brachytherapy with a total prescribed dose of 72.40 Gy to the apex. RESULTS: Among the included cases, 47.7 and 44.3% had a clinical tumour stage of T2 and T3, respectively. With a median follow-up of 84 (range 7-153) months, local control at 5 and 10 years was 100 and 95%, respectively. Among the 88 patients, 9 (10.2%) were enucleated after brachytherapy. Those with T1-T2 and T3-T4 disease had a 10-year CSS of 100 and 87.3%, respectively (p = 0.017). MFS at 5 and 10 years was 100% in those with T1-T2 disease and 92.1 and 83.1% in those with T3-T4, respectively (p = 0.016). Five patients had liver metastases, all of whom had T3-T4 disease. CONCLUSION: Ultrasound-guided episcleral brachytherapy with 125-I seeds yielded excellent local control for choroidal melanoma, with low complication rates and 90% eye preservation. Given the association between tumour stage and liver metastases, which remain the main cause of death, stricter control should be employed for T3-T4 tumours for the early detection and treatment of relapses.

Placing Dental Implants through Impacted Teeth to Support a Fixed Partial Denture in a Geriatric Patient as an Alternative to Invasive Extraction Surgeries.

Multiple dental impactions not associated with craniofacial syndromes are a rare condition and present the dentist with a therapeutic challenge when it comes to performing surgical/restorative treatments in adult patients. This case report describes a geriatric patient with multiple impacted teeth restored by means of two different protocols. In the second quadrant, an impacted tooth was extracted followed by regeneration and placement of an implant. In the third quadrant, implants were placed though impacted teeth for restoration with a fixed partial prosthesis. Placing dental implants through impacted teeth may offer a possible therapeutic option for implant-supported restorations in middle-aged or elderly patients, for whom surgery and orthodontic traction are not possible, and/or patients who refuse to undergo more invasive extraction surgery.

Should high-dose-rate brachytherapy boost be used in early nasopharyngeal carcinomas?

BACKGROUND: Radiation with or without chemotherapy is the main treatment of nasopharyngeal carcinomas (NPC). Local recurrence is difficult to manage. Local control is dose-dependent. AIM: To analyze the effect of an endocavitary brachytherapy boost after external beam radiation (EBRT) to decrease local recurrence. MATERIAL AND METHODS: Thirty patients with T0-T2 NPC were treated: 70% T1, 20% T2 and 10% T0; 33.3% N0, 20% N1, 43.3% N2 and 3.3% N3; 90% were undifferentiated carcinoma. All they received a 192-Ir high dose rate brachytherapy (HDR-BT) boost after 60 Gy of EBRT. The Rotterdam applicator was used in most cases, 3-4 fractions of 3.75-3 Gy in two days. RESULTS: With median follow-up (FU) of 63 months, a single parapharyngeal failure resulted in local control of 100% at 3 years and 95% at 5 years. Local control for T0-1 was 100% and for T2 67% at five years (p = 0.02). Regional-free recurrence survival was 92% at 5 years. Metastasis-free survival was 84% at 5 years. All cases of metastasis had histopathology of undifferentiated. The overall and cause-specific survival was 96% and 86% at 3 and 5 years. No late complications related to brachytherapy were described. CONCLUSION: A HDR-BT boost is useful to decrease the incidence of local recurrence of NPC to 5%. With a fractionated schedule of 3-4 fractions in two days, Rotterdam applicator and 3-D planning, no late complications are described. Therefore we recommend to use brachytherapy boost in all early NPC.

Orthopedic Surgery in Rheumatoid Arthritis: Results from the Spanish National Registry of Hospitalized Patients over 17 Years.

