Diagnosis and treatment of disorders of intracranial pressure: consensus statement of the Spanish Society of Neurology's Headache Study Group.

Primary intracranial pressure disorders include idiopathic intracranial hypertension and spontaneous intracranial hypotension. Remarkable advances have been made in the diagnosis and treatment of these 2entities in recent years. Therefore, the Spanish Society of Neurology's Headache Study Group (GECSEN) deemed it necessary to prepare this consensus statement, including diagnostic and therapeutic algorithms to facilitate and improve the management of these disorders in clinical practice. This document was created by a committee of experts belonging to GECSEN, and is based on a systematic review of the literature, incorporating the experience of the participants, and establishes practical recommendations with levels of evidence and grades of recommendation.

Valor pronóstico de una reevaluación precoz de la fracción de eyección reducida en insuficiencia cardíaca aguda / Prognostic value of early reassessment of reduced ejection fraction in acute heart failure

Background and objectives An improvement in left ventricular ejection fraction (LVEF) in patients with heart failure (HF) is associated with a better prognosis. Identifying these subjects early after an episode of decompensation, the necessary threshold of LVEF improvement, and its predictive factors are of great interest. Patients and methods One hundred and ten patients hospitalized for HF were prospectively reassessed at an early outpatient visit (mean of 38 days). Results and conclusions In subjects with depressed LVEF (<50%), 50.7% presented an improvement in LVEF≥5% between the acute episode and the outpatient visit. This improvement in depressed LVEF was found to be useful for identifying patients with a good prognosis (readmission due to HF+cardiovascular mortality, p=0.022) but not in patients with preserved LVEF (≥50%). Patients with improved LVEF were significantly younger and had new-onset HF, a better global longitudinal strain (GLS), and better renal function. A multivariate logistic regression model found GLS, new-onset HF, and a lower LV mass index as predictors of LVEF improvement ≥5% (AUC 0.85) (AU)

Antecedentes y objetivo La mejoría en la fracción de eyección de ventrículo izquierdo (FEVI) en insuficiencia cardíaca (IC) se relaciona con un mejor pronóstico. Identificar estos sujetos precozmente tras una descompensación, el umbral necesario de mejoría de FEVI y sus factores predictores resultan de gran interés. Pacientes y métodos Se reevaluaron prospectivamente 110 pacientes hospitalizados por IC en una visita ambulatoria precoz (media 38 días). Resultados y conclusiones En sujetos con FEVI deprimida (<50%) un 50,7% presentaron una mejoría de FEVI≥5% entre el episodio agudo y la visita ambulatoria. Esta mejoría en FEVI deprimida resultó ser útil para identificar pacientes con buen pronóstico (reingreso por IC+mortalidad cardiovascular, p=0,022), pero no en FEVI preservada (≥50%). Los pacientes con FEVI mejorada presentaban significativamente menor edad, debut de IC, mejor strain longitudinal global (SLG) y función renal. Un modelo de regresión logística multivariante seleccionó al SLG, debut de IC y un menor tamaño ventricular izquierdo como predictores de mejoría de FEVI≥5% (AUC 0,85) (AU)

Prognostic value of early reassessment of reduced ejection fraction in acute heart failure.

BACKGROUND AND OBJECTIVES: An improvement in left ventricular ejection fraction (LVEF) in patients with heart failure (HF) is associated with a better prognosis. Identifying these subjects early after an episode of decompensation, the necessary threshold of LVEF improvement, and its predictive factors are of great interest. PATIENTS AND METHODS: One hundred and ten patients hospitalized for HF were prospectively reassessed at an early outpatient visit (mean of 38 days). RESULTS AND CONCLUSIONS: In subjects with depressed LVEF (<50%), 50.7% presented an improvement in LVEF≥5% between the acute episode and the outpatient visit. This improvement in depressed LVEF was found to be useful for identifying patients with a good prognosis (readmission due to HF+cardiovascular mortality, p=0.022) but not in patients with preserved LVEF (≥50%). Patients with improved LVEF were significantly younger and had new-onset HF, a better global longitudinal strain (GLS), and better renal function. A multivariate logistic regression model found GLS, new-onset HF, and a lower LV mass index as predictors of LVEF improvement ≥5% (AUC 0.85).

