Factores asociados a la función cognitiva de los adultos mayores indonesios que viven en residencias de ancianos / Associated factors to the cognitive function among indonesian older adult living in nursing home

Objetivo: Muchos adultos mayores en Indonesia deciden vivir en residencias de ancianos. Vivir en un hogar de ancianos ha sido asociado al deterioro cognitivo en adultos mayores, afectando a la capacidad para llevar a cabo actividades de la vida diaria. Este estudio tuvo como objetivo determinar la asociación entre características demográficas y clínicas y la función cognitiva en adultos mayores que viven una residencia de ancianos en Indonesia. Método: Este estudio utilizó un diseño transversal, participando 60 adultos mayores de una residencia de ancianos. La función cognitiva se evaluó utilizando el instrumento Montreal Cognitive Assessment. Se evaluaron características demográficas y clínicas como edad, nivel educativo, tiempo de permanencia en la residencia, así como niveles séricos de factor neurotrófico derivado del cerebro y dopamina. Se utilizó la prueba de Spearman-rank para el análisis de datos. Resultados: La función cognitiva de atención se correlacionó positivamente con la edad (r=0,314, p=0,015) y el tiempo de permanencia en la residencia (r=0,268, p=0,038), y negativamente con los niveles séricos de dopamina (r=–0,425, p=0,001). La función cognitiva de denominación se relacionó positivamente con la edad (r=0,263, p=0,042). Conclusiones: Edad, tiempo de internado y niveles de dopamina se asociaron a la función cognitiva en adultos mayores que viven en una residencia de ancianos. El adulto mayor debe ser evaluado en cuanto a factores asociados a la función cognitiva, para realizar los programas de mejora cognitiva en residencias de ancianos.(UA)

Objective: Many older adults in Indonesia decide to live in nursing homes. Living in a nursing home has been associated with the incidence of cognitive decline in older adult that leads to decreasing ability to perform daily activity. This study aimed to determine the association between demographic and clinical characteristics with cognitive functions in older adults living in nursing homes in Indonesia. Methods: This study used a cross-sectional design and involved 60 older adults in a nursing home. Cognitive function was evaluated using the Montreal Cognitive Assessment instrument. Demographic and clinical characteristics such as age, education level, length of stay in the nursing home, as well as serum levels of brain-derived neurotrophic factor and dopamine were studied. Spearman-Rank test was used for data analysis. Results: Cognitive function of attention had a positive correlation with age (r=0.314, p=0.015), length of stay in the nursing home (r=0.268, p=0.038), and negative correlation with dopamine serum levels (r=-0.425, p=0.001). The cognitive function of naming has a positive correlation with age (r=0.263, p=0.042). Conclusions: Age, length of stay, and dopamine levels associated with cognitive function in older adult living in nursing homes. The older adult should be assessed in term of factors associated with cognitive function to make the cognitive improvement programs in nursing homes.(AU)

Associated factors to the cognitive function among indonesian older adult living in nursing home.

OBJECTIVE: Many older adults in Indonesia decide to live in nursing homes. Living in a nursing home has been associated with the incidence of cognitive decline in older adult that leads to decreasing ability to perform daily activity. This study aimed to determine the association between demographic and clinical characteristics with cognitive functions in older adults living in nursing homes in Indonesia. METHODS: This study used a cross-sectional design and involved 60 older adults in a nursing home. Cognitive function was evaluated using the Montreal Cognitive Assessment (MoCA) instrument. Demographic and clinical characteristics such as age, education level, length of stay in the nursing home, as well as serum levels of brain-derived neurotrophic factor (BDNF) and dopamine were studied. Spearman-Rank test was used for data analysis. RESULTS: Cognitive function of attention had a positive correlation with age (r=0.314, P=.015), length of stay in the nursing home (r=0.268, P=.038), and negative correlation with dopamine serum levels (r=-0.425, P=.001). The cognitive function of naming has a positive correlation with age (r=0.263, P=.042). CONCLUSIONS: Age, length of stay, and dopamine levels associated with cognitive function in older adult living in nursing homes. The older adult should be assessed in term of factors associated with cognitive function to make the cognitive improvement programs in nursing homes.

Prodromes and biological markers in schizophrenia: Importance for the dopamine, glutamate, and neurodevelopmental hypothesis / Pródromos e indicadores biológicos en la esquizofrenia: Importancia para la hipótesis dopaminérgica, glutamatérgica y del neurodesarrollo

Abstract Background Since schizophrenia is a multifactorial mental illness, a basic understanding of its etiological components improves its understanding, diagnosis, and the selection of therapeutic targets. Objective To identify the prodromes and biological markers in schizophrenic or ultra-high risk (UHR) patients and elucidate their specificity. Method Narrative review of relevant sources in English and Spanish in the Medline-PubMed database on minor physical abnormalities, cognitive abnormalities, neuroanatomical, and synaptic and cell changes present in schizophrenic patients and/or subjects with a high risk of developing schizophrenia Results Patients with SZ and, to a lesser extent, UHR subjects present phenotypic and behavioral manifestations that correlate with underlying cell processes. The study of the latter makes it possible to characterize diagnostic biomarkers. At present, its clinical application is limited by factors such as poorly understood pathophysiology, lack of study models, homology with other psychiatric disorders, and the dearth of clinical trials conducted. Discussion and conclusion Schizophrenia is the final manifestation of damage to prenatal and post-natal neurodevelopment and is reflected during the prodromal stage in early biological markers with clinical relevance. It is necessary to establish new study models that will increase knowledge to offer specific biomarkers for use in early clinical diagnosis.

