Assessment of delta-9-tetrahydrocannabinol (THC) in saliva and blood after oral administration of medical cannabis with respect to its effect on driving abilities.

Medical cannabis has recently been legalized in many countries, and it is currently prescribed with increasing frequency, particularly for treatment of chronic pain resistant to conventional therapy. The psychoactive substance delta-9-tetrahydro-cannabinol (THC) contained in cannabis may affect driving abilities. Therefore, the aims of this study (open-label, monocentric, nonrandomized) were to evaluate blood and saliva concentrations of THC after oral administration of medical cannabis and to assess the time needed for THC levels to decline below a value ensuring legal driving. The study involved 20 patients with documented chronic pain using long-term medical cannabis therapy. They were divided into two groups and treated with two different doses of cannabis in the form of gelatin capsules (62.5 mg or 125 mg). In all patients, the amount of THC was assessed in saliva and in blood at pre-defined time intervals before and after administration. THC levels in saliva were detected at zero in all subjects following administration of both doses at all-time intervals after administration. Assessment of THC levels in blood, however, showed positive findings in one subject 9 h after administration of the lower dose and in one patient who had been given a higher dose 7 h after administration. Our finding suggested that for an unaffected ability to drive, at least 9-10 h should elapse from the last cannabis use.

Trajectories of neuropsychological functioning in Mexican children with traumatic brain injury over the first year after injury.

BACKGROUND: Children with traumatic brain injury (TBI) usually displayed substantial neuropsychological impairment at short and long term after injury. OBJECTIVE: To compare the course of cognitive functioning among children with TBI and healthy controls over the first-year post-injury in Guadalajara, Mexico. METHODS: A sample of 46 children with TBI and 46 healthy controls from Guadalajara, Mexico were recruited. Both groups received a comprehensive neuropsychological evaluation at three-time (3, 6, and 12 months) with measures of memory, attention, executive function, processing speed, language, perceptual reasoning, visuo-spatial abilities, and intellectual functioning. Sixteen hierarchical linear models (HLMs) were performed to examine whether linear trajectories of cognitive functioning differed over time between groups. RESULTS: Trajectories of neuropsychological performance were significantly worse over time among children with TBI than healthy controls across every cognitive domain. HLMs suggested that cognitive performance increased over time in both groups, however, TBI group scored significantly lower at each time point compare to the control group, except in Stroop-Interference. CONCLUSIONS: Cognitive deficits are common during the first-year after pediatric TBI. Thus, it is imperative to implement early rehabilitation programs to mitigate the consequences of these problems in the social, academic, and family reintegration of these children.

Newly developed Learning and Verbal Memory Test (TAMV-I): Normative data for Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the Learning and Verbal Memory Test (TAMV-I) in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the TAMV-I as part of a larger neuropsychological battery. Free recall, memory delay and recognition scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models indicated main effects for age on all scores, such that scores increased linearly as a function of age. Age2 had a significant effect in all countries except Cuba, and Puerto Rico for free recall score; a significant effect for memory delay score in all countries except Cuba and Puerto Rico; and a significant effect for recognition score in in all countries except Guatemala, Honduras, and Puerto Rico. Models showed an effect for MLPE in Chile (free recall), Honduras (free recall), Mexico (free recall), Puerto Rico (free recall, memory delay, and recognition), and Spain (free recall and memory delay). Sex affected free recall score for Cuba, Ecuador, Guatemala, Mexico, Paraguay, Peru, and Spain, memory delay score for all countries except Chile, Paraguay, and Puerto Rico, and recognition score for Ecuador, Mexico, Peru, and Spain, with girls scoring higher than boys. CONCLUSIONS: This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate way to interpret the TAMV-I with pediatric populations.

Peabody Picture Vocabulary Test-III: Normative data for Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the Peabody Picture Vocabulary Test-III (PPVT-III) in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Honduras, Guatemala, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the PPVT-III as part of a larger neuropsychological battery. PPVT-III scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models showed main effects for age in all countries, such that scores increased linearly as a function of age. In addition, age2 had a significant effect in all countries, except Guatemala and Paraguay. Models showed that children whose parent(s) had a MLPE >12 years obtained higher scores compared to children whose parent(s) had a MLPE ≤12 years in all countries, except for Cuba, Peru, and Puerto Rico. Sex affected scores for Chile, Ecuador, Guatemala, Mexico, and Spain. CONCLUSIONS: This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate interpretation of the PPVT-III when used in pediatric populations.