[Treatment of relapsing-remitting multiple sclerosis with fingolimod in routine clinical practice]. / Tratamiento de la esclerosis multiple remitente recurrente con fingolimod en la practica clinica habitual.

INTRODUCTION: Fingolimod is a selective immunosuppressant that targets the S1P receptor, and is indicated in the treatment of aggressive relapsing-remitting multiple sclerosis (RRMS) and following treatment failure with first-order drugs. AIM: To investigate the safety and effectiveness of fingolimod under the conditions of routine clinical practice. PATIENTS AND METHODS: We conducted an observational study with prospective follow-up of patients with RRMS who received fingolimod from January 2011 until February 2014. Data assessed were the annualised relapse rate (ARR), disability measured by the Expanded Disability Status Scale (EDSS), magnetic resonance activity and the appearance of side effects. RESULTS: Our sample consisted of 122 patients, 79.5% of them females and with a mean age of 26.8 years. They were classified, according to the last treatment received, as being: naive (aggressive RRMS; n = 17), previous treatment failure (n = 67) and withdrawal of natalizumab due to risk of progressive multifocal leukoencephalopathy (n = 38). After a mean follow-up of 29.9 ± 15.9 months, the ARR and the appearance of new lesions with gadolinium enhancement were reduced in both the naive and the previous treatment failure groups. There were no differences between the various subgroups as regards the progression of EDSS or the time elapsed until the first attack or treatment failure. The risk of treatment failure is higher with a baseline EDSS > 3 (hazard ratio: 4.24; p = 0.001) and presence of IgM oligoclonal bands (hazard ratio: 2.45; p < 0.022). CONCLUSIONS: Fingolimod is an effective and well-tolerated drug under conditions of routine clinical practice. Having a baseline EDSS > 3 and IgM oligoclonal bands is predictive of a poor response to fingolimod.

TITLE: Tratamiento de la esclerosis multiple remitente recurrente con fingolimod en la practica clinica habitual.Introduccion. El fingolimod es un inmunosupresor selectivo dirigido contra el receptor SP-1, indicado en el tratamiento de la esclerosis multiple remitente recurrente (EMRR) agresiva y tras el fracaso del tratamiento con farmacos de primera linea. Objetivo. Investigar la seguridad y efectividad del fingolimod en condiciones de practica clinica habitual. Pacientes y metodos. Estudio observacional con seguimiento prospectivo de pacientes con EMRR que recibieron fingolimod desde enero de 2011 hasta febrero de 2014. Se evaluo la tasa anual de brotes (TAB), la discapacidad medida por la escala expandida del estado de discapacidad (EDSS), la actividad en la resonancia magnetica y la aparicion de efectos adversos. Resultados. Incluimos 122 pacientes, el 79,5% mujeres y con una edad media de 26,8 antilde;os. Se clasificaron segun el ultimo tratamiento recibido en: naive (EMRR agresiva; n = 17), fracaso a terapias previas (n = 67) y retirada de natalizumab por riesgo de leucoencefalopatia multifocal progresiva (n = 38). Tras un seguimiento medio de 29,9 ± 15,9 meses, se redujo de forma significativa la TAB y la aparicion de nuevas lesiones con realce de gadolinio en el grupo naive y el de fracaso a terapias previas. No ha habido diferencias en la evolucion de la EDSS ni en el tiempo hasta el primer brote o el fracaso terapeutico entre los diferentes subgrupos. El riesgo a fracaso terapeutico es mayor con la EDSS basal > 3 (hazard ratio: 4,24; p = 0,001) y presencia de bandas oligoclonales IgM (hazard ratio: 2,45; p < 0,022). Conclusiones. El fingolimod es un farmaco eficaz y seguro en la EMRR en condiciones de practica clinica habitual. Tener una EDSS basal > 3 y bandas oligoclonales IgM predice una mala respuesta al fingolimod.