OBJECTIVE: To analyze the trend of orthopedic surgery (OS) rates on patients with rheumatoid arthritis (RA). METHODS: Retrospective observational study based on information provided by the Spanish National System of Hospital Data Surveillance. All hospitalizations of patients with RA for orthopedic surgery [total hip arthroplasty (THA), total knee arthroplasty (TKA), arthrodesis, and upper limb arthroplasty (ULA)] during 1999-2015 were analyzed. The age-adjusted rate was calculated. Generalized linear models were used for trend analysis. RESULTS: There were 21,088 OS in patients over 20 years of age (77.9% women). OS rate adjusted by age was 754.63/100,000 RA patients/year (women 707.4, men 861.1). Neither an increasing nor a decreasing trend was noted for the total OS. However, trend and age interacted, so in the age ranges 20-40 years and 40-60 years, an annual reduction of 2.69% and 2.97%, respectively, was noted. In the age ranges over 80 years and 60-80 years, we noted an annual increase of 5.40% and 1.09%, respectively. The average age at time of OS increased 5.5 years during the period analyzed. For specific surgeries, a global annual reduction was noted in rates for arthrodesis. In THA, there was an annual reduction in patients under 80 years. In TKA and ULA, there was an annual reduction in patients under 60 years. CONCLUSION: Although the overall OS rate has not changed, there is a decrease in the rate of arthrodesis at all ages, THA in patients under 80 years of age, as well as TKA and ULA in patients under 60 years of age.

Mortality after osteoporotic hip fracture: incidence, trends, and associated factors.

BACKGROUND: It is known that mortality after hip fracture increases compared to the general population; the trend in mortality is a controversial issue. The objective of this study is to examine incidence, trends, and factors associated with mortality in patients with osteoporotic hip fractures. METHODS: This is a retrospective cohort study that uses the Registry for Hospital Discharges of the National Health System of our hospital. Patients older than 45 having an osteoporotic hip fracture between 1999 and 2015 were identified. Demographic data and comorbidities were obtained. A survival analysis was performed (Cox regression and Kaplan-Meier). Incidence rate, standardized death rate (SDR), trend (Poisson regression), and risk (hazard ratio) were calculated. RESULTS: During 1999-2015, in our hospital, there were a total of 3992 patients admitted due to osteoporotic hip fracture. Out of these 3992 patients, 3109 patients (77.9%) were women with an average age of 84.47 years (SD 8.45) and 803 (22.1%) were men with an average age of 81.64 years (SD 10.08). The cumulative incidence of mortality was 69.38%. The cumulative mortality rate for 12 months was 33%. The annual mortality was 144.9/1000 patients/year. The 1-year mortality rate increased significantly by 2% per year (IRR 1.020, CI95% 1.008-1.033). The median overall survival was 886 days (CI95% 836-951). The probability of mortality density for a period of 10 years following a hip fracture was 16% for women and 25% for men (first 90 days). The SDR was 8.3 (CI95% 7.98-8.59). Variables that showed statistically significant association with mortality were aged over 75, masculine, institutionalization, mild to severe liver disease, chronic kidney disease, COPD, dementia, heart failure, diabetes, the Charlson Index > 2 , presence of vision disorders and hearing impairment, incontinence, and Downton scale. CONCLUSIONS: For the last 17 years, an increase of mortality for patients with hip fracture and a higher mortality rate in men than in women were observed. Institutionalization combined with comorbidities is associated with a higher mortality.

Can invasive breast carcinoma with close or positive margins be managed without a new surgery?

We present the long-term outcome (FU 127 months) of a prospective study with 248 breast cancer patients with close or positive surgical margin, treated with 50 Gy whole breast irradiation plus high-dose-rate boost, 3 × 4.4 Gy. Actuarial breast failure at 10/15 years was 6.5%/11.6%; with positive margin (120) 6.8%/14.8%, with margin ≤2 mm (76) 9.8%/9.8%, with margin >2 mm <5 mm (52) 2%/2%. In 90 patients aged ≤50 was 11.9%/17.8%, between 51 and 70, 3.8%/8.2%, >70, 0%. Fibrosis appeared in 26.7%. Cosmetic outcome was excellent/good in 85.8%. This approach avoids a second surgery in women >50 with positive surgical margin, or with close margins in all ages.

Trends in hip fracture in patients with rheumatoid arthritis: results from the Spanish National Inpatient Registry over a 17-year period (1999-2015). TREND-AR study.

