Infant multiple mandibular fracture: case report / Fractura múltiple mandibular en infante: reporte de caso

Infant facial fracture incidence is low. Most reported cases affect the jaw and are single fractures. We present a twenty-two-month old patient, who had a high-energy car accident. Among other injures, she suffered a multiple mandibular fracture: bicondylar, left body and right parasymphyseal. Stable internal fixation of parasymphyseal and body mandibular fracture was performed on the third day. Condylar fractures had a functional treatment with switching elastic traction to prevent ankylosis. Computed tomography (CT) showed mandibular condyles remodelling after six months. Clinical examination showed that mandibular movement ranges were preserved without alteration. Successful treatment of paediatric patients is based on the achievement of an adequate anatomic reduction and the stability of the fracture, allowing opportune form and function recovery, in order to assure further development of dental and facial structures...

La incidencia de fracturas faciales en infantes es baja. Los casos reportados muestran que afectan principalmente a la mandíbula y corresponden a fracturas únicas. Presentamos una paciente de 22 meses de edad, que sufre accidente automovilístico. Resulta entre otros, con múltiples frac-turas mandibulares: bicondílea, de cuerpo izquierdo y parasinfisiaria derecha. Al tercer día se realiza fijación interna estable en fractura parasinfisiaria y de cuerpo mandibular y tratamiento funcional de las frac-turas condíleas a través de tracción elástica alterna-da, para prevenir la anquilosis. Tomografía computa-da a los seis meses muestra remodelación de los cóndilos mandibulares. Al examen clínico los rangos de movimiento mandibular están conservados y sin alteración. El éxito del tratamiento en pacientes pediátricos se basa en obtener una adecuada reducción anatómica y estabilidad de la fractura, que permita recuperar oportunamente forma y función, asegurando el futuro desarrollo de las estructuras dentarias y faciales.

Effects of a short-term occupational therapy intervention in an acute geriatric unit. A randomized clinical trial.

OBJECTIVES: To compare the benefits of a short-term occupational therapy intervention (OTI) when added to the conventional treatment model (CTM) in the functional recovery of patients admitted to an acute geriatric unit (AGU). STUDY DESIGN: Non-pharmacological randomized clinical trial. 400 patients were randomized to OTI (n = 198) or CTM (n = 202) group. Mean age 83.5. Interventions included needs assessment, iatrogenic prevention, retraining in activities of daily living, and instructions for caregivers in three groups of patients defined a priori (cardiopulmonary disease, stroke, other conditions) 5 days a week, 30-45 min a day. MAIN OUTCOME MEASURE: Recovery of ≥ 10 Barthel index points by discharge. Secondary outcome was the reduction in confusional episodes. RESULTS: The adjusted relative risk (RR) of functional recovery in the OTI group was 1.16 (95%CI 0.91-1.47). In participants with cardiopulmonary disease was 1.57 (95%CI 1.06-2.32), number needed to treat (NNT) 5. Participants with other conditions assigned to OTI had a reduction in acute confusional episodes; RR 0.48 (95% CI 0.26-0.87), NNT 7. CONCLUSIONS: Although overall there were no significant differences, patients with cardiopulmonary disease or non-stroke pathologies admitted to an AGU, may benefit from a short-term OTI.

Cardiovascular risk factors are associated with subclinical atherosclerosis in high functioning older adults.

BACKGROUND: The prevalence of subclinical atherosclerosis and its relationship with cardiovascular risk factors (CVRFs) is not well known in high functioning older adults. These data can help to decide if the implementation of preventive measures is necessary in this population. OBJECTIVE: To determine the prevalence and progression of subclinical atherosclerosis in high functioning older adults, the relationship between subclinical atherosclerosis and CVRFs, and the influence of the CVRFs on subclinical atherosclerosis progression. METHODS: Longitudinal cohort study. 246 high functioning older adults without clinical atherosclerotic disease. All subjects underwent carotid Doppler ultrasound at entry and 176 at 24 months. RESULTS: Plaque was observed in 146 (59.3%) subjects at baseline. CVRFs showed a linear relationship to the presence of plaque: plaque was observed in 32% of subjects with no CVRFs, 54.2% with 1 factor, 61.6% with 2 factors, and 69.3% with 3 or more (p=.001). Only hypertension was independently associated with the presence of plaque (OR 2.0; 95% CI 1.2-3.6; p=.013), adjusted for CVRFs. At 24 months, new plaque was observed in 20 (11.4%) subjects and carotid intima-media thickness had increased 0.02 mm per year. Subjects with plaque at baseline had a higher risk of greater total carotid plaque diameter at 2 years (OR 58.0; 95% CI, 19.7-170.5; p<.001), adjusted for all other CVRFs. CONCLUSIONS: Subclinical atherosclerosis is common in high functioning older adults and is associated with the classic CVRFs. Controlling these factors could be helpful in reducing atherosclerosis in older patients.

Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer / Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease

IntroducciónAnalizar la distribución de los síntomas psicológicos y conductuales de la demencia (SPCD) en mayores con enfermedad de Alzheimer (EA) y deterioro cognitivo leve (DCL) y su utilidad en el diagnóstico diferencial de ambas entidades.Material y métodosCiento setenta y nueve mayores de 64 años diagnosticados de DCL (n = 90) o EA (n = 89), estadio de la Global Deterioration Scale 4 o 5. Se determinaron los SPCD con la escala Neuropsychiatric Inventory. Se describe la prevalencia de los síntomas en cada grupo y se determina el riesgo que supone el presentar cada uno de los SPCD para que un paciente sea diagnosticado de EA en lugar de DCL.ResultadosSesenta y siete pacientes con DCL (74,4%) y 82 con EA (92,1%) presentaron algún SPCD (p<0,01) siendo los más prevalentes la depresión y la apatía en ambos grupos. La media de SPCD fue de 2,1 en los DCL y de 3,2 en los EA y fueron más frecuentes en pacientes con mayores lesiones isquémicas de sustancia blanca (LISB) (p<0,05). La presencia de algún SPCD aumentó el riesgo de que los pacientes fueran diagnosticados de EA en lugar de DCL (odds ratio [OR] de 3,6; intervalo de confianza [IC] del 95%: 1,4–5,7; p<0,01) tras ajustar por edad, sexo, Mini-Mental State Examination y LISB. Los SPCD asociados independientemente al diagnóstico de EA fueron los delirios (OR de 4,9; IC del 95%: 1,3–18,6; p<0,05), la apatía (OR de 2,5; IC del 95%: 1,3–4,7; p<0,01), la desinhibición (OR de 3,1; IC del 95%: 1,5–6,4; p<0,01) y las conductas motoras sin finalidad (OR de 6,3; IC del 95%: 1,7–23,4; p<0,01).ConclusionesLos SPCD son frecuentes en mayores con DCL y EA leve-moderada y pueden ayudar a diferenciar entre estas dos patologías(AU)

Material and methodsA total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities.ResultsSixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4–5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3–18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3–4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5–6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7–23.4; p<0.01).ConclusionsNPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities(AU9

Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer / Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease

IntroducciónAnalizar la distribución de los síntomas psicológicos y conductuales de la demencia (SPCD) en mayores con enfermedad de Alzheimer (EA) y deterioro cognitivo leve (DCL) y su utilidad en el diagnóstico diferencial de ambas entidades.Material y métodosCiento setenta y nueve mayores de 64 años diagnosticados de DCL (n = 90) o EA (n = 89), estadio de la Global Deterioration Scale 4 o 5. Se determinaron los SPCD con la escala Neuropsychiatric Inventory. Se describe la prevalencia de los síntomas en cada grupo y se determina el riesgo que supone el presentar cada uno de los SPCD para que un paciente sea diagnosticado de EA en lugar de DCL.ResultadosSesenta y siete pacientes con DCL (74,4%) y 82 con EA (92,1%) presentaron algún SPCD (p<0,01) siendo los más prevalentes la depresión y la apatía en ambos grupos. La media de SPCD fue de 2,1 en los DCL y de 3,2 en los EA y fueron más frecuentes en pacientes con mayores lesiones isquémicas de sustancia blanca (LISB) (p<0,05). La presencia de algún SPCD aumentó el riesgo de que los pacientes fueran diagnosticados de EA en lugar de DCL (odds ratio [OR] de 3,6; intervalo de confianza [IC] del 95%: 1,4–5,7; p<0,01) tras ajustar por edad, sexo, Mini-Mental State Examination y LISB. Los SPCD asociados independientemente al diagnóstico de EA fueron los delirios (OR de 4,9; IC del 95%: 1,3–18,6; p<0,05), la apatía (OR de 2,5; IC del 95%: 1,3–4,7; p<0,01), la desinhibición (OR de 3,1; IC del 95%: 1,5–6,4; p<0,01) y las conductas motoras sin finalidad (OR de 6,3; IC del 95%: 1,7–23,4; p<0,01).ConclusionesLos SPCD son frecuentes en mayores con DCL y EA leve-moderada y pueden ayudar a diferenciar entre estas dos patologías(AU)

Material and methodsA total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities.ResultsSixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4–5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3–18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3–4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5–6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7–23.4; p<0.01).ConclusionsNPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities(AU)

Differentiation between mild cognitive impairment and Alzheimer's disease using the FMLL mini-battery.