Verbal fluency tests: Normative data for Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the phonological and semantic verbal fluency tests (VFT) in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the VFT as part of a larger neuropsychological battery. Scores for letters F, A, S, and animals and fruit categories were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models showed main effects for age on all scores, such that scores increased linearly as a function of age. Age2 had a significant effect in Chile (animals), Cuba (A letter, fruits), Ecuador (animals, fruits), Honduras (F letter), Mexico (animals, fruits), Peru (fruits), and Spain (S letters, animals, fruits). Models showed an effect for MLPE in Chile (A letters, animals, fruits), Ecuador (S letter, animals, fruits), Guatelama (F, S letter, animals), Honduras (animals), Mexico (F, A, S letters, animals, fruits), Puerto Rico (A, letters, animals), and Spain (all scores). Sex scores were found significant in Chile (animals), Ecuador (A letter, fruits), Mexico (F letter, fruits), Paraguay (F, A, S letters, fruits), Puerto Rico (F letter, animals, fruits), and Spain (F letter, fruits). CONCLUSIONS: This is the largest multi-national Spanish speaking-pediatric normative study in the world, and as such it will allow neuropsychologists from these countries to have a more accurate way to interpret the phonological and semantic VFT in pediatric populations.

Shortened Version of the Token Test: Normative data for Spanish-speaking pediatric population.

OBJECTIVE: To generate normative data for the Shortened Version of the Token Test in Spanish-speaking pediatric populations. METHOD: The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the Shortened Version of the Token Test as part of a larger neuropsychological battery. Shortened Version of the Token Test total scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses. RESULTS: The final multiple linear regression models showed main effects for age in all countries, such that score increased linearly as a function of age. In addition, age2 had a significant effect in all countries, except Guatemala and Puerto Rico. Models showed that children whose parent(s) had a MLPE >12 years obtained higher score compared to children whose parents had a MLPE ≤12 years in Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, Puerto Rico, and Spain. The child's sex did not have an effect in the Shortened Version of the Token Test total score for any of the countries. CONCLUSIONS: This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate interpretation of the Shortened Version of the Token Test when used in pediatric populations.

Standard form of the Boston Naming Test: Normative data for the Latin American Spanish speaking adult population.

OBJECTIVE: To generate normative data on the Boston Naming Test (BNT) across 10 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate. METHOD: The sample consisted of 3,779 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the BNT as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms. RESULTS: The final multiple linear regression models explained between 3-32% of the variance in BNT scores. Although t-tests showed significant differences between men and women for Mexico, Argentina, Chile, Cuba, Guatemala, and Bolivia on the BNT, none of the six countries had an effect size larger than 0.3. As a result, gender-adjusted norms were not generated. CONCLUSIONS: This is the first normative multicenter study conducted in Latin America to generate norms for the BNT; this study will have substantial repercussions for the practice of neuropsychology throughout the global region.

Verbal fluency tests: Normative data for the Latin American Spanish speaking adult population.

OBJECTIVE: To generate normative data for the Verbal Fluency Tests across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate. METHOD: The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the Verbal Fluency Test as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms. RESULTS: The final multiple linear regression models for the letter F explained 8-30% of the variance, 7-32% for letter A, 8-32% for the letter S, and 16-43% for the animal category in Verbal Fluency Test scores. Although t-tests showed significant differences between men and women on the Verbal Fluency Test, they did not have an effect size larger than 0.3. As a result, gender-adjusted norms were not generated. CONCLUSIONS: This is the first normative multicenter study conducted in Latin America aiming to create norms for the Verbal Fluency Test; this study will have important outcomes for the future of neuropsychology in the region.

[Acute abdominal pain in elderly patients evaluated in the emergency department at a tertiary level]. / Dolor abdominal agudo en pacientes geriátricos evaluados en el servicio de urgencias en un hospital de tercer nivel.

BACKGROUND: Life expectancy in México has increased in the last decades with a remarkable increase in geriatric population. Acute abdominal pain (AAP) in elderly people compared with young people has different clinical presentation because of the concomitant chronic diseases, the use of medications, history of abdominal surgeries and decrease in perception of pain and immunity. OBJECTIVE: To know the cause and associated mortality of acute abdominal pain in geriatric patients who attend the emergency room. METHODS: Geriatric patients' files with acute abdominal pain admitted from January 2004 to December 2008 were retrospectively reviewed. Age, gender, presence of chronic diseases, use of medications, history of surgical procedures, definitive diagnosis causative of the symptoms and the associated mortality were recorded. RESULTS: 17 524 patients were admitted, of whom 324 (1.8%) were geriatric patients with AAP: 110 were men (36.9) and 214 were women (66%), with a mean age of 78 years (range 60 to 102 years). The most common causes of AAP were acute cholecystitis in 49 patients (15.1%), irritable bowel syndrome in 42 (12.9%), ulcerative syndrome in 40 (12.3%), intestinal obstruction in 35 (10.8%) and diverticulitis in 23 (10.8%). Nine patients died (2.7%). CONCLUSIONS: In our hospital the most common cause of AAP in geriatric patients is related to biliary disease followed by functional gastrointestinal disorder and ulcerative syndrome. Mortality is low.