PURPOSE: To analyse trends in hip fracture (HF) rates in patients with rheumatoid arthritis (RA) over an extended time period (17 years). METHODS: This observational retrospective survey was performed by reviewing data from the National Surveillance System for Hospital Data, which includes more than 98% of Spanish hospitals. All hospitalisations of patients with RA and HF that were reported from 1999 to 2015 were analysed. Codes were selected using the Ninth International Classification of Diseases, Clinical Modification: ICD-9-CM: RA 714.0 to 714.9 and HF 820.0 to 820.3. The crude and age-adjusted incidence rate of HF was calculated by age and sex strata over the last 17 years. General lineal models were used to analyse trends. RESULTS: Between 1999 and 2015, 6656 HFs occurred in patients with RA of all ages (84.25% women, mean age 77.5 and 15.75% men, mean age 76.37). The age-adjusted osteoporotic HF rate was 221.85/100 000 RA persons/ year (women 227.97; men 179.06). The HF incidence rate increased yearly by 3.1% (95% CI 2.1 to 4.0) during the 1999-2015 period (p<0.001) and was more pronounced in men (3.5% (95% CI 2.1 to 4.9)) than in women (3.1% (95% CI 2.3 to 4.1)). The female to male ratio decreased from 1.54 in 1999 to 1.14 in 2015. The average length of hospital stays (ALHS) decreased (p<0.001) from 16.76 days (SD 15.3) in 1999 to 10.78 days (SD 7.72) in 2015. Age at the time of hospitalisation increased (p<0.001) from 75.3 years (SD 9.33) in 1999 to 79.92 years (SD 9.47) in 2015. There was a total of 326 (4.9%) deaths during admission, 247 (4.4%) in women and 79 (7.5%) in men (p<0.001). CONCLUSION: In Spain, despite the advances that have taken place in controlling disease activity and in treating osteoporosis, the incidence rate of HF increased in both male and female patients with RA.

High-dose-rate interstitial brachytherapy boost in inoperable locally advanced tongue carcinoma.

PURPOSE: Locally advanced tongue carcinomas (LATCs) in inoperable lesions are managed with external beam radiation therapy (EBRT) and chemotherapy. In our institution, the boost to the gross tumor volume is delivered with high-dose-rate brachytherapy (HDR-BT) after EBRT. We review the outcome of these patients when HDR-BT is added as a boost. METHODS AND MATERIALS: From May 2000 to December 2014, a total of 24 patients with LATC, nonsurgical oral tongue, and base of tongue carcinomas were treated with EBRT and with interstitial plastic tubes for brachytherapy; median dose was 18-24 Gy in 6-8 fractions after 50-60 Gy of EBRT. Mean age was 60 years, 20 men and 4 women. The distribution by stages was 11 patients in Stage III and 13 patients in Stage IV. All cases but one received chemotherapy. RESULTS: With a median followup of 44 months, local control (LC) rate at 4 years was 80% for the entire group, 78% in Stage III, and 90% in Stage IV. The cause-specific survival was 68% at 4 years; the regional control was 76%. Four patients developed distant metastasis with disease free from distant metastasis of 77% at 4 years. The overall survival was 68% at 4 years. CONCLUSIONS: HDR-BT yields similar results to low dose rate in treatment of patients with LATC, with better results than those reported with exclusive EBRT. HDR-BT allows to increase the local dose, with good LC rates. In patients with large tumors requiring very mutilating surgery and patients who refuse surgery, EBRT with HDR-BT boost is a good option to increase the LC and cause-specific survival while keeping a better functional outcome.

Um estudo das metodologias e funcionalidades dos índices de segregação / Un estudio de las metodologías y funcionalidades de los índices de segregación / A study of methods and functionality of segregation indicators

Os índices de segregação têm o intuito de avaliar a distribuição, mais especificamente, a dispersão ou a concentração de certo grupo em determinado espaço, como uma região geográfica. Enquanto uma análise mais qualitativa dos fatores definidores da mobilidade das pessoas foca em questões sociais, econômicas e culturais, os índices de segregação procuram determinar os fatores da mobilidade geográfica de forma quantitativa para, posteriormente, associar a fatores qualitativos. Este trabalho tem por objetivo tratar da metodologia dos índices de segregação, da forma como eles são construídos e a aplicação das medidas propostas. Assim, o foco é abordar os índices de segregação do tipo uniformização (evenness), exposição (exposure), concentração (concentration), agrupamento (clustering) e centralização (centralization) e, em seguida, construir uma aplicação empírica utilizando dados da Relação Anual de Informações Sociais (Rais). A análise consiste em avaliar a segregação espacial do rendimento anual recebido pelos trabalhadores formais nos municípios da Região Metropolitana de São Paulo (RMSP).