Resumen Antecedentes La esquizofrenia es una enfermedad mental multifactorial. Una comprensión básica de sus componentes etiológicos mejora su entendimiento, su diagnóstico y la selección de posibles blancos terapéuticos. Objetivo Reportar los pródromos e indicadores biológicos en pacientes esquizofrénicos o de ultra-alto riesgo (UHR) y dilucidar su especificidad. Método Revisión narrativa de fuentes relevantes en inglés y español en la base de datos Medline-PubMed sobre las anomalías física menores, anomalías cognitivas, cambios neuroanatómicos, sinápticos y celulares presentes en pacientes esquizofrénicos y/o en sujetos de UHR. Resultados Los pacientes con EZ y, de manera menos predominante, los sujetos de UHR presentan manifestaciones fenotípicas y conductuales que se correlacionan con los procesos celulares subyacentes. El estudio de éstos permite caracterizar diferentes biomarcadores diagnósticos. En la actualidad, su aplicación en la clínica es limitada por distintos factores como son la fisiopatología poco comprendida, la falta de modelos de estudio, la homología con otros trastornos psiquiátricos y los escasos ensayos clínicos realizados. Discusión y conclusión La esquizofrenia es la manifestación final de daños en el neurodesarrollo prenatal y post-natal, y se refleja durante la etapa prodrómica en indicadores biológicos tempranos con relevancia clínica. Se requiere establecer nuevos modelos de estudio que permitan ampliar el conocimiento para ofrecer biomarcadores específicos para ser usados en el diagnóstico clínico temprano.

Characterization of the nigroestriatal system in a sample of patients with amyotrophic lateral sclerosis / Caracterização do sistema nigroestriatal em uma amostra de pacientes com esclerose lateral amiotrófica

Abstract Background The coexistence of amyotrophic lateral sclerosis (ALS) with clinical forms of Parkinson disease (PD), although uncommon, is found to a greater degree than one would expect by chance. The pathological mechanisms of ALS and PD are still not fully understood, and the coexistence of these two diseases suggests that they could share mechanisms in common. Objective Here we present a sample of patients with clinically definitive or probable ALS who were evaluated with single-photon emission computed tomography SPECT/TRODAT and compared with non-ALS controls. Methods Patients with clinically definite or probable ALS were assessed with the amyotrophic lateral sclerosis functional rating scale (ALSFRS) to define severity and had their demographic data collected. The TRODAT results of patients with ALS were compared with those of patients with a diagnosis of PD with less than 10 years of duration, and with patients with a diagnosis of others movement disorders not associated with neurodegenerative diseases. Results A total of 75% of patients with ALS had TRODAT results below the levels considered normal; that was also true for 25% of the patients in the control group without neurodegenerative disease, and for 100% of the patients in the PD group. A statistically significant difference was found between patients with ALS and the control group without neurodegenerative disease in the TRODAT values < 0.05. Conclusions Our study fits with the neuropathological and functional evidence that demonstrates the existence of nigrostriatal dysfunction in patients with ALS. Further research to better understand the role of these changes in the pathophysiological process of ALS needs to be performed.

Resumo Antecedentes A coexistência da esclerose lateral amiotrófica (ELA) com formas clínicas da doença de Parkinson (DP), embora incomum, é encontrada em um grau maior do que seria esperado ao acaso. Os mecanismos patológicos da ELA e da DP ainda não são totalmente compreendidos e a coexistência dessas duas doenças sugere que elas podem compartilhar mecanismos em comum. Objetivo Apresentamos uma amostra de pacientes com ELA clinicamente definida ou provável que foram avaliados com tomografia computadorizada por emissão de fóton único (SPECT)/TRODAT e comparados com controles sem ELA. Métodos Pacientes com ELA clinicamente definida ou provável foram avaliados com a escala funcional de esclerose lateral amiotrófica (ALSFRS) para definir a gravidade e foram coletados os seus dados demográficos. Os resultados do TRODAT de pacientes com ELA foram comparados com aqueles de pacientes com diagnóstico de DP com menos de 10 anos de duração e com pacientes com diagnóstico de outros distúrbios do movimento não associados a doenças neurodegenerativas. Resultados Um total de 75% dos pacientes com ELA apresentou resultados de TRODAT abaixo dos níveis considerados normais; 25% no grupo controle sem doença neurodegenerativa e 100% no grupo DP. Uma diferença estatisticamente significativa foi encontrada entre os pacientes com ELA e o grupo controle sem doença neurodegenerativa nos valores de TRODAT p< 0,05. Conclusões Nosso estudo está de acordo com as evidências neuropatológicas e funcionais que demonstram a existência de disfunção nigroestriatal em pacientes com ELA. Mais pesquisas para entender melhor o papel dessas mudanças no processo fisiopatológico da ELA precisam ser realizadas.

Anaesthetic management of a dopamine-secreting phaeochromocytoma.

Pheochromocytomas are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla. Most adrenal pheochromocytomas secrete norepinephrine and epinephrine. Dopamine secreting pheochromocytomas are extremely rare and differs from classic pheochromocytomas in clinical features, posing a significant diagnostic challenge. A 41-year-old women presented to our emergency department because of acute flank colic pain and normotension. The screening abdominal computed tomography scan revealed a left adrenal mass. The laboratory test showed significantly increase in plasma dopamine and 24-h urine dopamine. During surgical removal the patient remained hypotensive requiring doses of norepinephrine. The patient presented significant hypertensive responde during direct laryngoscopy and intubation.

Manejo anestésico de feocromocitoma productor de dopamina / Anaesthetic management of a dopamine-secreting phaeochromocytoma

El feocromocitoma es un tumor neuroendocrino raro que se origina en las células cromafines de la cresta neural del sistema nervioso autónomo. La mayoría de las feocromocitomas se caracterizan por secretar adrenalina y noradrenalina. Los productores de dopamina son infrecuentes y no presentan la sintomatología clínica típica, por lo que el diagnóstico puede ser complicado. Actualmente disponemos de escasa bibliografía sobre el manejo anestésico de este tipo de tumores.Presentamos el caso clínico de una mujer de 41 años que acudió a nuestro centro por dolor lumbar de tipo cólico de un mes de evolución y normotensión. Se realizó una tomografía axial computarizada abdominal que reveló masa hipercaptante en glándula suprarrenal izquierda. Los niveles de dopamina en orina y en plasma estaban elevados, los niveles de adrenalina y noradrenalina eran normales. Durante la intervención quirúrgica la paciente se mantuvo hipotensa precisando dosis de noradrenalina. Solo presentó un único pico hipertensivo durante la laringoscopia y la intubación orotraqueal.(AU)