Ausencia de implicación de la cistatina C en el remodelado ventricular y la insuficiencia cardiaca / Absence of cystatin C involvement in ventricular remodelling and heart failure

La cistatina C (CisC) es una proteasa codificada por genes de mantenimiento («housekeeping genes»). Aunque su valor pronóstico en la insuficiencia cardiaca (IC) es bien conocido, se debate si es debido a su mayor precisión en la estimación del filtrado glomerular, o a su implicación en el remodelado ventricular patológico. El propósito de este estudio fue comprobar si la expresión de CisC se modificaba en el miocardio de fetos de diferentes edades y en el de adultos con diversas enfermedades cardiovasculares, así como analizar la correlación entre sus concentraciones séricas y la estructura y morfología cardiaca en un grupo de pacientes con IC. Pacientes y métodos. Se analizaron las correlaciones (test de Pearson y Spearman) entre la CisC sérica y los parámetros ecocardiográficos de 351 pacientes con IC. También se realizó una tinción inmunohistoquímica para CisC, metaloproteinasa 9 (MMP-9) y desmina en 9 muestras de tejido cardiaco procedentes de las autopsias de 4 fetos con diferente edad gestacional y 5 adultos sanos o con enfermedad cardiovascular. Resultados. En pacientes con IC no se encontró correlación entre las concentraciones de CisC y los parámetros cardiacos medidos por ecocardiografía 2D. La inmunohistoquímica mostró una débil tinción de fondo para CisC en todas las muestras, independientemente de la edad y la presencia o no de enfermedades cardiovasculares. Conclusiones. Nuestros resultados sugieren que la CisC no tiene un papel significativo en el remodelado patológico del ventrículo izquierdo en la IC (AU)

Cystatin C (CysC) is a protease encoded by housekeeping genes. Although its prognostic value in heart failure (HF) is well known, it is debatable whether this value is due to the greater accuracy of CysC in calculating the glomerular filtration rate or to its involvement in pathological ventricular remodelling. The aim of this study was to determine whether CysC expression changes in the myocardium of foetuses of different ages and in the myocardium of adults with various cardiovascular diseases, as well as to analyse the correlation between its serum concentrations and cardiac structure and morphology in a patient group with HF. Patients and methods. We analysed the correlations (Pearson's r and Spearman's test) between the serum CysC levels and echocardiographic parameters of 351 patients with HF. We also performed immunohistochemical staining for CysC, metalloproteinase-9 (MMP-9) and desmin in 9 cardiac tissue samples from autopsies of 4 foetuses of different gestational ages and 5 healthy adults or adults with cardiovascular disease. Results. For the patients with HF, there was no correlation between the CysC concentrations and the cardiac parameters measured by 2D echocardiography. The immunohistochemistry showed a weak background staining for CysC in all samples, regardless of age and the presence or absence of cardiovascular diseases. Conclusions. Our results suggest that CysC does not have a significant role in the pathological remodelling of the left ventricle in HF (AU)

Absence of cystatin C involvement in ventricular remodelling and heart failure.

UNLABELLED: Cystatin C (CysC) is a protease encoded by housekeeping genes. Although its prognostic value in heart failure (HF) is well known, it is debatable whether this value is due to the greater accuracy of CysC in calculating the glomerular filtration rate or to its involvement in pathological ventricular remodelling. The aim of this study was to determine whether CysC expression changes in the myocardium of foetuses of different ages and in the myocardium of adults with various cardiovascular diseases, as well as to analyse the correlation between its serum concentrations and cardiac structure and morphology in a patient group with HF. PATIENTS AND METHODS: We analysed the correlations (Pearson's r and Spearman's test) between the serum CysC levels and echocardiographic parameters of 351 patients with HF. We also performed immunohistochemical staining for CysC, metalloproteinase-9 (MMP-9) and desmin in 9 cardiac tissue samples from autopsies of 4 foetuses of different gestational ages and 5 healthy adults or adults with cardiovascular disease. RESULTS: For the patients with HF, there was no correlation between the CysC concentrations and the cardiac parameters measured by 2D echocardiography. The immunohistochemistry showed a weak background staining for CysC in all samples, regardless of age and the presence or absence of cardiovascular diseases. CONCLUSIONS: Our results suggest that CysC does not have a significant role in the pathological remodelling of the left ventricle in HF.

A safer disposal of hazardous phosphate coating sludge by formation of an amorphous calcium phosphate matrix.

