Volumetric and morphological characteristics of the hippocampus are associated with progression to schizophrenia in patients with first-episode psychosis.

BACKGROUND: Abnormalities in the hippocampus have been implicated in the pathophysiology of psychosis. However, it is still unclear whether certain abnormalities are a pre-existing vulnerability factor, a sign of disease progression or a consequence of environmental factors. We hypothesized that first-episode psychosis patients who progress to schizophrenia after one year of follow up will display greater volumetric and morphological changes from the very beginning of the disorder. METHODS: We studied the hippocampus of 41 patients with a first-episode psychosis and 41 matched healthy controls. MRI was performed at the time of the inclusion in the study. After one year, the whole sample was reevaluated and divided in two groups depending on the diagnoses (schizophrenia vs. non-schizophrenia). RESULTS: Patients who progressed to schizophrenia showed a significantly smaller left hippocampus volume than control group and no-schizophrenia group (F=3.54; df=2, 77; P=0.03). We also found significant differences in the morphology of the anterior hippocampus (CA1) of patients with first-episode psychosis who developed schizophrenia compared with patients who did not. CONCLUSIONS: These results are consistent with the assumption of hyperfunctioning dopaminergic cortico-subcortical circuits in schizophrenia, which might be related with an alteration of subcortical structures, such as the hippocampus, along the course of the disease. According with these results, hippocampus abnormalities may serve as a prognostic marker of clinical outcome in patients with a first-episode psychosis.

Ancianos frágiles: ¿cuántos y por qué? / Frail elderly subjects: how many and why?

OBJETIVO. Conocer la prevalencia de ancianos frágiles en la población atendida en un centro de salud. MÉTODOS. Estudio transversal realizado en un centro de salud urbano de Castelldefels. Se eligieron aleatoriamente 527 pacientes mayores de 65 años, separados en dos grupos: el primero de 65 a 74 años y el segundo de 75 o más años. Hubo 46 no respuestas. Mediciones principales: el test de Barber, validado fuera de nuestro medio, que mide la fragilidad en el anciano. Variables: edad, sexo, número de convivientes, consumo de fármacos y nivel de estudios. RESULTADOS. Se obtuvieron 481 encuestas (91,3%). La edad media fue de 73,5 (desviación estándar [DE]: 6,4) años. El 45,1% eran hombres. Presentaron test de Barber positivo 261 (54,3%). La fragilidad era superior en las mujeres y en el grupo de edad de mayores de 75 años. Reconocieron dificultad visual (94 pacientes, el 17,9%) y auditiva (93 pacientes, el 17,3%). Vivían solos un 17%. El nivel de estudios era inferior en el género femenino (p < 0,0001). Los pacientes tomaban 3,3 (DE: 2,3) fármacos al día, más al aumentar la edad y el género masculino (p < 0,001). La media de convivientes fue de 1,62 (DE:1,24) por paciente, siendo de 1,44 (DE:1,36) en pacientes frágiles y de 1,84 (DE:1,03) en pacientes no frágiles (p = 0,0007). CONCLUSIONES. Más de la mitad de la población mayor de 65 años de la comunidad presenta fragilidad. La fragilidad era más frecuente en mujeres y a mayor edad. La Atención Primaria debe detectar los ancianos frágiles para realizar una valoración geriátrica integral y aplicar medidas preventivas adecuadas a esta población de riesgo

OBJECTIVE. To know the prevalence of frail elderly subjects in the population attended in the health care site. METHODS. Cross-sectional study performed in urban health care site of Castelldefels. A total of 527 patients over 65 years were randomly chosen. They were separated into two groups: the first one from 65 to 74 years and the second one of 75 years and older. Forty six did not answer. Main measurements: Barber test, validated outside of our setting, that measures frailness in the elderly. Variables: age, gender, number of subjects living together, drugs taken and study level. RESULTS. A total of 481 (91.3%) surveys were obtained. Mean age was 73.5 (SD 6.4 years), 45.1% of whom were men. Barber test was positive in 261 (54.3%). Frailness was greater in the women and in the over 75-year old age group. Visual difficulty was found in 94 patients (17.9%) and auditory ones in 93 patients (17.3%). Seventeen percent lived alone. Study level was lower in the women (p < 0.0001). The patients took 3.3 (SD: 2.3) drugs per day, this increasing as age increased and in men (p < 0.001). Mean number of subjects living together was 1.62 (S: 1.24) per patient, this being 1.44 (SD: 1.36) in frail patients and 1.84 (SD: 1.03) in non-frail patients (p = 0.0007). CONCLUSIONS. More than half of the population over 65 years of the community were frail. Frailness was more frequent in women and at an older age. Primary Health Care should detect the frail elderly to made a complete geriatric assessment and apply adequate preventive measures in this risk group

Cefepime monotherapy as an empirical initial treatment of patients with febrile neutropenia.