Pheochromocytomas are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla. Most adrenal pheochromocytomas secrete norepinephrine and epinephrine. Dopamine secreting pheochromocytomas are extremely rare and differs from classic pheochromocytomas in clinical features, posing a significant diagnostic challenge.A 41-year-old women presented to our emergency department because of acute flank colic pain and normotension. The screening abdominal computed tomography scan revealed a left adrenal mass. The laboratory test showed significantly increase in plasma dopamine and 24-hour urine dopamine. During surgical removal the patient remained hypotensive requiring doses of norepinephrine. The patient presented significant hypertensive responde during direct laryngoscopy and intubation.(AU)

Catecholamines production by kidney tissue and mesangial cell culture is differentially modulated by diabetes / A produção de catecolaminas pelo tecido renal e a cultura de células mesangiais é modulada diferencialmente pelo diabetes

Abstract Introduction: According to the International Diabetes Federation, the number of people with diabetes mellitus may reach 700 million in 2045. Catecholamines are involved in the regulation of several kidney functions. This study investigates the effects of hyperglycemia on catecholamines' metabolism in kidney tissue from control, diabetic, and insulin-treated diabetic rats, both in vivo and in vitro. Methods: Male Wistar-Hannover rats were randomized into: control, diabetic, and insulin-treated diabetic groups. Diabetes was induced by a single injection of streptozotocin, and diabetic treated group also received insulin. After 60 days, blood and kidney tissue from all groups were collected for catecholamines' quantification and mesangial cells culture. Results: diabetic rats had lower body weight, hyperglycemia, and increase water intake and diuresis. Additionally, diabetes promoted a sharp decrease in creatinine clearance compared to control group. Regarding the whole kidney extracts, both diabetic groups (treated and non-treated) had significant reduction in norepinephrine concentration. In mesangial cell culture, catecholamines' concentration were lower in the culture medium than in the intracellular compartment for all groups. Norepinephrine, epinephrine, and dopamine medium levels were increased in the diabetic group. Conclusion: The major finding of the present study was that 8 weeks of diabetes induction altered the kidney catecholaminergic system in a very specific manner, once the production of catecholamines in the excised kidney tissue from diabetic rats was differentially modulated as compared with the production and secretion by cultured mesangial cells.

Resumo Introdução: Segundo a Federação Internacional de Diabetes, o número de pessoas com diabetes mellitus pode chegar a 700 milhões em 2045. As catecolaminas estão envolvidas na regulação de várias funções renais. Este estudo investiga os efeitos da hiperglicemia no metabolismo das catecolaminas no tecido renal de ratos controle, diabéticos e diabéticos tratados com insulina, tanto in vivo como in vitro. Métodos: Os ratos Wistar-Hannover machos foram randomizados em: grupos controle, diabéticos e diabéticos tratados com insulina. O diabetes foi induzido por uma única injeção de estreptozotocina, e o grupo diabético tratado também recebeu insulina. Após 60 dias, sangue e tecido renal dos grupos foram coletados para quantificação de catecolaminas e cultura de células mesangiais. Resultados: ratos diabéticos apresentaram peso corporal mais baixo, hiperglicemia, e aumento da ingestão de água e diurese. Ademais, o diabetes promoveu uma redução acentuada na depuração de creatinina comparado com o grupo controle. Quanto aos extratos de rim total, ambos os grupos diabéticos (tratados/não tratados) tiveram redução significativa na concentração de noradrenalina. Na cultura de células mesangiais, a concentração de catecolaminas foi menor no meio de cultura do que no compartimento intracelular para todos os grupos. Níveis médios de noradrenalina, adrenalina e dopamina estavam aumentados no grupo diabético. Conclusão: O principal achado deste estudo foi que 8 semanas de indução de diabetes alteraram o sistema catecolaminérgico renal de maneira muito específica, já que a produção de catecolaminas no tecido renal excisado de ratos diabéticos foi modulada diferencialmente comparada com produção e secreção por células mesangiais cultivadas.

Fase premonitoria, una etapa clave en la migraña / The premonitory phase: A crucial stage in migraine

Introducción: La fase premonitoria comprende una amplia esfera de síntomas que anteceden hasta en 48 horas al dolor en una crisis de migraña. Este periodo a menudo no es reconocido por el propio paciente y, sin embargo, también merma de forma significativa su calidad de vida.Al ser el estadio más precoz de una crisis de migraña es fundamental para ayudarnos a comprender puntos clave del origen de la misma.DesarrolloA lo largo de esta revisión, en forma de pregunta-respuesta, se repasan los principales estudios clínicos que analizan de forma dirigida los síntomas premonitorios, se valora la capacidad predictiva de los mismos, se relacionan estos síntomas con la biología de la migraña, se revisa el papel de la neuroimagen en esta fase y, por último, la relevancia como potencial diana terapéutica que pueda tener en un futuro.ConclusionesEl estudio de la fase premonitoria nos ha mostrado que el hipotálamo tiene un papel esencial en el origen de una crisis de migraña, y nos hace plantearnos la búsqueda de nuevas dianas en el tratamiento de una crisis de migraña dirigidas a actuar antes del inicio del dolor, un hecho que implicaría un antes y un después en la vida del paciente migrañoso. (AU)

Introduction: The premonitory phase comprises a wide range of symptoms that precede the onset of pain in a migraine episode by up to 48 hours. Premonitory symptoms are often not recognised by patients but do have a significant impact on their quality of life. As these symptoms represent the first stage of a migraine attack, they are crucial in improving our understanding of the key points of the origin of migraine.DevelopmentThis paper uses a question-answer format to review the main clinical studies analysing premonitory symptoms, their predictive capacity, the relationship between these symptoms and the biology of migraine, and the role of neuroimaging in the premonitory phase. Finally, we discuss the relevance of these symptoms as potential therapeutic targets in the future.ConclusionsThis study of the premonitory phase has demonstrated that the hypothalamus plays an essential role in the origin of migraine attacks. We should consider the search for new targets in acute migraine treatment in order to act before the onset of the pain. This would imply a radical change in the lives of patients with migraine. (AU)

Anaesthetic management of a dopamine-secreting phaeochromocytoma. / Manejo anestésico de feocromocitoma productor de dopamina.