Phosphate coating hazardous wastes originated from the automotive industry were efficiently encapsulated by an acid-base reaction between phosphates present in the sludge and calcium aluminate cement, yielding very inert and stable monolithic blocks of amorphous calcium phosphate (ACP). Two different compositions of industrial sludge were characterized and loaded in ratios ranging from 10 to 50 wt.%. Setting times and compressive strengths were recorded to establish the feasibility of this method to achieve a good handling and a safe landfilling of these samples. Short solidification periods were found and leaching tests showed an excellent retention for toxic metals (Zn, Ni, Cu, Cr and Mn) and for organic matter. Retentions over 99.9% for Zn and Mn were observed even for loadings as high as 50 wt.% of the wastes. The formation of ACP phase of low porosity and high stability accounted for the effective immobilization of the hazardous components of the wastes.

Réplica: Red de cuidadores informales de los pacientes con demencia en la provincia de Alicante, descripción de sus características / Reply to: "informal caregivers network of patients with dementia in Alicante province, characteristics description"

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Experiencia clínica con los cannabinoides en la terapia de la espasticidad en la esclerosis múltiple / Clinical experiences with cannabinoids in spasticity management in multiple sclerosis

Introducción: La espasticidad es un síntoma muy frecuente entre los pacientes con esclerosis múltiple (EM). El objetivo del presente estudio es evaluar la efectividad y la seguridad de la combinación de delta-9-tetrahidrocannabinol (THC) y cannabidiol (CBD) en la práctica clínica del tratamiento de la espasticidad en EM. Métodos: Estudio observacional retrospectivo con los pacientes tratados con THC/CBD inhalado de abril del 2008 a marzo del 2012. Se recogieron variables descriptivas de paciente y tratamiento. La respuesta se evaluó mediante impresión global de respuesta terapéutica analizada por el médico. Resultados: Cincuenta y seis pacientes iniciaron tratamiento, 6 fueron excluidos por falta de datos. Se evaluó a 50 pacientes (42% hombres), mediana de edad 47,8 años, el 38% de ellos diagnosticados de EM primaria progresiva, el 44% de EM secundaria progresiva y el 18% de EM remitente recurrente. El motivo de prescripción fue espasticidad (44%), dolor (10%) o ambos (46%). Se suspendió tratamiento en 16 pacientes por inefectividad (7 pacientes), abandono (4) y efectos adversos (5). La mediana de tiempo de exposición de los pacientes que suspendieron tratamiento fue 30 días y 174 días para los que continuaban tratamiento al final del estudio. THC/CBD fue efectivo en un 80% de pacientes, con dosis mediana de 5 (2-10) pulverizaciones/ día. El perfil de efectos adversos fue: mareo (11 pacientes), somnolencia (6), debilidad muscular (7), molestias bucales (2), diarrea (3), sequedad de boca (2), visión borrosa (2), agitación (1), náuseas (1), ideas paranoides (1). Conclusiones: THC/CBD se muestra como una buena alternativa al tratamiento habitual mejorando la espasticidad refractaria en la EM con perfil de toxicidad aceptable

Introduction: Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta- 9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS. Methods: Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor’s analysis and overall impression. Results: Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data.We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of thestudy. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1). Conclusions: THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile

Treatment of toxic metal aqueous solutions: encapsulation in a phosphate-calcium aluminate matrix.

Polyphosphate-modified calcium aluminate cement matrices were prepared by using aqueous solutions polluted with toxic metals as mixing water to obtain waste-containing solid blocks with improved management and disposal. Synthetically contaminated waters containing either Pb or Cu or Zn were incorporated into phosphoaluminate cement mortars and the effects of the metal's presence on setting time and mechanical performance were assessed. Sorption and leaching tests were also executed and both retention and release patterns were investigated. For all three metals, high uptake capacities as well as percentages of retention larger than 99.9% were measured. Both Pb and Cu were seen to be largely compatible with this cementitious matrix, rendering the obtained blocks suitable for landfilling or for building purposes. However, Zn spoilt the compressive strength values because of its reaction with hydrogen phosphate anions, hindering the development of the binding matrix.

Clinical experiences with cannabinoids in spasticity management in multiple sclerosis.