Segregation indicators measure the evenness of distribution, that is, the contrasting dispersion or concentration of a certain group in a given space, such as a geographical area. Whereas the qualitative analysis of people's mobility focuses on social, economic and cultural factors, segregation indicators aim at determining geographic mobility by quantitative factors than can later connect to qualitative factors. This article deals with segregation indicators and describes how they are derived and how each one functions. The following types of indicators are described: evenness, exposure, concentration, clustering and centralization. The empirical analysis is based on data from the Annual (Brazilian) Report on Social Information (RAIS) and the analysis is based on the spatial segregation of annual formal labor income in the São Paulo Metropolitan Region.

Los índices de segregación tienen el propósito de evaluar la distribución o, más específicamente, la dispersión o concentración de un grupo dado en un determinado espacio, como una región geográfica. Mientras un análisis más cualitativo de los factores definidores de la movilidad de las personas aborda cuestiones sociales, económicas y culturales, los índices de segregación intentan determinar los factores de la movilidad geográfica de forma cuantitativa para, posteriormente, asociarlos a factores cualitativos. Este trabajo tiene como objetivo tratar de la metodología de los índices de segregación, de la forma como son construidos, y de la aplicación de las medidas propuestas. De este modo, el enfoque es abordar los índices de segregación del tipo uniformización (evenness), exposición (exposure), concentración (concentration), agrupamiento (clustering) y centralización (centralization), para luego construir una aplicación empírica utilizando datos de la Relación Anual de Informaciones Sociales (Rais). El análisis consiste en evaluar la segregación espacial del ingreso anual recibido por los trabajadores formales en los municipios de la Región Metropolitana de São Paulo (RMSP).

Caregiver distress associated with behavioral and psychological symptomsin mild Alzheimers disease / Desgaste do cuidador associado a sintomas comportamentais e psicológicos na doença de Alzheimer leve

The aim of this study was to analyze the relationship between Caregiver Distress and Behavioral and Psychological Symptoms in Dementias (BPSD) in mild Alzheimers disease. Methods: Fifty patients and caregivers were interviewed using the Neuropsychiatric Inventory (NPI). Results: 96.0% of the patients had at least one BPSD. The mean NPI total score was 19.6 (SD=18.05; range=0-78) whereas the mean Caregiver Distress Index (CDI) total score was 11.5 (SD=10.41; range=0-40). For the individual symptoms, the weighted mean CDI was 2.8 (SD=1.58). All symptom CDI means were higher than 2.0 except for euphoria/elation (m=1.8; SD=1.49). There were correlations between CDI and derived measures (Frequency, Severity, FxS, and Amplitude) for all symptoms, except Disinhibition and Night-time behavior. Correlations ranged between 0.443 and 0.894, with significance at p<0.05. Conclusions: All the derived measures, including amplitude, were useful in at least some cases. The data suggests that CDI cannot be inferred from symptom presence or profile. Symptoms should be systematically investigated.

Analisar as relações entre desgaste do cuidador e Sintomas Comportamentais e Psicológicos nas Demências (SCPD) na doença de Alzheimer leve. Métodos: Cinquenta pacientes e cuidadores foram entrevistados com o Inventário Neuro-Psiquiátrico (INP). Resultados: 96,0% dos pacientes tinham pelo menos um SCPD. A média do escore total do INP foi 19,6 (dp=18,05; amplitude=0-78). A média do índice de desgaste do cuidador (IDC) foi 11,5 (dp=10,41; amplitude=0-40). Para os sintomas individuais, a média ponderada do IDC foi 2,8 (dp=1,58) (escala 0-5). Exceto para euforia/elação (m=1,8; dp=1,49), as médias dos IDC foram maiores do que 2,0. Foram encontradas correlações entre o IDC e medidas derivadas para todos os sintomas, exceto Desinibição e Sono. As correlações variaram entre 0,443 e 0,894 (p<0,05). Conclusões: Todas as medidas derivadas foram úteis em algum caso. Os dados sugerem que o IDC não pode ser inferido pela presença ou perfil dos sintomas. Antes, deve ser investigado sistematicamente.