A prospective 2-year clinical evaluation of overdentures attached to nonsplinted implants utilizing ERA attachments.

Edentulism is a major oral healthcare issue for an ever-increasing older population in the United States. Most previous studies examined the success of overdentures supported by splinted implants utilizing clip bars and other types of attachments. This longitudinal study of 10 consecutive patients involves mandibular overdentures supported by nonsplinted implants with ERA attachments. Two-year results indicate that nonsplinted implants can be successfully used with ERA attachments to support overdentures. Each patient reported increased satisfaction with comfort, chewing, retention, and phonetics with the implant-assisted ERA-retained overdenture.

Creencias y actitudes de las enfermeras de cuidados intensivos sobre el efecto que la visita abierta produce en el paciente, familia y enfermeras / Opinions and attitudes of intensive care nurses on the effect of open visits on patients, family members, and nurses

La política de visitas de los familiares a los pacientes ingresados en UCI se ha ido liberalizando en los últimos años ante la creencia del efecto beneficioso que la presencia de la familia tiene en los pacientes.En nuestra Unidad este cambio también se ha producido de forma progresiva y en la actualidad las familias permanecen durante periodos de tiempo al lado del paciente. Con el fin de conocer las creencias/opiniones y actitud de las enfermeras sobre el tema se ha realizado este estudio con el objetivo de analizar la relación entre las creencias de las enfermeras y sus actitudes sobre el efecto que la visita abierta produce en los pacientes, familia y enfermeras.Este estudio descriptivo correlacional se ha realizado en una Unidad de Cuidados Intensivos Polivalente.La muestra estaba formada por 46 enfermeras, quienes cumplimentaron un cuestionario autocompletado y anónimo. Este cuestionario incluía: una escala tipo Likert mediante la cual se analizaron las creencias de las enfermeras sobre el efecto de las visitas y una escala semántica diferencial para analizar sus actitudes hacia la visita de los familiares.La creencia sobre el efecto positivo de las visitas dio un valor medio de 3,001, siendo el valor máximo 4. La puntuación obtenida en la escala de actitudes hacia la visita abierta fue de 6,005 para un valor máximo de 7. La correlación obtenida entre las creencias y actitudes ha sido significativa y positiva (r= 0,523, p< 0,0001). Al comparar las variables sociodemográficas y las variables de interés no se han obtenido diferencias estadísticamente significativas, excepto en la variable actitud, y el hecho de tener hijos (t= -2,254, p= 0,03) que obtuvieron una puntuación más elevada.Se concluye que las creencias de las enfermeras sobre los efectos positivos de la visita abierta se corresponden con las actitudes que ellas adoptan y mayoritariamente están satisfechas con el sistema actual de visitas. (AU)

Phosphorylation of protein kinase N by phosphoinositide-dependent protein kinase-1 mediates insulin signals to the actin cytoskeleton.

Growth factors such as insulin regulate phosphatidylinositol 3-kinase-dependent actin cytoskeleton rearrangement in many types of cells. However, the mechanism by which the insulin signal is transmitted to the actin cytoskeleton remains largely unknown. Yeast two-hybrid screening revealed that the phosphatidylinositol 3-kinase downstream effector phosphoinositide-dependent protein kinase-1 (PDK1) interacted with protein kinase N (PKN), a Rho-binding Ser/Thr protein kinase potentially implicated in a variety of cellular events, including phosphorylation of cytoskeletal components. PDK1 and PKN interacted in vitro and in intact cells, and this interaction was mediated by the kinase domain of PDK1 and the carboxyl terminus of PKN. In addition to a direct interaction, PDK1 also phosphorylated Thr(774) in the activation loop and activated PKN. Insulin treatment or ectopic expression of the wild-type PDK1 or PKN, but not protein kinase Czeta, induced actin cytoskeleton reorganization and membrane ruffling in 3T3-L1 fibroblasts and Rat1 cells that stably express the insulin receptor (Rat1-IR). However, the insulin-stimulated actin cytoskeleton reorganization in Rat1-IR cells was prevented by expression of kinase-defective PDK1 or PDK1-phosphorylation site-mutated PKN. Thus, phosphorylation by PDK1 appears to be necessary for PKN to transduce signals from the insulin receptor to the actin cytoskeleton.