INTRODUCTION: Spasticity is a common symptom among patients with multiple sclerosis (MS). This study aims to assess the effectiveness and safety of the combination of delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) in clinical practice for the treatment of spasticity in MS. METHODS: Retrospective observational study with patients treated with inhaled THC/CBD between April 2008 and March 2012. Descriptive patient and treatment variables were collected. Therapeutic response was evaluated based on the doctor's analysis and overall impression. RESULTS: Of the 56 patients who started treatment with THC/CBD, 6 were excluded because of missing data. We evaluated 50 patients (42% male) with a median age 47.8 years (25.6-76.8); 38% were diagnosed with primary progressive MS, 44% with secondary progressive MS, and 18% with relapsing-remitting MS. The reason for prescribing the drug was spasticity (44%), pain (10%), or both (46%). Treatment was discontinued in 16 patients because of ineffectiveness (7 patients), withdrawal (4), and adverse effects (5). The median exposure time in patients whose treatment was discontinued was 30 days vs 174 days in those whose treatment continued at the end of the study. THC/CBD was effective in 80% of patients at a median dose of 5 (2-10) inhalations/day. The adverse event profile consisted of dizziness (11 patients), somnolence (6), muscle weakness (7), oral discomfort (2), diarrhoea (3), dry mouth (2), blurred vision (2), agitation (1), nausea (1), and paranoid ideation (1). CONCLUSIONS: THC/CBD appears to be a good alternative to standard treatment as it improves refractory spasticity in MS and has an acceptable toxicity profile.

Solidification/stabilization of toxic metals in calcium aluminate cement matrices.

The ability of calcium aluminate cement (CAC) to encapsulate toxic metals (Pb, Zn and Cu) was assessed under two curing conditions. Changes in the consistency and in the setting time were found upon the addition of the nitrates of the target metals. Both Pb and Cu caused a delay in CAC hydration, while Zn accelerated the stiffening of the mortar. Compressive strengths of the metal-doped mortars, when initially cured at 60 °C/100% RH, were comparable with that of the free-metal mortar. Three different pore size distribution patterns were identified and related to the compounds identified by XRD and SEM. Sorbent capacities of CAC for the toxic metals were excellent: a total uptake was achieved for up to 3 wt.% loading of the three metals. In this way, CAC mortars were perfectly able to encapsulate the toxic metals, allowing the use of CAC for waste management as proved by the leaching tests.

Red de cuidadores informales de los pacientes con demencia en la provincia de Alicante, descripción de sus características / Characteristics of informal caregivers of patients with dementia in Alicante province

Introducción: Los cuidadores informales garantizan el cuidado de los pacientes con demencia, prolongando la estancia en su domicilio. Objetivos: Describir las características de los pacientes con demencia de la provincia de Alicante, así como los perfiles y roles de los cuidadores implicados en su manejo. Pacientes y métodos: Estudio prospectivo multicéntrico realizado en 4 consultas de neurología de la provincia de Alicante (junio del 2009-enero del 2010). Inclusión consecutiva de familiares/cuidadores de pacientes con demencia. Analizamos: a) datos demográficos del paciente y cuidadores (edad/sexo, estado civil/laboral, estudios, parentesco); b) unidad de convivencia del paciente; c) motivación para el cuidado del cuidador principal (CP); d) roles del cuidador secundario (CS); e) nacionalidad del cuidador formal (CF) y origen remuneración (privada/institucional), y f) formación en demencias de los cuidadores. Resultados: Nuestros pacientes residen en su domicilio (74,8%). Principalmente, son mujeres (69%) con enfermedad de Alzheimer (78,4%) moderadamente grave (GDS 4-5, 71,6%). CP y CS son mujeres (72,1% vs 60,5%), de edad media, parentesco directo (hijo/a 64,3% vs 54,4%), nivel cultural bajo y amas de casa. Las primeras garantizan el cuidado por obligación moral (75%), las segundas se ocupan del ocio/estimulación del paciente (82,3%). Los grandes ausentes son los varones (73,3%), quienes residen lejos del familiar (52,4%). El CF es una mujer (91,7%), espa˜nola (81,8%) con remuneración privada. Conclusiones: La mujer es el elemento principal en la red de cuidadores de pacientes con demencia: como CP, de apoyo o CF (todos con escasa formación en demencias), siendo el varón el gran ausente. Conocer la estructura de cuidados de estos pacientes facilitará su manejo (AU)