Caregiver distress associated with behavioral and psychological symptoms in mild Alzheimer's disease.

The aim of this study was to analyze the relationship between Caregiver Distress and Behavioral and Psychological Symptoms in Dementias (BPSD) in mild Alzheimer's disease. METHODS: Fifty patients and caregivers were interviewed using the Neuropsychiatric Inventory (NPI). RESULTS: 96.0% of the patients had at least one BPSD. The mean NPI total score was 19.6 (SD=18.05; range=0-78) whereas the mean Caregiver Distress Index (CDI) total score was 11.5 (SD=10.41; range=0-40). For the individual symptoms, the weighted mean CDI was 2.8 (SD=1.58). All symptom CDI means were higher than 2.0 except for euphoria/elation (m=1.8; SD=1.49). There were correlations between CDI and derived measures (Frequency, Severity, FxS, and Amplitude) for all symptoms, except Disinhibition and Night-time behavior. Correlations ranged between 0.443 and 0.894, with significance at p<0.05. CONCLUSIONS: All the derived measures, including amplitude, were useful in at least some cases. The data suggests that CDI cannot be inferred from symptom presence or profile. Symptoms should be systematically investigated.

Analisar as relações entre desgaste do cuidador e Sintomas Comportamentais e Psicológicos nas Demências (SCPD) na doença de Alzheimer leve. MÉTODOS: Cinquenta pacientes e cuidadores foram entrevistados com o Inventário Neuro-Psiquiátrico (INP). RESULTADOS: 96,0% dos pacientes tinham pelo menos um SCPD. A média do escore total do INP foi 19,6 (dp=18,05; amplitude=0-78). A média do índice de desgaste do cuidador (IDC) foi 11,5 (dp=10,41; amplitude=0-40). Para os sintomas individuais, a média ponderada do IDC foi 2,8 (dp=1,58) (escala 0-5). Exceto para euforia/elação (m=1,8; dp=1,49), as médias dos IDC foram maiores do que 2,0. Foram encontradas correlações entre o IDC e medidas derivadas para todos os sintomas, exceto Desinibição e Sono. As correlações variaram entre 0,443 e 0,894 (p<0,05). CONCLUSÕES: Todas as medidas derivadas foram úteis em algum caso. Os dados sugerem que o IDC não pode ser inferido pela presença ou perfil dos sintomas. Antes, deve ser investigado sistematicamente.

Sintomas obsessivo-compulsivos nas demências: [revisão] / Obsessive-compulsive symptoms in dementia: [review]

CONTEXTO: Demências são cada vez mais prevalentes na população. Sintomas cognitivos costumam ser acompanhados de sintomas comportamentais e psicológicos das demências (SCPD), causando aumento do custo dos cuidados e da carga do cuidador. OBJETIVOS: Identificar na literatura indexada até junho de 2008 artigos relacionados a estudos sobre a ocorrência de sintomas obsessivo-compulsivos (SOC) nas diversas síndromes demenciais para identificar prevalência, características e impacto nos cuidadores em termos de carga, qualidade de vida ou custo socioeconômico. MÉTODOS: Procedeu-se à busca sistemática nos indexadores PubMed e LILACS, utilizando as palavras-chave obsessive, compulsive, obsession, compulsion e dementia, identificando-se 10 artigos. RESULTADOS: Desses, cinco enfocavam primariamente os SOC, enquanto, nos outros cinco, SOC eram objetivos secundários; oito estudos relatavam exames de neuroimagem; oito relataram sintomas compulsivos; dois relataram sintomas obsessivos e compulsivos, enquanto nenhum trouxe sintoma simplesmente obsessivo. A maioria dos estudos aborda pacientes com demência frontotemporal. CONCLUSÃO: A análise dos 10 artigos evidenciou a escassez de investigação de SOC nas demências, a importância da neuroimagem para esse tipo de estudo e grande diversidade de instrumentos para avaliar os SOC. Nenhum artigo avaliou impacto dos SOC nos cuidadores, o que pode direcionar estudos futuros.

