Factors associated with Mediterranean diet adherence in Huntington's disease.

BACKGROUND & AIMS: Little is known about the importance of the Mediterranean Diet (MeDi) and dietary intake as environmental neuroprotective factors in Huntington's disease (HD); so, we evaluated and analyzed the prevalence and factors associated with MeDi adherence, and dietary intake in HD. METHODS: Spanish participants of the European Huntington Disease Network (EHDN) Registry study diagnosed with HD or premanifest HD gene carriers were included from June 2012 to August 2013. Self-reported dietary intake was collected by 3-day dietary record, MeDi adherence was assessed by 0-9 range (proposed by Trichopoulou et al.) and, other contributing factors related to nutrition were collected by telephone. Demographics and clinical variables were obtained from the EHDN Registry study database. Association of HD with MeDi adherence and nutritional characteristics were performed using logistic regression models. RESULTS: Ninety eight participants were included in the study, median age of 48 years (38-60 range), and median total functional capacity (TFC) 9 (5-13 range). HD severity was similar between participants with low vs moderate/high MeDi; however, quality of life (P = 0.009) was significantly higher among participants with moderate/high MeDi adherence. In terms of nutrients, higher MUFA/SFA intake was moderately correlated with better TFC and Unified HD Rating Scale (UHDRS) cognitive. Better TFC was associated with having a caregiver (OR = 11.86, P < 0.001), and non-smoking (OR = 0.21, P = 0.013). Moderate adherence to MeDi, was associated with older participants (OR = 1.19, P = 0.031), lower comorbidity (OR = 0.18, P = 0.018), lower UHDRS motor (OR = 0.90, P = 0.041), and lower risk for abdominal obesity (OR = 0.02, P = 0.011). CONCLUSIONS: In HD the moderate MeDi adherence is associated with better quality of life, lower comorbidity, lower motor impairment and lower risk for abdominal obesity compared to those participants with low MeDi adherence.

Postdural puncture headache: impact of needle type, a randomized trial.

BACKGROUND CONTEXT: The most common adverse event after a lumbar puncture (LP) is a headache: In anaesthesiology, well studied is the protective effect of atraumatic spinal needles, and they are routinely used. However, this is less well known in diagnostic LP, and neurologists use atraumatic needles in less than 2% of times. PURPOSE: The purpose of this study was to define the impact of needle type, atraumatic (Sprotte [S]) versus traumatic (Quincke [Q]) on postdural puncture headache (PDPH) incidence. STUDY DESIGN: The study is based on a prospective, randomized, and simple-blinded clinical trial. PATIENT SAMPLE: Patients older than 14 years were scheduled for a diagnostic or therapeutic LP. OUTCOME MEASURES: The outcome measure included the development of PDPH according to the International Headache Association criteria. METHODS: Patients fulfilling eligibility criteria were randomly allocated to one of two kinds of spinal needle: atraumatic or S-type or traumatic or Q-type. They were interviewed on days 2 and 7 about the development of PDPH. RESULTS: The incidence of PDPH was 22.43% with Q-type needle and 8.51% with S-type needle, p=.04. The duration of PDPH in patients in the S-type was 1 day or less, compared with a median of 4.14 days in the Q-type (p=.00). In the logistic regression model, the S-type needle together with the age of the patient were the only two statistically significant factors in the development of postlumbar puncture headache (PLPH), both of them being protective. CONCLUSIONS: We found a lower incidence of PDPH with atraumatic needles, and it was statistically significant compared with the traumatic needles. Our study confirms the effectiveness of the atraumatic needles to prevent PDPH.

Rubella vaccination of unknowingly pregnant women during 2006 mass campaign in Argentina.

We report a prospective study of 56 pregnant women inadvertently vaccinated with rubella vaccine during the 2006 campaign performed in Argentina. Of these patients, 48 (87%) were immune, whereas the remaining 9 (16%) were susceptible. In the latter group, 7 presented with a primary reaction to the vaccine confirmed through immunoglobulin (Ig) G antibody avidity testing or seroconversion of IgG titers. During the clinical and laboratory follow-up, newborns did not present evidence of infection or malformations compatible with congenital rubella syndrome.

Tratamiento de tumores neuroendocrinos (TNE) con péptidos análogos de la somatostatina marcados con radionucleidos / Treatment of neuroendocrine tumors (NET) with radiolabelled somatostatin analogues

Propósito. Los TNE avanzados tienen escasa respuesta a radioterapia o quimioterapia, el tratamiento sistémico con análogos de la SST radiactivos es una herramienta promisoria en su tratamiento. Presentamos nuestra experiencia, pionera en Latinoamérica, utilizando análogos de SST marcados con 90Y ó 177Lu. Material. Evaluamos 40 pacientes (50.3 años, rango 12-74) con TNE confirmados histológicamente y sobre-expresión de receptores de SST demostrada mediante imágenes. SPECT (111In-DOTATOC) ó PET/CT (68Ga-DOTATATE). Se evaluó respuesta clínica, laboratorio, imágenes con 111In-DOTATATE, post-terapia con 90Y ó 177Lu, 68Ga-DOTATATE PET/CT o TAC. Resultados. Observamos progresión de enfermedad en 10 (25.0 por ciento), remisión parcial en 25 (62.5 por ciento), enfermedad estable en 3 (7.5 por ciento) y remisión completa en 2 (5.0 por ciento). Hubo escasa toxicidad sin deterioro renal significativo. Observamos reducción tumoral y mejoría de calidad de vida en la mayoría de los pacientes. Conclusión. La terapia con radiopéptidos es un procedimento seguro y efectivo en el tratamiento de TNE avanzados.