Introduction: Informal caregivers provide care to dementia patients, and this service prolongs their stay at home. Objectives: To describe characteristics of dementia patients in the province of Alicante, as well as the profiles and roles of caregivers who assist them. Patients and methods: Multi-centre prospective study carried out in 4 neurology departments in Alicante (June 2009 to January 2010). Dementia patients’ relatives/caregivers were included in sequential order. The following variables were analysed: a) Demographic information pertaining to the patient and caregivers (age, sex, marital and employment status, educational level, relationship to patient); b) patient’s family unit; c) motivating factor for primary caregiver (PC); d) secondary caregiver (SC) roles; e) country of citizenship of formal caregiver (FC) and source of remuneration (private/public); f) caregivers’ knowledge of dementia. Results: Most of our patients live at home (74.8%), and are female (69%) with Alzheimer’s disease (78.4%) in a moderately severe stage (GDS level 4-5, 71.6%). PCs and SCs are mainly women (72.1% and 60.5% respectively), middle-aged and directly related to the patient (sons/daughters account for 64.3% of the PCs and 54.4% of the SCs); most are homemakers with a low educational level. Caregivers in the first category (PC) provide care due to moral obligation (75%), while those in the second (SC) involve patients in leisure or other stimulating activities (82.3%). Absent caregivers tend to be males (73.3%) residing long distances from the relative (52.4%). The FC tends to be female (91.7%), Spanish (81.8%) and privately remunerated. Conclusions: Women dominate the network of caregivers for dementia patients, whether as principal caregivers, supporting caregivers or formal caregivers (in all cases, they have only limited training in dementia management). Males are largely absent. Better knowledge of the care structure supporting dementia patients may be helpful in the overall management of these patients (AU)

Characteristics of informal caregivers of patients with dementia in Alicante province.

INTRODUCTION: Informal caregivers provide care to dementia patients, and this service prolongs their stay at home. OBJECTIVES: To describe characteristics of dementia patients in the province of Alicante, as well as the profiles and roles of caregivers who assist them. PATIENTS AND METHODS: Multi-centre prospective study carried out in 4 neurology departments in Alicante (June 2009 to January 2010). Dementia patients' relatives/caregivers were included in sequential order. The following variables were analysed: a) Demographic information pertaining to the patient and caregivers (age, sex, marital and employment status, educational level, relationship to patient); b) patient's family unit; c) motivating factor for primary caregiver (PC); d) secondary caregiver (SC) roles; e) country of citizenship of formal caregiver (FC) and source of remuneration (private/public); f) caregivers' knowledge of dementia. RESULTS: Most of our patients live at home (74.8%), and are female (69%) with Alzheimer's disease (78.4%) in a moderately severe stage (GDS level 4-5, 71.6%). PCs and SCs are mainly women (72.1% and 60.5% respectively), middle-aged and directly related to the patient (sons/daughters account for 64.3% of the PCs and 54.4% of the SCs); most are homemakers with a low educational level. Caregivers in the first category (PC) provide care due to moral obligation (75%), while those in the second (SC) involve patients in leisure or other stimulating activities (82.3%). Absent caregivers tend to be males (73.3%) residing long distances from the relative (52.4%). The FC tends to be female (91.7%), Spanish (81.8%) and privately remunerated. CONCLUSIONS: Women dominate the network of caregivers for dementia patients, whether as principal caregivers, supporting caregivers or formal caregivers (in all cases, they have only limited training in dementia management). Males are largely absent. Better knowledge of the care structure supporting dementia patients may be helpful in the overall management of these patients.

Encapsulation, solid-phases identification and leaching of toxic metals in cement systems modified by natural biodegradable polymers.