Pheochromocytomas are rare neuroendocrine tumors that arise from chromaffin cells of the adrenal medulla. Most adrenal pheochromocytomas secrete norepinephrine and epinephrine. Dopamine secreting pheochromocytomas are extremely rare and differs from classic pheochromocytomas in clinical features, posing a significant diagnostic challenge. A 41-year-old women presented to our emergency department because of acute flank colic pain and normotension. The screening abdominal computed tomography scan revealed a left adrenal mass. The laboratory test showed significantly increase in plasma dopamine and 24-hour urine dopamine. During surgical removal the patient remained hypotensive requiring doses of norepinephrine. The patient presented significant hypertensive responde during direct laryngoscopy and intubation.

Active lifestyle enhances protein expression profile in subjects with Lewy body pathology / O estilo de vida ativo melhora o perfil de expressão de proteínas em indivíduos com a patologia de corpos de lewy

ABSTRACT. Clinical trials of the effects of physical activity have reported improvements in symptoms and quality of life in patients with Parkinson's disease (PD). Additionally, morphological brain changes after exercising were reported in PD animal models. However, these lifestyle-related changes were not evaluated in postmortem brain tissue. Objective: We aimed to evaluate, by immunohistochemistry, astrocytes, tyrosine hydroxylase (TH) and structural proteins expression (neurofilaments and microtubules — MAP2) changes in postmortem brain samples of individuals with Lewy body pathology. Methods: Braak PD stage≥III samples, classified by neuropathology analysis, from The Biobank for Aging Studies were classified into active (n=12) and non-active (n=12) groups, according to physical activity lifestyle, and paired by age, sex and Braak staging. Substantia nigra and basal ganglia were evaluated. Results: Groups were not different in terms of age or gender and had similar PD neuropathological burden (p=1.00). We observed higher TH expression in the active group in the substantia nigra and the basal ganglia (p=0.04). Astrocytes was greater in the non-active subjects in the midbrain (p=0.03) and basal ganglia (p=0.0004). MAP2 levels were higher for non-active participants in the basal ganglia (p=0.003) and similar between groups in the substantia nigra (p=0.46). Neurofilament levels for non-active participants were higher in the substantia nigra (p=0.006) but not in the basal ganglia (p=0.24). Conclusion: Active lifestyle seems to promote positive effects on brain by maintaining dopamine synthesis and structural protein expression in the nigrostriatal system and decrease astrogliosis in subjects with the same PD neuropathology burden.

RESUMO. Estudos dos efeitos da atividade física relataram melhora nos sintomas e na qualidade de vida de pacientes com doença de Parkinson (DP). Além disso, alterações morfológicas do cérebro após o exercício físico foram relatadas em modelos animais da DP. No entanto, essas mudanças relacionadas ao estilo de vida não foram avaliadas em tecido cerebral post-mortem. Objetivo: Avaliar a expressão de astrócitos, tirosina hidroxilase (TH) e a expressão de proteínas estruturais (neurofilamentos e microtúbulos — MAP2) por imuno-histoquímica, em amostras cerebrais post-mortem de indivíduos com corpos de Lewy. Métodos: Amostras com estágio de Braak para DP≥III, classificação neuropatológica, fornecidas pelo biobanco de estudos do envelhecimento foram classificadas em grupos ativos (n=12) e não ativos (n=12), de acordo com o estilo de vida (atividade física), e pareados por idade, sexo e estadiamento de Braak. Analisou-se a substância negra e gânglios da base. Resultados: Idade, sexo e classificação para DP foram semelhantes (p=1,00). Observou-se maior expressão de TH no grupo ativo (p=0,04). Amostras de não ativos revelaram maior expressão de astrócitos no mesencéfalo (p=0,03) e nos gânglios da base (p=0,0004); MAP2 nos gânglios da base (p=0,003); os níveis de neurofilamentos foram maiores na substância negra (p=0,006). Conclusão: O estilo de vida ativo parece promover efeitos positivos no cérebro, mantendo a síntese de dopamina e a expressão estrutural de proteínas no sistema nigrostriatal e com diminuição da ativação de astrócitos em indivíduos com a mesma classificação neuropatológica para a DP.

The premonitory phase: A crucial stage in migraine. / Fase premonitoria, una etapa clave en la migraña.

INTRODUCTION: The premonitory phase comprises a wide range of symptoms that precede the onset of pain in a migraine episode by up to 48hours. Premonitory symptoms are often not recognised by patients but do have a significant impact on their quality of life. As these symptoms represent the first stage of a migraine attack, they are crucial in improving our understanding of the key points of the origin of migraine. DEVELOPMENT: This paper uses a question-answer format to review the main clinical studies analysing premonitory symptoms, their predictive capacity, the relationship between these symptoms and the biology of migraine, and the role of neuroimaging in the premonitory phase. Finally, we discuss the relevance of these symptoms as potential therapeutic targets in the future. CONCLUSIONS: This study of the premonitory phase has demonstrated that the hypothalamus plays an essential role in the origin of migraine attacks. We should consider the search for new targets in acute migraine treatment in order to act before the onset of the pain. This would imply a radical change in the lives of patients with migraine.

Asociación entre el sistema de recompensa del cerebro y elección de comida en adultos mayores y de mediana edad / Association between the reward system and food choice in middle-aged and older adults

Resumen Introducción. Todos los días las personas toman diferentes decisiones relacionadas con su elección de alimentos, lo que a su vez determina sus hábitos alimenticios. El sistema de recompensa del cerebro (SRC) permite asociar ciertas situaciones con una sensación de placer, lo que influye en la posterior elección de alimentos. Objetivo. Describir cómo influye el SRC en el proceso de elección de comida en adultos de mediana edad y en adultos mayores autosuficientes. Materiales y métodos. Se realizó una búsqueda de la literatura en PubMed y SciELO. Se buscaron artículos escritos en inglés y español y publicados entre 1996 y 2018 utilizando los siguientes términos (en ambos idiomas): "elección de la comida", "sistema de recompensa", "nutrición", "adulto", "adulto mayor", "estado nutricional" y "envejecimiento". Resultados. 50 artículos cumplieron con los criterios de inclusión. Solo 1 estudio estaba escrito en español; 22 fueron realizados en adultos mayores y el resto en adultos entre 20 y 40 años. Conclusiones. Teniendo en cuenta el escaso número de estudios sobre la conducta alimentaria en general, y en particular sobre la elección de comida en adultos mayores y de mediana edad, es necesario realizar más estudios en Latinoamérica sobre los procesos que subyacen al SRC y su relación con la elección de comida, y cómo estos cambian con la edad para predecir posibles conductas alimentarias e implementar intervenciones efectivas, pues una dieta saludable es esencial para un envejecimiento saludable.

