Diagnostic Accuracy, Item Analysis and Age Effects of the UPSIT Spanish Version in Parkinson's Disease.

OBJECTIVE: The University of Pennsylvania Smell Identification Test (UPSIT) is the most commonly used test to detect olfactory impairment in Parkinson's disease (PD), but the cut-off score for clinical purposes is often difficult to establish because of age and sex effects. The current work aims to study the sensitivity and specificity of the UPSIT Spanish version and its accuracy in discriminating PD patients at different age groups from healthy controls (HC), and to perform an item analysis. METHOD: Ninety-seven non-demented PD patients and 65 HC were assessed with the UPSIT Spanish version. Sensitivity, specificity, and diagnostic accuracy for PD were calculated. Multiple regression analysis was used to define predictors of UPSIT scores. RESULTS: Using the normative cut-off score for anosmia (≤18), the UPSIT showed a sensitivity of 54.6% with a specificity of 100.0% for PD. We found that, using the UPSIT cut-off score of ≤25, sensitivity was 81.4% and specificity 84.6% (area under the receiver operating characteristic curve = 0.908). Diagnosis and age were good predictors of UPSIT scores (B = -10.948; p < .001; B = -0.203; p < .001). When optimal cut-off scores were considered according to age ranges (≤60, 61-70, and ≥71), sensitivity and specificity values were >80.0% for all age groups. CONCLUSIONS: In the Spanish UPSIT version, sensitivity and specificity are improved when specific cut-off scores for different age groups are computed.

Cortical thinning correlates of changes in visuospatial and visuoperceptual performance in Parkinson's disease: A 4-year follow-up.

BACKGROUND: Growing evidence highlights the relevance of posterior cortically-based cognitive deficits in Parkinson's disease (PD) as possible biomarkers of the evolution to dementia. Cross-sectional correlational studies have established a relationship between the degree of atrophy in posterior brain regions and visuospatial and visuoperceptual (VS/VP) impairment. The aim of this study is to address the progressive cortical thinning correlates of VS/VP performance in PD. METHODS: Forty-four PD patients and 20 matched healthy subjects were included in this study and followed for 4 years. Tests used to assess VS/VP functions included were: Benton's Judgement of Line Orientation (JLOT), Facial Recognition (FRT), and Visual Form Discrimination (VFDT) Tests; Symbol Digit Modalities Test (SDMT); and the Pentagon Copying Test (PCT). Structural magnetic resonance imaging data and FreeSurfer were used to evaluate cortical thinning evolution. RESULTS: PD patients with normal cognition (PD-NC) and PD patients with mild cognitive impairment (PD-MCI) differed significantly in the progression of cortical thinning in posterior regions. In PD-MCI patients, the change in VS/VP functions assessed by PCT, JLOT, FRT, and SMDT correlated with the symmetrized percent change of cortical thinning of occipital, parietal, and temporal regions. In PD-NC patients, we also observed a correlation between changes in FRT and thinning in parieto-occipital regions. CONCLUSION: In this study, we establish the neuroanatomical substrate of progressive changes in VS/VP performance in PD patients with and without MCI. In agreement with cross-sectional data, VS/VP changes over time are related to cortical thinning in posterior regions.

The utility of genotypic tropism testing in clinical practice.

A review of a large number of HIV-1 tropism test requests (n = 1148) performed at a London tertiary referral centre was carried out. The aim was to establish whether these were being performed in line with recommendations from published guidelines and whether this represented the most cost-effective use of these tests in informing prescribing decisions of the CCR5 antagonist drug, maraviroc. The cost of these assays within the UK was covered by commercial funding until April 2013 which has subsequently been withdrawn. Furthermore, all healthcare settings are under increasing cost constraints and hence establishing the real utility and appropriate use of these tests is of vital importance.

Structural MRI correlates of the MMSE and pentagon copying test in Parkinson's disease.