Cement mortars loaded with Cr, Pb and Zn were modified by polymeric admixtures [chitosans with low (LMWCH), medium (MMWCH) and high (HMWCH) molecular weight and hydroxypropylchitosan (HPCH)]. The influence of the simultaneous presence of the heavy metal and the polymeric additive on the fresh properties (consistency, water retention and setting time) and on the compressive strength of the mortars was assessed. Leaching patterns as well as properties of the cement mortars were related to the heavy metals-bearing solid phases. Chitosan admixtures lessened the effect of the addition of Cr and Pb on the setting time. In all instances, chitosans improved the compressive strength of the Zn-bearing mortars yielding values as high as 15 N mm(-2). A newly reported Zn phase, dietrichite (ZnAl(2)(SO(4))(4)·22H(2)O) was identified under the presence of LMWCH: it was responsible for an improvement by 24% in Zn retention. Lead-bearing silicates, such as plumalsite (Pb(4)Al(2)(SiO(3))(7)), were also identified by XRD confirming that Pb was mainly retained as a part of the silicate network after Ca ion exchange. Also, the presence of polymer induced the appearance and stabilization of some Pb(IV) species. Finally, diverse chromate species were identified and related to the larger leaching values of Cr(VI).

Cefalea menstrual: subtipos, fenotipos clínicos y tratamiento / Menstrual headache: subtypes, clinical phenotypes and treatment

Introducción. Más del 60% de las mujeres refieren presentar cefalea relacionada con el ciclo menstrual. Se ha incluido la ‘migraña menstrual’ en la segunda edición de la Clasificación Internacional de las Cefaleas; sin embargo, la ‘cefaleatensional durante la menstruación’ es una entidad no reconocida por la Sociedad Internacional de Cefaleas.Objetivos. Evaluar la prevalencia de los diferentes subtipos de cefalea menstrual y analizar sus características clínicas y eltratamiento prescrito.Pacientes y métodos. Evaluamos de forma prospectiva a todas las mujeres atendidas en varias consultas de neurología,desde enero a noviembre de 2008, cuya cefalea aparecía durante el período menstrual. Resultados. Se incluyeron un total de 108 pacientes durante el período del estudio, con una edad media de 34,8 ± 8,9 años. El 29,3% presentaba migraña menstrual pura, el 58,7% migraña menstrual relacionada con la menstruación, el 4,5% cefalea tensional pura durante la menstruación y el 7,5% cefalea tensional relacionada con la menstruación. Conclusiones. Nuestros resultados sugieren que la cefalea tensional en el contexto de la menstruación existe, con unaprevalencia en torno al 12% en las pacientes valoradas en nuestras consultas (AU)

Introduction. Up to 60% of women relate their episodes of headache to menstrual cycle. Menstrual migraine has been included in the second edition of the International Classification of Headache disorders. Menstrual tension-type headache has not yet been recognised by the International Headache Society. Aims. To evaluate the prevalence of different subtypes of menstrual headache and to analyze their clinical features and the treatment prescribed. Patients and methods. We prospectively included women attending several neurology outpatient clinics, from January toNovember 2008 whose headache appeared during the menstrual period. Results. A total of 108 patients were included during the study period. Mean age was 34.8 ± 8.9 years-old. 29.3% sufferedfrom pure menstrual migraine, 58.7% from menstrual related migraine, 4.5% from pure menstrual tension-type headacheand 7.5% from menstrual related tension type headache.Conclusions. Our data suggest that menstrual related tension-type headaches exist with a prevalence found about 12%, inour neurology outpatient clinics

Interaction of carboxymethylchitosan and heavy metals in cement media.

The performance of an etherified chitosan, carboxymethylchitosan (CMCH), when added to cement mortars doped with heavy metals, was assessed. In the presence of heavy metals (Cr, Pb, Zn) strong modifications of the fresh-state properties were evaluated. The addition of the polymer was seen to be useful in minimising some of these modifications, as those related to the setting time. A competitive mechanism for adsorption between the oxoanionic form of the metals and the carboxylate groups of the chitosan derivative was established. Studies on the metal chelating ability of the polymer and leaching from the hardened specimens showed scarce complexation under alkaline conditions, pointing to physical entrapment based on metal adsorption. However, significant chelation of metals was proved at near-neutral pH, suggesting the potential usefulness of the polymer as an agent for removing heavy metals from polluted waters and subsequently immobilizing them in cement mortars. Leaching tests carried out on polymer-metal complex-bearing samples showed a reduction in the amount of released Pb and Zn.