Abstract Introduction: Every day, people make different decisions regarding the food they choose, which in turn determine their eating habits. The reward system (RS) allows associating certain situations to pleasure, which influences subsequent food choices. Objective: To describe how the RS influences the selection of foods in middle-aged and self-reliant older adults. Materials and methods: A literature search was conducted in PubMed and SciELO. Articles written in English and Spanish and published between 1996 and 2018 were included in the search; the following search terms (in both languages) were used: "food choice", "reward system", "nutrition", "adult", "elderly", "nutritional status" and "aging". Results: 50 articles met the inclusion criteria. Only 1 study was written in Spanish; 22 were conducted on older adults and the rest on adults between 20 and 40 years old. Conclusions: Studies on eating behavior in general and on food choice in older and middle-aged adults in particular, are scarce. Therefore, further research in the Latin-America is needed to analyze the processes underlying the RS and its relationship to food choice, and how these processes change as people age in order to predict possible eating behaviors and implement effective interventions, since a healthy diet is essential for healthy aging.

Evolución clínica de niños con shock séptico refractario a fluidos tratados con dopamina o adrenalina. Estudio retrospectivo en un servicio de emergencias pediátrico de Argentina / Clinical outcome of children with fluid-refractory septic shock treated with dopamine or epinephrine. A retrospective study at a pediatric emergency department in Argentina

RESUMEN Objetivo: Analizar la evolución clínica de niños con shock séptico refractario a volumen tratados inicialmente con dopamina o adrenalina. Métodos: Estudio de cohorte retrospectivo con ámbito en un servicio de urgencias pediátrico de un hospital de tercer nivel. Población: niños ingresados con shock séptico refractario a volumen. Se comparó la evolución clínica entre 2 grupos: Grupo Dopamina y Grupo Adrenalina. Las variables de interés fueron: uso de ventilación mecánica invasiva, días de inotrópicos, estancia hospitalaria, estancia en cuidados intensivos y mortalidad. Para variables numéricas y categóricas utilizamos medidas de tendencia central y para comparación las pruebas de U Mann Whitney y χ2 test. Resultados: Incluimos 118 pacientes. El 58,5% recibió dopamina y 41,5% adrenalina. El uso de ventilación mecánica invasiva fue 38,8% para adrenalina versus 40,6% para dopamina (p = 0,84) con una mediana de 4 días para adrenalina y 5,5 para dopamina (p = 0,104). La mediana para días de inotrópicos fue de 2 días para ambos grupos (p = 0,714). La mediana de estancia hospitalaria fue de 11 para adrenalina y 13 para dopamina (p = 0,554) y de estancia en cuidados intensivos se registró una mediana de 4 días (0 - 81 días) siendo igual en ambos grupos (p = 0,748). La mortalidad fue de 5% para el Grupo Adrenalina versus 9% para el Grupo Dopamina (p = 0,64). Conclusiones: En nuestro centro, no observamos diferencias en uso de ventilación mecánica invasiva y tiempo de inotrópicos, estancia hospitalaria y cuidados intensivos y mortalidad entre niños ingresados al servicio de urgencias pediátrico con diagnóstico de shock séptico refractario a volumen tratados inicialmente con dopamina o adrenalina.

Abstract Objective: To analyze the clinical outcome of children with fluid-refractory septic shock initially treated with dopamine or epinephrine. Methods: A retrospective cohort study was conducted at a pediatric emergency department of a tertiary hospital. Population: children admitted because of fluid-refractory septic shock. Clinical outcome was compared between two groups: Dopamine and Epinephrine. Variables evaluated were use of invasive mechanical ventilation, days of inotropic therapy, length of hospital stay, intensive care stay, and mortality. For numerical and categorical variables, we used measures of central tendency. They were compared by the Mann-Whitney U-test and the (2 test. Results: We included 118 patients. A total of 58.5% received dopamine and 41.5% received epinephrine. The rate of invasive mechanical ventilation was 38.8% for epinephrine versus 40.6% for dopamine (p = 0.84), with a median of 4 days for the Epinephrine Group and 5.5 for the Dopamine Group (p = 0.104). Median time of inotropic therapy was 2 days for both groups (p = 0.714). Median hospital stay was 11 and 13 days for the Epinephrine and Dopamine groups, respectively (p = 0.554), and median stay in intensive care was 4 days (0 - 81 days) in both groups (p = 0.748). Mortality was 5% for the Epinephrine Group versus 9% for the Dopamine Group (p = 0.64). Conclusions: At our center, no differences in use of invasive mechanical ventilation, time of inotropic therapy, length of hospital stay, length of intensive care unit stay, or mortality were observed in children admitted to the pediatric emergency department with a diagnosis of fluid-refractory septic shock initially treated with dopamine versus epinephrine.

Angina de Ludwig complicada con shock séptico / Ludwig´s angina complicated with septic shock

Introduction: Ludwig's angina is one of the soft tissue infections of the neck and tongue floor with the most admissions to intensive care units (ICU) due to its compromise of the airway and complications from septic shock. The incidence is higher in the adult population, and with the use of the latest generation antibiotics, its incidence has decreased. One of the most frequent causes is the presence of an odontogenic focus such as abscesses, mainly in the second and third molars. Objective: To describe a clinical case, admitted to the hospital ICU, highlighting the comprehensive management and adequate antibiotic therapy. Main data of the case: 24-year-old female patient, a native of Latacunga, went to the emergency service of the Hospital del Sur de Quito for a fever of 10 days of evolution and taking the general condition with signs of shock, and intense pain in the tongue, with edema, and impaired phonation. For initial management, intravenous tramal, IV hydrocortisone, and a broad spectrum antibiotic with piperacillin with tazobactam 4 grams IV every 6 hours, and IV metronidazole every 8 hours. Conclusions: Ludwig's angina is a pathology that usually involves young patients, whose evolution is rapid and its inadequate management leads to death, associated with obstructive respiratory failure and severe sepsis, which requires a timely diagnosis.