BACKGROUND: Dementia is increasingly prevalent in the population. Cognitive symptoms are usually accompanied by behavioral and psychological symptoms of dementia (BPSD), causing an increase in the cost of care and the burden of the caregiver. OBJECTIVES: To search in the indexed literature until June 2008 articles related to studies on the occurrence of obsessive-compulsive symptoms (OCS) and trying to identify their prevalence, characteristics and impact on caregivers in terms of loading, quality of life and socioeconomic cost. METHODS: A systematic search was performed in the PubMed and LILACS indexing services, using the keywords: obsessive, compulsive, obsession, compulsion and dementia, having been identified 10 articles. RESULTS: Among those, five focused on primary OCS, while in the other five OCS were a secondary objective; eight studies reported test of neuroimaging procedures; eight reported compulsive symptoms; two reported both an obsessive and compulsive symptoms, while no study reported only obsesssion. The majority of the studies reported cases of frontotemporal dementia patients. DISCUSSION: The analysis of the 10 articles denified in our search highlighted the scarcity on research on OCS and dementia, the importance of associating neuroimaging to this kind of research and the diversity of trials to evaluate OCS. No article evaluated the impact of OCS in caregivers, which could be a suggestion for future studies.

Visuospatial cognitive tests for the evaluation of patients with Parkinson's disease.

Parkinson's disease (PD) is a neurological disorder characterized by motor disturbances, neuropsychological symptoms and cognitive changes, including cases of dementia. The most frequently described cognitive changes in these patients involve executive and visuospatial functions, which are very important for the execution of daily life activities. OBJECTIVE: To compare different tests used to examine visuospatial functions in patients with PD. METHODS: Thirty-five patients (21 women) with PD symptoms (medicated and "on") and mean schooling of 5.5±4.2 years were examined using the following tests: Mini-Mental State Examination (MMSE), Dementia Rating Scale (DRS), Scales of Outcomes of Parkinson's Disease (SCOPA-COG), Hooper Visual Organization Test (HVOT), Judgment of Line Orientation, Form V (JLO), and Clock drawing task - CLOX (1 and 2). RESULTS: The mean MMSE score was 24.8±3.03and 54.8% of the patients performed correctly in the copy of a pentagon drawing, with a medium-level performance in most tests. Good correlations were detected between JLO versus SCOPA Assembling patterns (0.67), JLO versus HVOT (0.56), JLO versus CLOX2 (0.64), SCOPA Figure Composition versus HVOT (0.54), CLOX1 versus CLOX2 (0.43), and DRS Construction versus CLOX2 (0.42). DISCUSSION: Although correlations were detected, not all were strong, probably because the tests employed do not measure solely visuospatial functions, but also other skills such as attention, motor ability and executive functions. A limitation of the present study was the lack of a control group for the establishment of adequate standards for this population.

A doença de Parkinson (PD) é um transtorno neurológico caracterizado por distúrbios motores, sintomas neuropsicológicos e por alterações cognitivas, inclusive casos de demência. As alterações cognitivas mais descritas nesses pacientes são as funções executivas e as visuais-espaciais, funções importantíssimas para a realização de atividades da vida diária. OBJETIVO: Comparar diferentes testes que examinam funções visuais-espaciais em pacientes com DP. MÉTODOS: Foram avaliados 35 pacientes (21 mulheres) sintomáticos para DP (medicados e em "on") e escolaridade média de 5,5±4,2 com os seguintes testes: Mini-Exame do Estado Mental (MEEM), Escala de Avaliação de Demência de Mattis (EADM), Escala de Conseqüências da Doença de Parkinson (SCOPA-COG), Teste de Organização Visual de Hooper (TOVH), Julgamento de Orientação de Linhas ­ Forma V (JOL), e Teste do Desenho do Relógio ­ CLOX (1 e 2). RESULTADOS: Os pacientes obtiveram média 24,8±3,03 no MMSE e 54,8% acertou o de cópia do desenho do pentágono e desempenho mediano na maioria dos testes. Foram encontradas boas correlações entre JOL versus SCOPA Composição de Figuras (0.67), JLO versus TOVH (0.56), JOL versus CLOX2 (0.64), SCOPA Composição de Figuras versus TOVH (0.54), CLOX1 versus CLOX2 (0.43) e EADM Construção versus CLOX2 (0.42). DISCUSSÃO: Mesmo tendo sido verificadas correlações, nem todas foram "fortes", o que pode ser explicado pelo fato de que os testes não medem somente funções visuais-espaciais, mas outras habilidades como atenção, habilidade motora e funções executivas. Uma dificuldade do presente estudo diz respeito à falta de grupo controle para estabelecer padrões adequados à essa população.