BACKGROUND: Cognitive impairment in Parkinson's disease (PD) is common and recent studies have focused on addressing the most suitable screening tool for its assessment. MMSE is commonly used in clinical practice and longitudinal studies found a relationship between the MMSE pentagon copying item and progression to dementia, but its neuroanatomical correlates have been poorly investigated. The aim of this study is to investigate the MRI structural correlates of the global MMSE and the pentagon item scores in PD patients in the absence of dementia. METHODS: We selected a sample of 92 PD patients and 36 controls. MMSE was used as a global measure of cognitive status, and the pentagon copying test as a measure of visuospatial performance. FreeSurfer software was used to assess intergroup differences in cortical thickness (CTh) and global atrophy measures, as well as their relationship with cognitive performance. RESULTS: Compared to controls, patients showed significant differences in measures of global atrophy, which correlated with performance on MMSE and the pentagon item. Regional differences in CTh were seen between PD patients and controls bilaterally in the temporo-parietal-occipital region. Patients with impaired performance compared with those of normal performance also showed CTh reductions in these regions. CONCLUSION: Our results suggest MMSE and the pentagon item reflect brain changes which at a regional level involve mainly posterior regions. Correlates of the pentagon item were seen in the same regions where PD patients exhibited significant thinning, and involved more areas and bigger cluster sizes than the correlates of MMSE global scores.

Evaluation of the Roche prototype 454 HIV-1 ultradeep sequencing drug resistance assay in a routine diagnostic laboratory.

BACKGROUND: Studies have shown that low-frequency resistance mutations can influence treatment outcome. However, the lack of a standardized high-throughput assay has precluded their detection in clinical settings. OBJECTIVE: To evaluate the performance of the Roche prototype 454 UDS HIV-1 drug resistance assay (UDS assay) in a routine diagnostic laboratory. STUDY DESIGN: 50 plasma samples, previously characterized by population sequencing and that had shown ≥1 resistance associated mutation (RAM), were retrospectively tested by the UDS assay, including 18 B and 32 non-B subtypes; viral loads between 114-1,806,407 cp/ml; drug-naive (n=27) and drug-experienced (n=23) individuals. RESULTS: The UDS assay was successful for 37/50 (74%) samples. It detected all RAMs found by population sequencing at frequencies above 20%. In addition, 39 low-frequency RAMs were exclusively detected by the UDS assay at frequencies below 20% in both drug-naïve (19/26, 73%) and drug-experienced (9/18, 50%) individuals. UDS results would lead to changes from susceptible to resistant to efavirenz (EFV) in one drug-naive individual with suboptimal response to an EFV-containing regimen and from susceptible to resistance to lamivudine (3TC) in one drug naïve subject who subsequently failed a 3TC-containing regimen and in a treatment experienced subject who had failed a 3TC-containing regimen. CONCLUSIONS: The UDS assay performed well across a wide range of subtypes and viral loads; it showed perfect agreement with population sequencing for all RAMs analyzed. In addition, the UDS assay detected additional mutations at frequencies below 20% which correlate with patients' treatment history and had in some cases important prognostic implications.

Comparative evaluation of the performance of the Abbott real-time human immunodeficiency virus type 1 (HIV-1) assay for measurement of HIV-1 plasma viral load following automated specimen preparation.

The performance of the new Abbott real-time human immunodeficiency virus type 1 (HIV-1) assay for HIV-1 RNA load determination in plasma was compared to that of the Abbott LCx HIV-1 RNA quantitative assay following automated RNA isolation by the Abbott m1000 extractor. The measured viral loads of 89 clinical specimens differed by mean 0.19 log10 copies/ml (95% confidence interval, 0.12 to 0.26 log10 copies/ml). Although the difference in viral load determinations was positively skewed in favor of the LCx assay, it did not reach statistical significance (P = 0.42). Results were linearly associated (R2 = 0.94) and strongly correlated (R = 0.96). Good performance was observed with HIV-1 subtypes other than B and circulating recombinant forms, although results obtained with two subtype G specimens and one H specimen showed a more substantial difference.

[Short-term time off work: its characteristics at a health centre from 2000-2002 inclusive]. / Incapacidad temporal: características en un centro de salud durante el período 2000-2002.