AIM: To construct and validate a mini-battery to discriminate between Alzheimer's disease (AD) and mild cognitive impairment (MCI) in patients seen at a hospital memory clinic. METHODS: In a cohort of 310 subjects (137 with MCI and 173 with AD), the area under the receiver operating curve (AUC) was used to select the neuropsychologic diagnostic test battery subtests with the best overall performance, namely, the Mini-Mental State Examination (MMSE, 0.715), Logical Memory II (LMII, 0.721), Verbal Fluency Test (0.747), and Lawton index (0.742). A mini-battery test was constructed with the following formulation: FMLL = [(Fluency Test/17 + MMSE/30 + LMII/32 + Lawton/8)/4] x 100. Another cohort of 87 subjects with MCI and 100 with AD was used to validate the mini-battery and to calculate the psychometric properties. RESULTS: The concurrent validity with Reisberg's Global Deterioration Scale was r = 0.792 (p < 0.001). Cronbach's alpha internal consistency was 0.6358. The AUC to diagnose MCI or AD was 0.879 (95% CI: 0.832-0.927; p < 0.001). Specificity for MCI diagnosis was 0.9 when FMLL scores were above 59% and 1 when scores were above 76%. CONCLUSION: The FMLL mini-examination is a useful tool to differentiate between MCI and AD in patients seen in a memory clinic.

[Neuropsychiatric symptoms in mild cognitive impairment and Alzheimer's disease]. / Síntomas psicológicos y conductuales en deterioro cognitivo leve y enfermedad de Alzheimer.

INTRODUCTION: To describe the neuropsychiatric symptoms (NPS) in elderly patients with either mild cognitive impairment (MCI) or Alzheimer's disease (AD) and their relevance in the differential diagnosis between the two entities. MATERIAL AND METHODS: A total of 179 subjects, aged more than 64 years old, with either MCI (n=90) or AD (n=89) and Global Deterioration Scale stage 4-5 were studied. NPS were assessed using the Neuropsychiatric Inventory scale. We identified the prevalence of the symptoms in each group and determined the risk conferred by each symptom to the differential diagnosis between the two entities. RESULTS: Sixty-seven patients with MCI (74.4%) and 82 with AD (92.1%) showed at least one NPS (p<0.01), the most prevalent being depression and apathy in both groups. The mean number of NPS was 2.1 in MCI and 3.2 in AD. NPS were more frequent in patients with more white matter ischemic lesions (WMIL) (p<0.05). The presence of at least one NPS increased the risk of being diagnosed with AD rather than MCI (odds ratio [OR] 3.6: 95% confidence interval [CI] 1.4-5.7; p<0.01) adjusted by age, sex, Mini-Mental State Examination and WMIL. The NPS independently associated with a diagnosis of AD were delusions (OR 4.9; 95% CI 1.3-18.6; p<0.05), apathy (OR 2.5; 95% CI 1.3-4.7 p<0.01), disinhibition (OR 3.1; 95% CI 1.5-6.4; p<0.01) and aberrant motor behavior (OR 6.3; 95% CI 1.7-23.4; p<0.01). CONCLUSIONS: NPS are frequent in elderly individuals with MCI and mild-moderate AD and may help to differentiate between these two entities.

Upper extremity function, an independent predictor of adverse events in hospitalized elderly.

OBJECTIVE: To examine the relationships between upper extremity function (UEF) and mortality, need for social assistance and change of residence, at discharge from hospital and at 1 month following discharge. METHODS: Observational, cohort study. SETTING: Acute Geriatric Unit of a Tertiary Teaching Hospital. SUBJECTS: 356 Consecutive patients admitted over a 6-month period. Performance of 4 UEF tasks (UEFTs) was assessed by direct observation on admission, at discharge and at 1 month after discharge: picking up a full glass, touching the scapula, cutting with a knife and unfastening a button. UEF was correlated with measures of global physical and mental functioning, namely the Barthel index, the Lawton index, Holden's FAC scale and Pfeiffer's test. The association of UEF with adverse events such as mortality, need for social assistance and change of residence was also assessed. RESULTS: UEF was well-correlated with global functioning scales (p<0.001). Using multivariant models, the inability to perform 3 or 4 UEFTs on admission was an independent predictor of mortality at discharge (OR 15.2; CI 95% 5.2-44.4) and at 1 month (OR 3.3; CI 95% 1.8-6.2), of need for social assistance at discharge (OR 2.1; CI 95% 1.1-4.1) and at 1 month (OR 3.3; CI 95% 1.1-10.1), and of change of residence at discharge (OR 3.5; CI 95% 1.2-10.4). CONCLUSIONS: UEF, independently of global functioning, is a predictor of adverse events in the hospitalized elderly. Its determination by direct observation may be an indirect measure of global functioning during hospitalization, avoiding potentially biased data facilitated by caregivers.