Purpose. Advanced NETs have little response to radiotherapy or chemotherapy, systemic treatment with radioactive SST analogous is a promissory tool in its treatment. We present our pioneering experience in Latin America using analogous of SST labeled either with 90Y or 177Lu. Materials. We evaluated 40 patients (50.3 years, range 12-74) with histological proved NET and SST receptors over-expression demonstrated by SPECT or PET/CT images with 111In-DOTATOC or 68Ga-DOTATATE. We evaluated clinical response, laboratory test, images with 111In-DOTATATE, 90Y, 177Lu, and 68Ga-DOTATATE PET/CT or CT. Results. We observed progression of disease in 10 (7,5 percent), partial remission in 25 (62,5 percent), stable disease in 3 (7,5 percent) and complete remission in 2 (5,0 percent). There was little toxicity without significant renal deterioration. We observed tumor mass reduction and improvement of quality of life in most of the patients. Conclusion. The therapy with radiopeptides is a safe and effective procedure in the treatment of advanced NET.

Gallium-68 (68Ga); the revival of an old positron emission tomography (PET) agent: the leading experience in Chile

In January 2008, we set up a 68Ge/ 68Ga generator able to produce enough quantities of 68Ga to label the same polypeptides, somatostatin analogos, used to treat patients suffering from neuroendocrine tumors. As far as we know, this is the first time that such a device is installed in Latin-America for specific PET/CT imaging different from 18F. During the last three months we have studied 30 patients for staging, re-staging and treatment control of neuroendocrine tumors using PET/CT images with 68Ga-DOTATATE. In all cases the image quality was excellent, providing clinically useful information in most of them. 68Ga is a very promising positron emitter radionuclide, cyclotron-independent, to label peptides and other molecules that open a wide window for Molecular Imaging.

En Enero de 2008 instalamos un generador de 68Ge/ 68Ga capaz de producir cantidades suficientes de 68Ga para marcar los mismos péptidos, análogos de la somatostatina, utilizados para el tratamiento de pacientes con tumores neuroendocrinos. De acuerdo con nuestro conocimiento, esta es la primera vez que se utilizada este aparato en Latinoamérica para obtener imágenes PET/CT específicas con un agente diferente al 18F. Durante los últimos tres meses hemos estudiado 30 pacientes con tumores neuroendocrinos con 68Ga-DOTATATE para etapificación, re-etapificación y control de tratamiento mediante imágenes PET/CT. En todos los casos la calidad de la imagen fue excelente proporcionando información clínicamente útil en la mayoría de ellos. 68Ga es un promisorio radionucleido emisor de positrones, independiente de un ciclotrón, para marcar péptidos y otras moléculas abriendo una amplia ventana para las Imágenes Moleculares.

Eficacia de F18_fluorodeoxiglucosa SPECT para evaluar infarto reciente y viabilidad miocárdica / Efficacy of F18_fluorodeoxiglucose SPECT for recent infarction evaluation and myocardial viability

El mejor examen disponible para evaluar viabilidad miocárdica es el Fluor18-fluordeoxiglucosa (F18FDG) que mide metabolismo celular y utilización de glucosa como sustrato. Su asociación a marcadores de flujo miocárdico permiten conocer la existencia y extensión de tejido con función potencialmente recuperable. El objetivo de este trabajo fue evaluar el rendimiento del F18FDG SPECT en pacientes con infarto reciente de miocardio. Material y Método: Se estudiaron preliminarmente 23 pacientes (7M,16H), edad promedio 63 ñ 13 años (rango:40-85), con evolución promedio de 10 días postinfarto (rango:5-24). En 14 casos, el infarto fue anterior y en 9 casos inferior. Se realizó F18FDG en cámara ADAC doble cabezal con colimadores de 511 Kev, con dosis promedio de 211 MBq (rango: 52-444) , con adquisición de las imágenes a los 45 min postinyección. Contemporáneamente, se efectuó Tl201 SPECT reposo redistribución con dosis de 148 MBq y adquisición de imágenes a los 10 min y 3 hrs. Se realizó análisis visual de ambos estudios en forma independiente dividiendo el miocardio en 17 segmentos (total de segmentos: 391). Resultados: Tanto en el SPECT con Tl201 como en el con F18 FDG hubo 21/23 (91 por ciento) de casos con segmentos alterados, en que hubo concordancia de 83 por ciento. En el Tl201 reposo redistribución, se encontraron 32 por ciento de segmentos alterados y en el estudio conjunto Tl201 reposo F18 FDG, se observó un 34 por ciento de segmentos alterados del total de los analizados. En dichos segmentos, el Tl201 reposo redistribución mostró 65 por ciento de segmentos viables y el Tl201 F18 FDG 77 por ciento de segmentos con viabilidad. Conclusión: 1) Tanto el Tl201 como el estudio con F18 FDG tienen buena concordancia, tanto por pacientes como por segmentos, en el infarto reciente de miocardio. 2) El SPECT Tl201 asociado a F18 FDG detecta un mayor número de segmentos viables que el examen de Tl201 reposo- redistribución aislado