Introducción: La angina de Ludwig constituye una de las infecciones de los tejidos blandos del cuello y piso de la lengua con más ingresos en las unidades de cuidados intensivos (UCI) por su compromiso de la vía aérea y complicaciones por shock séptico. La incidencia es mayor en la población adulta, y con el uso de los antibióticos de última generación, su incidencia ha disminuido. Una de las causas más frecuentes es la presencia de un foco odontogénico como los abscesos, principalmente en el segundo y el tercer molar. Objetivo: Describir un caso clínico, internado en la UCI del hospital, destacando el manejo integral y la terapia antibiótica adecuada. Datos principales del caso: paciente femenina de 24 años, natural de Latacunga, acude al servicio de emergencias del Hospital del sur de Quito por fiebre de 10 días de evolución y toma del estado general con signos de shock, y dolor intenso en lengua, con edema, y deterioro de la fonación. Para el abordaje inicial se administra tramadol por vía intravenosa (IV), hidrocortisona IV y antibiótico de amplio espectro con piperacilina con tazobactam 4 gramos IV cada 6 horas, y metronidazol IV cada 8 horas. Conclusiones: la angina de Ludwig es una afección que habitualmente involucra pacientes jóvenes, cuya evolución es rápida y su inadecuado abordaje conlleva a la muerte, asociado con insuficiencia respiratoria obstructiva y sepsis grave, por lo que requiere un diagnóstico oportuno

Dopamine D2 receptor influences eye development and function in Zebrafish. / El receptor de dopamina D2 influye en el desarrollo y la función del ojo en el pez cebra.

Dopamine is synthesized by tyrosine hydroxylase and is considered as a major catecholamine in the vertebrate retina, including zebrafish. However, little is known about the role of dopamine D2 receptor (DRD2) in retinal physiology. Therefore, to elucidate the role of DRD2 in the eye development and function in zebrafish, fish were exposed to fluphenazine, quinpirole, or combination of both. Subsequently, the eye size, optic nerve diameter (ONd), and visual background adaptation were evaluated. The results showed that fluphenazine (fluphenazine, DRD2 antagonist) decreased eye size and optic nerve diameter followed by disruption of visual function. The addition of Quinpirole (quinpirole, DRD2 agonist) reversed the effects caused by fluphenazine, implying that DRD2 is necessary for normal eye development and function in zebrafish. Considering the role of dopaminergic neurons in retinal development and function, dysfunction of dopaminergic neuron signaling pathways in the retina may cause visual abnormalities, particularly in the involvement of dopamine in regulating light response.

Adicción y metabolismo digital. Una mirada desde la filosofía de la tecnología / Addiction and Digital Metabolism. An Approach from the Philosophy of Technology / Dependência e metabolismo digital. Um olhar a partir da filosofia da tecnologia

Propósito/Contexto. Este artículo tiene como propósito analizar los fenóme-nos de adicción digital en el contexto contemporáneo, que se caracteriza por transformaciones tecnológicas en continua expansión. Metodología/Enfoque. El análisis se lleva a cabo desde el punto de vista de la filosofía de la tecnología y siguiendo la perspectiva farmacológica que formula el filósofo Bernard Stiegler en el marco de los estudios digitales, esto es, una visión de la tecnología, siempre y al mismo tiempo, como veneno y remedio para el ser humano. Resultados/Hallazgos. El artículo arroja luz sobre los orígenes y las consecuencias de semejante situación adictogénica, enfocándose en las causas socioeconómicas y en las posibilidades de escape que la tecnología misma nos proporciona; el problema ético se pone en relación con los estilos de vida de los usuarios y la pregunta es si las tecnologías actuales dejan lugar para un mejora-miento de las condiciones cotidianas o si solo amplifican el malestar que la vida contemporánea crea. Discusión/Conclusiones/Contribuciones. Finalmente, se proporcionan algunos ejemplos enfocados en la reeducación y la comprensión del farmakon, para devolver autonomía y capacidad de toma de decisiones a los adictos, desarrollando en ellos un "saber consumir" que alivia los efectos tóxicos de la relación con los dispositivos y los dota de una capacidad de inventar nuevas posibilidades para encontrar una forma distinta de relación en y con la sociedad.

Purpose/Context. This article aims to discuss the phenomena of digital addiction in the contemporary context, which is characterized by ever-expanding technological transformations. Methodology/Approach. The analysis is carried out from the philosophy of technology and Bernard Stiegler's pharmacological perspective within digital studies:a vision of technology as a poison and remedy for humans always and simultaneously. Results/Findings. It sheds light on the origins and consequences of such an addictive situation, focusing on the socioeconomic causes and the possibilities of escape technology offers. The ethical problem is related to users' lifestyles, and the question is whether current technologies leave room for improving daily conditions or only amplify the discomfort that contemporary life causes. Discussion/Conclusions/Contributions. Finally, it provides some examples focused on the reeducation and understanding of pharmakon to restore autonomy and decisionmaking capacity to addicts. Pharmakon develops in them a "knowing how to use" that alleviates the toxic effects of the relationship with devices and an ability to create new possibilities to find a different form of bonding in and with society.