Currently, monotherapy is considered a valid alternative to the combination antibiotic treatments used for initial, empirical management of febrile neutropenia. The advent of new cephalosporins warrants assessment. The aim of this study was to prospectively evaluate the effectiveness of cefepime monotherapy in the treatment of cancer patients with febrile granulocytopenia (< 1000 leukocytes/muL and/or < 500 neutrophils/muL). A prospective, multicenter, nonrandomized trial was conducted. Initial treatment consisted of iv cefepime, 2 g every 8 h. If the patient was still febrile after 72 h, amikacin, vancomycin/teicoplanin, and amphotericin B were added sequentially. Response was evaluated according to EORTC criteria. One hundred twenty episodes were analyzed in 81 males and 39 females (median age, 52 yr; range, 15-83). The median leukocyte count at the time of diagnosis was 781 microL(-1) (range, 100-2600) and the median neutrophil count was 173 microL(-1) (range 0-500). The median duration of neutropenia (< 1000 neutrophils/microL) was 4.8 d (range, 3-20). Fifty-two episodes (44%) were confirmed microbiologically (42 presented as bacteremia), 31 with Gram-positive bacteria and 21 with Gram-negative bacteria, 47 (39.3%) were confirmed clinically, 16 (13.3%) were considered as probable infections, and 5 (4.2%) as doubtful infections. Protocol success was achieved in 110 episodes (91.7%), 8 (6.6%) were treatment failures, and 2 (1.7%) were not evaluable. Ninety-nine episodes (83.3%) were controlled with cefepime monotherapy, with 19 other episodes requiring additional antibiotics: amikacin in 7 (5.8%), amikacin + vancomycin/teicoplanin in 12 (10.1%). Three patients (2,5%) died during an episode of neutropenic fever. Cefepime is effective as an initial, empirical treatment of febrile neutropenia. The early addition of amikacin and/or vancomycin resolves most of the monotherapy failures, which seem somewhat lower than with other monotherapies.

Metastasis to the breast from extramammary malignancies: a report of four cases and a review of literature.

Breast metastases from extramammary tumours are rare with few cases reported. Four cases of metastasis to the breast are presented and the diagnostic problems of this condition are reviewed. Correlation between the histology of primary tumour and the cytology of breast metastatic tumour can avoid the surgical breast biopsy and unnecessary mastectomy. Metastasis to the breast has poor prognosis.

The EFQM excellence model is useful for primary health care teams.

BACKGROUND: Primary care teams are facing an increased need to develop quality programmes at local level. GPs must lead this process and promote a positive organizational culture if they want to achieve and maintain a continuous improvement of the service. OBJECTIVE: The aim of the present study was to test the applicability and reliability of the European Foundation for Quality Management (EFQM) excellence model self-assessment questionnaire in a primary health care organization. METHOD: A cross-sectional study was carried out of the EFQM questionnaire to compare the scores achieved by a primary health care team in Spain caring for 42 000 inhabitants using internal self-assessment with the scores achieved by professional management auditors through an external audit. RESULTS: The scores of each criterion achieved by self-evaluation are similar to or lower than those assessed by the external evaluation. There is agreement in the areas suitable for improvement. CONCLUSIONS: The experience proves the applicability of the EFQM excellence model for primary health care teams and its reliability, at least when the team undergoing self-assessment know they are going to be re-evaluated. There is high concordance in the identification of areas for improvement.

Determination of linuron and related compounds in soil by microwave-assisted solvent extraction and reversed-phase liquid chromatography with UV detection.

The combination of microwave-assisted solvent extraction (MASE) and reversed-phase liquid chromatography (RPLC) with UV detection has been investigated for the efficient determination of phenylurea herbicides in soils involving the single-residue method (SRM) approach (linuron) and the multi-residue method (MRM) approach (monuron, monolinuron, isoproturon, metobromuron, diuron and linuron). Critical parameters of MASE, viz, extraction temperature, water content and extraction solvent were varied in order to optimise recoveries of the analytes while simultaneously minimising co-extraction of soil interferences. The optimised extraction procedure was applied to different types of soil with an organic carbon content of 0.4-16.7%. Besides freshly spiked soil samples, method validation included the analysis of samples with aged residues. A comparative study between the applicability of RPLC-UV without and with the use of column switching for the processing of uncleaned extracts, was carried out. For some of the tested analyte/matrix combinations the one-column approach (LC mode) is feasible. In comparison to LC, coupled-column LC (LC-LC mode) provides high selectivity in single-residue analysis (linuron) and, although less pronounced in multi-residue analysis (all six phenylurea herbicides), the clean-up performance of LC-LC improves both time of analysis and sample throughput. In the MRM approach the developed procedure involving MASE and LC-LC-UV provided acceptable recoveries (range, 80-120%) and RSDs (<12%) at levels of 10 microg/kg (n=9) and 50 microg/kg (n=7), respectively, for most analyte/matrix combinations. Recoveries from aged residue samples spiked at a level of 100 microg/kg (n=7) ranged, depending of the analyte/soil type combination, from 41-113% with RSDs ranging from 1-35%. In the SRM approach the developed LC-LC procedure was applied for the determination of linuron in 28 sandy soil samples collected in a field study. Linuron could be determined in soil with a limit of quantitation of 10 microg/kg.