OBJECTIVE: To describe short-term time off work procedures, its duration and the determining factors in an active population covered by health insurance at a health centre. DESIGN: Descriptive and observational study of prevalence. SETTING: Ribadeo Health Centre, Lugo, Spain. PARTICIPANTS: All sickness certificates issued in 2000-2002 were included (n=1714). MAIN MEASUREMENTS: The age and sex of each patient, amount of time off, place of residence (rural/urban), job (according to CNAE-93), type of social security cover, and cause of illness (according to CIE-9) were all recorded. RESULTS: The short-term time off rate ran at 14.79 per 100 persons a year. Mean age was 40.13 (SD, 12.08); 936 (54.6%) were male. 85.7% of time-off periods were due to chronic illness, 12.2% to accidents not at work and 2.1% to accidents at work. Main associated pathologies were bone and muscular problems (25.7%), respiratory system problems (16.4%), and traumatisms (16.2%). All episodes accounted for the loss of 114,355 working days. Mean days lost per worker were 99.79 (SD, 136.37). Mean days lost per episode were 66.72 (SD, 98.79). Multivariate analysis showed that longer episodes were associated with older patients, women and the self-employed or workers at home. The longest periods off work were caused by cancer and mental disorders. CONCLUSIONS: Age, sex, job, and pathology are variables related to short-term time off work.

Incapacidad temporal: características en un centro de salud durante el período 2000-2002 / Short-term time off work: its characteristics at a health centre from 2000-2002 inclusive

Objetivo. Describir las características de los procesos de incapacidad temporal (IT), su duración y los factores determinantes en la población activa asegurada de un centro de salud. Diseño. Estudio observacional de prevalencia, descriptivo. Emplazamiento. Centro de salud de Ribadeo (Lugo). Participantes. Se incluyó el total de partes de baja de IT registrados durante el período 2000-2002 (n = 1.714). Mediciones principales. Se recogieron la edad de cada paciente, el sexo, la duración de la IT, el núcleo de residencia (rural/urbano), la actividad económica (según CNAE-93), el régimen de la seguridad social y la causa de la incapacidad (según CIE-9). Resultados. La tasa de IT fue de 14,79 por 100 personas-año. La media de edad fue de 40,13 ± 12,08 años y 936 (54,6%) procesos correspondieron a varones. Un 85,7% de las bajas se debió a enfermedades comunes, un 12,2% a accidentes no laborales y un 2,1% a accidentes laborales. Los principales grupos de enfermedades asociadas fueron las enfermedades del sistema osteomuscular (25,7%), del aparato respiratorio (16,4%) y los traumatismos (16,2%). El total de episodios supuso la pérdida de 114.355 jornadas laborales. La media de días perdidos por trabajador fue de 99,79 ± 136,37. La media de días perdidos por episodio fue de 66,72 ± 98,79. Según los resultados del análisis multivariable, los episodios de IT de mayor duración se asociaron a pacientes de mayor edad, mujeres y a los regímenes de autónomos o empleados del hogar. Las bajas más largas fueron las causadas por tumores y trastornos mentales. Conclusiones. La edad, el sexo, la profesión y la enfermedad son variables relacionadas con los procesos de IT

Objective. To describe short-term time off work procedures, its duration and the determining factors in an active population covered by health insurance at a health centre. Design. Descriptive and observational study of prevalence. Setting. Ribadeo Health Centre, Lugo, Spain. Participants. All sickness certificates issued in 2000-2002 were included (n=1714). Main measurements. The age and sex of each patient, amount of time off, place of residence (rural/urban), job (according to CNAE-93), type of social security cover, and cause of illness (according to CIE-9) were all recorded. Results. The short-term time off rate ran at 14.79 per 100 persons a year. Mean age was 40.13 (SD, 12.08); 936 (54.6%) were male. 85.7% of time-off periods were due to chronic illness, 12.2% to accidents not at work and 2.1% to accidents at work. Main associated pathologies were bone and muscular problems (25.7%), respiratory system problems (16.4%), and traumatisms (16.2%). All episodes accounted for the loss of 114 355 working days. Mean days lost per worker were 99.79 (SD, 136.37). Mean days lost per episode were 66.72 (SD, 98.79). Multivariate analysis showed that longer episodes were associated with older patients, women and the self-employed or workers at home. The longest periods off work were caused by cancer and mental disorders. Conclusions. Age, sex, job, and pathology are variables related to short-term time off work

Colecistitis enfisematosa / Emphysematous cholecistitis

No disponible

Broncoaspiración de contraste baritado / Bronchoaspiration of barium contrast medium

No disponible

Molecular epidemiology of caliciviruses causing outbreaks and sporadic cases of acute gastroenteritis in Spain.