Objetivo/Contexto. Este artigo tem como objetivo analisar os fenômenos da dependência digital no contexto contemporâneo, que se caracteriza por transformações tecnológicas em constante expansão. Metodologia/Abordagem. A análise é realizada a partir do ponto de vista da filosofia da tecnologia e seguindo a perspectiva farmacológica que é formulada pelo filósofo Bernard Stiegler no âmbito dos estudos digitais, ou seja, uma visão da tecnologia, sempre e ao mesmo tempo, como um veneno e remédio para o ser humano. Resultados/Descobertas. O artigo atira luz sobre as origens e as consequências de tal situação de dependência, enfocando-se nas causas socioeconômicas e nas possibilidades de fuga que a própria tecnologia nos fornece; o problema ético está relacionado com os estilos de vida dos usuários e a questão é se as tecnologias atuais deixam espaço para melhorias das condições diárias ou se apenas amplificam o desconforto que a vida contemporânea cria. Discussão/Conclusões/Contribuições. Ao final, apresentamse alguns exem-plos voltados para a reeducação e a compreensão do farmakon, para restaurar a autonomia e a capacidade de tomada de decisão aos dependentes, desenvolvendo neles um "saber consumir" que ameniza os efeitos tóxicos da relação com os dispositivos e os outorga de uma capacidade de inventar novas possibilidades para achar uma forma diferente de relacionamento na e com a sociedade.

Tratamiento de la enfermedad de Parkinson temprana / Treatment of early Parkinson's disease

RESUMEN La enfermedad de Parkinson (EP) es principalmente una enfermedad de pacientes ancianos. Es un trastorno multifacético que comprende síntomas motores y no motores en todas las etapas de la enfermedad. Esta revisión busca integrar los datos de las opciones de tratamiento más recientes con los datos de las terapias establecidas, a fin de proporcionar una referencia actualizada basada en la evidencia para los médicos que tratan la EP temprana, con medicamentos que puedan usarse como alternativa a la levodopa. El enfoque de los médicos para el tratamiento de la enfermedad de Parkinson (EP) temprana debe tener en cuenta numerosos aspectos, entre ellos, cómo informar al paciente sobre el diagnóstico y la decisión crítica de qué terapia adoptar y cuándo iniciarla. El tratamiento del trastorno motor asociado con la EP temprana debe considerar varios factores cruciales, como la edad de inicio, las comorbilidades y los requisitos funcionales del paciente, y no se puede resumir en una fórmula simple. En pacientes más jóvenes (es decir, antes de la edad de 70 años) y en aquellos sin altos requisitos funcionales, el tratamiento generalmente se inicia con agonistas de dopamina y / o inhibidores de la enzima monoaminooxidasa-B (MAO- B I). En pacientes más jóvenes, la levodopa se debe agregar a los agonistas de la dopamina y / o MAO-B I, según lo requiera la progresión de la enfermedad, mientras que en los pacientes mayores, cuando la respuesta a la levodopa sola no es satisfactoria, los agonistas de la dopamina o los inhibidores de la catecol-O- metiltransferasa pueden posteriormente ser agregados.

SUMMARY Parkinson's disease (PD) is primarily a disease of elderly patients. Is a multifaceted disorder comprised of both motor and non-motor symptoms at all stages of the disease. This review seeks to integrate data from the newest treatment options with data from established therapies, so as to provide an up-to- date evidence-based reference for clinicians treating early PD, with medications that can be used as an alternative to levodopa. The clinicians' approach to the treatment of early Parkinson's disease (PD) should take into account numerous aspects, including how to inform a patient upon diagnosis and the critical decision of what therapy to adopt and when to start it. The treatment of the motor disorder associated with early PD needs to consider several crucial factors, such as age at onset, comorbidities, and the patient's functional requirements, and cannot be summarized in a simple formula. In younger patients (i.e., before the age of 70) and in those without high functional requirements, treatment is usually initiated with dopamine agonists and/or monoamine oxidase-B enzyme inhibitors (MAO-B I). In younger patients, levodopa should be added to dopamine agonists and/or MAO-B I, as required by disease progression, whereas in older patients, when response to levodopa alone is not satisfactory, dopamine agonists or catechol-O- methyltransferase inhibitors may subsequently be added.

Efeitos citotóxicos do aripiprazol nas linhagens celulares MKN45 e NIH3T3 e efeitos genotóxicos nos linfócitos sanguíneos periféricos humanos / Cytotoxic effects of aripiprazole on mkn45 and nih3t3 cell lines and genotoxic effects on human peripheral blood lymphocytes

ABSTRACT BACKGROUND: Gastric cancer is known as the fourth most common cancer. Current treatments for cancer have damaged the sensitive tissues of the healthy body, and in many cases, cancer will be recurrent. Therefore, need for treatments that are more effective is well felt. Researchers have recently shifted their attention towards antipsychotic dopamine antagonists to treat cancer. The anticancer activities of aripiprazole remain unknown. OBJECTIVE: This study aimed to evaluate the efficacy and safety of aripiprazole on gastric cancer and normal cell lines. METHODS: In this regard, the cytotoxicity and genotoxicity of aripiprazole were investigated in MKN45 and NIH3T3 cell lines by methyl tetrazolium assay and on peripheral blood lymphocytes by micronucleus assay. For this purpose, cells were cultured in 96 wells plate. Stock solutions of aripiprazole and cisplatin were prepared. After cell incubation with different concentrations of aripiprazole (1, 10, 25, 50, 100 and 200 μL), methyl tetrazolium solution was added. For micronucleus assay fresh blood was added to RPMI culture medium 1640 supplemented, and different concentrations of aripiprazole (50, 100 and 200 μL) were added. RESULTS: The finding of present study showed that the IC50 of aripiprazole in the cancer cell line (21.36 μg/mL) was lower than that in the normal cell line (54.17 μg/mL). Moreover, the micronucleus assay showed that the frequency of micronuclei of aripiprazole at concentrations below 200 μM was much less than cisplatin. CONCLUSION: Aripiprazole can be a good cytotoxic compound and good candidate for further studies of cancer therapy.