[Opinions and attitudes of intensive care nurses on the effect of open visits on patients, family members, and nurses]. / Creencias y actitudes de las enfermeras de cuidados intensivos sobre el efecto que la visita abierta produce en el paciente, familia y enfermeras.

The policy of family visits to patients admitted to the intensive care unit has been liberalized in recent years. This change has been progressive in our unit and family members now spend long periods of time with patients. An analysis was made of the beliefs, opinions and attitudes of nurses toward family visits and the relation between the beliefs of nurses and their attitude toward the effect of an open visiting policy on patients, family members and nurses. A descriptive correlation study was carried out in the Polyvalent Intensive Care Unit. The sample included 46 nurses who completed a self-administered, anonymous questionnaire. This questionnaire contained a Likert type scale analyzing the opinions of nurses regarding the effect of visits and a differential semantic scale analyzing nurses' attitudes toward visits by family members. The opinion that visits had a positive effect achieved a mean value of 3.001 on a scale with a maximum value of 4. The score obtained on the scale of attitudes toward an open visiting policy was 6.005, with a maximum value of 7. The correlation between opinions and attitudes was significant and positive (r = 0.523, p > 0.0001). Comparison of sociodemographic and other variables disclosed no statistically significant differences, except for the variables attitude and having children (t = -2.254, p = 0.03), which obtained a higher score. It is concluded that the opinions of nurses regarding the positive effect of open visits depended on their attitudes. For the most part, they were satisfied with the current visiting policy.

Surgical treatment of hepatic metastatic colorectal cancer.

73 patients (men age 54 years, range 17-78), underwent an hepatic resection for metastatic, colorectal cancer. Operative mortality was 1.36% Overall 5 years survival rate (Kaplan-Meier) was 27%; 5 years disease free interval was equally 27%. This could demonstrate that 5 years survivors could be also considered free from the risk of metastatic recurrence. This is confirmed by our survivors over 5 years (70-79-94 months) that are still disease free.

Accion sobre la respuesta inmune humoral y celular a la administracion de autobioterápicos de sangre en enfermedades respiratorias cronicas / Action upon the cellular and humoral immune response by blood autobiotherapics administration in chronic respiratory diseases

En una muestra aleatoria de pacientes con diversas enfermedades respiratoria cronicas, se evaluo el efecto de los autobioterapicos de sangre sobre la respuesta inmune y la evolucion clinica de los pacientes

Accion sobre la respuesta inmune humoral y celular a la administracion de autobioterápicos de sangre en enfermedades respiratorias cronicas / Action upon the cellular and humoral immune response by blood autobiotherapics administration in chronic respiratory diseases

En una muestra aleatoria de pacientes con diversas enfermedades respiratoria cronicas, se evaluo el efecto de los autobioterapicos de sangre sobre la respuesta inmune y la evolucion clinica de los pacientes

Straight ileo-anal anastomosis with myectomy as an alternative to ileal pouch-anal anastomosis in restorative proctocolectomy.

Restorative proctocolectomy with various types of reservoir is widely used in the elective surgery of ulcerative colitis and familial adenomatous polyposis. Both, advantages and disadvantages of this procedure are well known and documented. Straight ileo-anal anastomosis (IAA) yields unsatisfactory clinical results due to the lack of storage capacity of the distal ileum and the frequency of bowel movements related to high pressure ileal waves. In an attempt to create an alternative to the above procedures, we have performed a straight ileo-anal anastomosis with two rectangular (10 cm x 1 cm) myectomies down to 2 cm, above the anastomotic line. The two myectomies are spaced at 120 degrees to each other and to the mesenteric border of the ileal loop. The rationale of this approach is to reduce the peristaltic drive of the ileum by weakening the muscular wall. This study presents the results in three patients operated on with this new method in the last year.

Estudios preliminares del efecto de los autonósicos sobre los linfocitos T y B de pacientes con enfermedades respiratorias crónicas / Preliminary studies of autonosicos over lymphocyte T and B of patients with cronical respiratory diseases

The results of the treatement with a blood nosode in 8 patients with a cronic respiratory disease, show a very good clinical performance, associated to increased response of T and B lymphocytes. (AU)