The molecular epidemiology of human caliciviruses (HuCVs) causing sporadic cases and outbreaks of acute gastroenteritis around eastern Spain (Catalonia and the Valencian Community) was studied by reverse transcription-PCR (RT-PCR) and by sequencing part of the RNA polymerase gene in open reading frame 1. HuCVs were detected in 44 of 310 stool specimens (14.19%) negative for other enteric pathogens obtained from children with acute gastroenteritis. Norwalk-like viruses (NLVs) were the most common cause of the gastroenteritis outbreaks investigated here. They were detected in 14 out of 25 (56%) outbreaks with an identified pathogen. Genotypes producing both sporadic cases and outbreaks were diverse, with a predominance of GGII strains related to genotypes Melksham and Lordsdale. Five strains clustered with a "new variant" designated GGIIb, which was detected circulating throughout quite a few European countries in the years 2000 and 2001. The emergence mechanism of these strains might be the occurrence of intertypic recombinations between different viruses. The nucleotide sequence of part of the capsid gene (ORF2) from three of these strains demonstrated their relationship with Mexico virus.

La importancia del médico de la familia en el aprovechamiento escolar / The doctorïs of the family in the aproiment school importance

Se realizó un estudio de un año que incluyó cinco circulos infantiles y cinco escuelas donde se ubicaronlos primeros medicos de la familia en la provincia de Cienfuegos, con el propósito de analizar los alumnos con dificultades en el aprendizaje y el componente causal que podia incidir en este aspecto. Se evaluaron un total de 40 niños, 10 de circulos infantilesy 30 que correspondían a la enseñanza preuniversitaria, la mayor presentaban retraso en el desarrollo intelectual, irascibilidad, problemas en la comunicación con los demás, negativismo, etc. Algunas de estascaracterísticas no son congénitas, constituyen una consecuencia de la educación y el desarrollo de estosniños en familias incompletas y desafavorables pedagogicamente, donde el médico de la familia estableció relaciones e hizo posible que todos los niños tuvieran adelantos en el aprovechamiento escolar

La importancia del médico de la familia en el aprovechamiento escolar / The doctorïs of the family in the aproiment school importance

Se realizó un estudio de un año que incluyó cinco circulos infantiles y cinco escuelas donde se ubicaronlos primeros medicos de la familia en la provincia de Cienfuegos, con el propósito de analizar los alumnos con dificultades en el aprendizaje y el componente causal que podia incidir en este aspecto. Se evaluaron un total de 40 niños, 10 de circulos infantilesy 30 que correspondían a la enseñanza preuniversitaria, la mayor presentaban retraso en el desarrollo intelectual, irascibilidad, problemas en la comunicación con los demás, negativismo, etc. Algunas de estascaracterísticas no son congénitas, constituyen una consecuencia de la educación y el desarrollo de estosniños en familias incompletas y desafavorables pedagogicamente, donde el médico de la familia estableció relaciones e hizo posible que todos los niños tuvieran adelantos en el aprovechamiento escolar (AU)

Transient hypogammaglobulinemia in the adult. Functional assessment of T and B lymphocytes.

The woman described suffered from a pruritic erythematous rash, edema, malaise and fever which appeared during Tegretol therapy. The patient was shown to have a severe hypogammaglobulinemia with absence of circulating B lymphocytes, but normal cell-mediated immunity. There was an absence of in vitro immunoglobulin production by the patient's cells, but this was not due to excessive T-suppressor activity or lack of T-cell help. When drug administration was stopped the edema and rash began to recede promptly, and a few months later her serum immunoglobulin levels, antibody titers and in vitro immunoglobulin production became normal. This transient, probably drug-dependent case of hypogammaglobulinemia, added to three previously reported cases, stresses the need of considering non-conventional immunosuppressive drugs as a potential-etiological agent in acquired hypogammaglobulinemia.