RESUMO CONTEXTO: O câncer gástrico é conhecido como o quarto câncer mais comum. Os tratamentos atuais para o câncer danificaram os tecidos sensíveis do corpo saudável e, em muitos casos, o cancro será recorrente. Portanto, a necessidade de tratamentos que são mais eficazes é desejada. Recentemente, os pesquisadores mudaram sua atenção para os antagonistas antipsicóticos da dopamina para tratar o câncer. As atividades anticâncer de aripiprazol permanecem desconhecidas. OBJETIVO: Este estudo objetivou avaliar a eficácia e a segurança do aripiprazol no câncer gástrico e nas linhagens celulares normais. MÉTODOS: A este respeito, a citotoxicidade e a genotoxicidade do aripiprazol foram investigadas em linhas celulares MKN45 e NIH3T3 por ensaio de metil tetrazólio e em linfócitos periféricos de sangue por ensaio de micronúcleos. Para este efeito, as células foram cultivadas em 96 placas. As soluções de estoque de aripiprazol e cisplatina foram preparadas. Após incubação celular com diferentes concentrações de aripiprazol (1, 10, 25, 50, 100 e 200 μL), a solução de metil tetrazólio foi adicionada. Para o ensaio do micronúcleo o sangue fresco foi adicionado ao meio de cultura RPMI 1640 suplementado, e as concentrações diferentes de aripiprazole (50, 100 e 200 μL) foram adicionadas. RESULTADOS: O presente estudo mostrou que o IC50 de aripiprazol na linhagem celular cancerosa (21,36 μg/mL) foi menor do que na linha celular normal (54,17 μg/ mL). Além disso, o ensaio de micronúcleos demonstrou que a frequência de micronúcleos de aripiprazol em concentrações inferiores a 200 μM foi muito inferior à cisplatina. CONCLUSÃO: O aripiprazol pode ser um bom composto citotóxico e bom candidato para estudos adicionais da terapia do câncer.

Síndrome de piernas inquietas en niños: caracterización clínica / Characterization of restless leg syndrome in children

El Síndrome de piernas inquietas (SPI) o Enfermedad de Willis­Ekbom, es una condición neurológica que afecta al 2-4% de los niños en edad escolar. Etiológicamente se ha relacionado al metabolismo del hierro y a factores genéticos entre otros. En niños aun es una patología poco diagnosticada. Trabajo observacional descriptivo, en el cual se realiza caracterización clínica, según criterios internacionales, en 14 pacientes menores de 18 años, 9 varones. Edad promedio 8 años. Sintomatología inicial variada, desde resistencia a ir a la cama, hasta dibujar sus molestias. En 10 se comprobó déficit de hierro. En 11 pacientes se realizó un polisomnograma, 10 de ellos con un índice elevado de movimientos periódicos de extremidades. El uso de pregabalina y aporte de hierro fue el tratamiento más utilizado. Dos pacientes tenían padres diagnosticados con SPI.

Abstract. The Restless Legs Syndrome (RLS) or Willis-Ekbom Disease is a neurological condition that affects 2-4% of school-age children. Its etiology has been related to the metabolism of iron and genetic factors among others. In children it is still a frequently undiagnosed disorder. This is a descriptive observational report, in which clinical characterization is carried out according to international criteria in 14 patients under 18 years old, 9 boys. Average age is 8 years old. The initial symptomatology was varied, from resistance to comply with bedtime, to drawing their discomfort. In 9, iron deficiency was found. A polysomnogram was performed in 11 patients, 10 of which had a high periodic limb movements index. The use of pregabalin and supplementary iron were the most used treatments. Two patients had parents diagnosed with RLS.

Efeito da levodopa na mecânica coclear e no sistema auditivo eferente de indivíduos com doença de Parkinson / Effect of levodopa on cochlear mechanics and efferent auditory system of Parkinson's disease individuals

RESUMO Objetivo Analisar o efeito da levodopa na dinâmica coclear, bem como na via eferente olivococlear medial de indivíduos com doença de Parkinson idiopática (DP). Método Indivíduos com e sem DP, acompanhados em um hospital universitário, realizaram a pesquisa das emissões otoacústicas por produto de distorção (EOAPD) e do efeito inibitório das EOAPD (EIEOA) na presença de ruído contralateral. Foram estabelecidas as medidas de correlação entre os resultados das EOAPD e do EIEOA com estágio Hoehn&Yahr (H&Y), dose diária de levodopa e tempo de diagnóstico da DP. Além disso, as medidas eletroacústicas foram comparadas entre os indivíduos sem DP e com DP, estratificados de acordo com a dose de levodopa administrada diariamente. Resultados Foi identificada correlação fraca e negativa entre a amplitude das EOAPD com a dose diária de levodopa e correlações positivas, de força moderada e fraca, entre o EIEOA com a dose diária de levodopa e o tempo de diagnóstico da DP, respectivamente. A amplitude das EOAPD foi maior nos indivíduos com DP em uso de levodopa ≤ 600 miligramas quando comparada à de indivíduos sem DP e com DP, em uso de dose superior. Já o EIEOA foi menor nos indivíduos em uso de doses ≤ 600 miligramas, quando comparado aos demais grupos. Conclusão Doses diárias de levodopa iguais ou inferiores a 600 mg/dia aumentam as respostas mecanotransdutoras cocleares nas frequências de 2 e 3 kHz, enquanto que a ação dos sistemas eferentes olivococleares é reduzida nesta região.

ABSTRACT Purpose To evaluate the effect of levodopa on cochlear dynamics and on the medial olivocochlear efferent pathway of idiopathic Parkinson's disease (PD) individuals. Methods Individuals with and without PD, followed at a University Hospital, were submitted to Distortion Product Otoacoustic Emissions (DPOAE) and DPOAE Inhibitory Effect (OAEIE) in the presence of contralateral noise. Correlation measures between DPOAE and OAEIE results with Hoehn&Yahr (H&Y) stage, daily dose of levodopa and PD diagnosis period were established. Furthermore, electroacoustic measures were compared between individuals without and those with PD, stratified by dose of levodopa daily administered. Results Weak negative correlation between DPOAE amplitude and daily dose of levodopa was found, as well positive correlations between EIEOA with daily dose of levodopa and time of PD diagnosis, respectively. Higher DPOAE amplitude was found in individuals with PD using daily doses of levodopa ≤ 600 milligrams when compared to individuals without PD and those with PD using higher doses. EIEOA was lower in individuals using doses ≤ 600 milligrams, when compared to the other groups. Conclusion Daily doses of levodopa up to 600 mg / day increase the cochlear mechanical-transducer responses in 2 and 3 kHz frequencies, while the action of olivocochlear efferent systems is reduced in this region.