Executive cognitive tests for the evaluation of patients with Parkinson's disease.

Parkinson's disease (PD) is characterized by changes in movement, which are later followed by cognitive, behavioral and psychological changes. The objective of the present study was to correlate different tests used to examine executive functions in PD patients followed at a specialized outpatient clinic. METHODS: Thirty-five patients with idiopathic PD aged 63.0 years on average and with mean schooling of 5.5±4.2 years, were examined using the following tests: Mattis Dementia Rating Scale (MDRS), Scales for Outcomes of Parkinson's Disease-Cognition (SCOPA-COG), Wisconsin Card Sorting Test (WCST), Frontal Assessment Battery (FAB), Digit Span - Inverse Order (IO) (a subtest of the WAIS III) and Verbal Fluency Test (category animals). RESULTS: Significant correlations were detected between FAB and MDRS Conceptualization (0.814), MDRS Initiation/Perseveration (I/P) and SCOPA-COG Executive Function (0.643), FAB and MDRS I/P (0.601), FAB and Verbal Fluency (0.602), MDRS I/P and MDRS Conceptualization (0.558), Verbal Fluency and MDRS I/P (0.529), MDRS Attention and SCOPA-COG Executive Function (0.495), MDRS Conceptualization and SCOPA-COG Executive Function (0.520), FAB and Digit Span (OI) (0.503), Verbal Fluency and MDRS Conceptualization (0.501), and WCST perseverative errors and FAB (-0.379), WCST perseverative errors and MDRS Conceptualization (0.445), WCST perseverative errors and MDRS I/P (-0.407) and WCST categories completed and MDRS Conceptualization (0.382). DISCUSSION: The results demonstrated strong correlations between most of the tests applied, but no associations were detected between the WCST and the other tests, a fact that may be explained by the heterogeneity of scores obtained in the tests by the patients evaluated. A difficulty of the present study was the lack of a control groups for the establishment of adequate standards for this population.

A doença de Parkinson (DP) caracteriza-se por alterações do movimento, cognitivas, comportamentais e psicológicas. O objetivo do presente estudo foi correlacionar diferentes testes que examinam funções executivas em pacientes com DP acompanhados em um ambulatório especializado. MÉTODOS: Foram avaliados 35 pacientes com DP idiopática com idade média de 63,0 anos e escolaridade média de 5,5±4,2 utilizando os seguintes testes: Escala de Avaliação de demência de Mattis (EADM), Escala de Desfechos da Doença de Parkinson (SCOPA-COG), Teste Wisconsin de Classificação de Cartas (WCST), Bateria de Avaliação Frontal (BAF), Amplitude de Dígitos-Ordem Inversa (OI) (subteste do WAIS III) e Teste de Fluência Verbal (categoria animais). RESULTADOS: Foram encontradas correlações significativas entre BAF e EADM Conceituação (0,814), EADM Iniciativa/Perseveração (I/P) e SCOPA-COG Funções Executivas (0,643), BAF e EADM I/P (0,601), BAF e Fluência Verbal (0,602) e EADM I/P e EADM Conceituação (0,558), Fluência Verbal e EADM I/P (0,529), EADM Atenção e SCOPA-COG Funções Executivas (0,49), EADM Conceituação e SCOPA-COG Funções Executivas (0,495), BAF e Amplitude de dígitos (OI) (0,503), Fluência Verbal e EADM Conceituação (0,501), WCST Erros Perseverativos e BAF (­0,379), WCST erros perseverativos e MDRS Conceptualization (­0,445), WCST erros perseverativos e EADM I/P (­0,407) e WCST categorias completas e EADM Conceituação (0,382). DISCUSSÃO: Os resultados evidenciaram fortes correlações entre a maioria dos testes aplicados. Uma dificuldade do estudo presente diz respeito à falta de grupo controle para estabelecer padrões adequados a essa população.