Cognitive changes after surgery vs stenting for carotid artery stenosis.

OBJECTIVES: Cognitive function has not been evaluated systematically in the context of carotid endarterectomy (CEA) versus carotid artery stenting (CAS). Cognitive decline can occur from microembolization or hypoperfusion during CEA or CAS. Carotid revascularization may, however, also improve cognitive dysfunction resulting from chronic hypoperfusion. We compared cognitive outcomes in consecutive asymptomatic patients undergoing CAS or CEA. METHODS: This is a prospective nonrandomized single-center study of patients with asymptomatic carotid stenosis ≥ 70% undergoing CAS or CEA using standard techniques. Neurologic symptoms were evaluated by history, physical examination, and the National Institutes of Health Stroke Scale. A 50-minute cognitive battery was performed 1 to 3 days before and 4 to 6 months after CEA/CAS. The tests (Trail Making Tests A/B, Processing Speed Index (PSI) of the Wechsler Adult Intelligence Scale - Third Edition (WAIS-III), Boston Naming Test, Working Memory Index (WMI) of the Wechsler Memory Scale - Third Edition (WMS-III), Controlled Oral Word Association, and Hopkins Verbal Learning Test) for six cognitive domains (motor speed/coordination and executive function, psychomotor speed, language (naming), working memory/concentration, verbal fluency, and learning/memory) were conducted by a neuropsychologist. The primary analysis of impact of treatment modality was a normalized cognitive change score. RESULTS: Forty-six patients underwent prepost testing (CEA = 25, CAS = 21). Women comprised 36% of the cohort, mean preprocedural stenosis was 84%, and 54% were right-sided lesions. All patients were successfully revascularized without periprocedural complications. The scores for each test improved after CEA except WMI, which decreased in 20 of 25 patients. Improvement occurred in all tests after CAS except PSI, which decreased in 18 of 21 patients. In addition to comparing the changes in individual test scores, overall cognitive change was measured by calculating the change in composite cognitive score (CCS) postprocedure versus baseline. To compute the CCS, the raw scores from each test were transformed into z scores and then averaged to calculate each patient's composite score. The composite score at baseline was then compared with that from the postprocedure testing. The CCS improved after both CEA and CAS, and the changes were not significantly different between the groups (.51 vs .47; P = NS). CONCLUSIONS: Carotid revascularization results in an overall improvement in cognitive function. There are no differences in the composite scores of five major cognitive domains between CEA and CAS. When individual tests are compared, CEA results in a reduction in memory, while CAS patients show reduced psychomotor speed. Larger studies will help confirm these findings.

Avaliação da situação nutricional e dietética de idosos hospitalizados / Assessment of nutritional and dietary status of hospitalized elderly / Evaluación de la situación dietética y nutricional de los ancianos hospitalizados

Objetivo: avaliar a situação nutricional e dietética de idosos hospitalizados. Método: pesquisa do tipo descritiva, exploratória, transversal e quantitativa. Foi realizada com 44 idosos hospitalizados, de ambos os sexos, atendidos em um hospital público da cidade de Bocaiúva, Minas Gerais, Brasil. Para avaliar a situação nutricional e dietética dos idosos hospitalizados utilizou-se a mini avaliação nutricional. Resultados: verifica-se que 55% dos idosos apresentaram-se com baixo peso, com maior quantitativo no sexo masculino. Observou-se prevalência de hipertensão, diabetes e insuficiência cardíaca congestiva. Entre os participantes, 25% informaram que possuem alguma restrição na motilidade. Identificou que mais de 60% dos idosos utilizam acima de três medicamentos e bebem menos de cinco copos de água por dia. Conclusão: a realização de pesquisas sobre o estado nutricional de idosos e a associação de fatores que contribuem para agravar o quadro de desnutrição é fundamental para definir e acompanhar a qualidade de vida, bem como sustentar projetos terapêuticos.

Objective: to evaluate the nutritional and dietary situation of hospitalized elderly. Method: descriptive, exploratory, cross-sectional and quantitative research. It was carried out with 44 elderly inpatients, both genders, treated in a public hospital in the city of Bocaiúva, Minas Gerais, Brazil. To assess the nutritional and dietary status of the hospitalized elderly, the mini nutritional assessment was used. Results: 55% of the elderly were underweight, with higher numbers in males. Prevalence of hypertension, diabetes and congestive heart failure were observed. Among the participants, 25% reported to have some restriction on motility. Over 60% of the elderly were found to use more than three medications and drink less than five glasses of water per day. Conclusion: conducting research on the nutritional status of the elderly and the association of factors that contribute to aggravate malnutrition is fundamental to define and monitor quality of life, as well as to sustain therapeutic projects

Objetivo: valorar el estado nutricional y dietética de ancianos hospitalizados. Método: estudio descriptivo, exploratorio, transversal y el análisis cuantitativo. Se llevó a cabo con 44 ancianos hospitalizados, de ambos sexos, atendidos en un hospital público de la ciudad de Bocaiúva, Minas Gerais, Brasil. Para evaluar la situación dietética y nutricional de los ancianos hospitalizados utilizó el mini nutricional assessment. Resultados: el 55% de los ancianos tenían bajo peso, con un mayor número de hombres. Se observó prevalencia de hipertensión, diabetes e insuficiencia cardíaca congestiva. Entre los participantes, el 25% informó que tienen alguna restricción en la motilidad. Descubrió que más del 60% de las personas mayores usan más de tres medicamentos y beben menos de cinco vasos de agua al día. Conclusión: realizar investigaciones sobre el estado nutricional de los ancianos y la asociación de factores que contribuyen a agravar la desnutrición es fundamental para definir y controlar la calidad de vida, así como para sostener proyectos terapéuticos.

Biomechanical comparison of unipedicular versus bipedicular kyphoplasty.

STUDY DESIGN: A cadaveric study comparing the biomechanics of unipedicular versus bipedicular kyphoplasty in the treatment of osteoporotic vertebral compression fractures. OBJECTIVES: The objectives of this study were to compare unipedicular kyphoplasty to bipedicular kyphoplasty in restoring strength, stiffness, and height to osteoporotic vertebral compression fractures and to study the degree of unilateral wedging when using a unipedicular versus bipedicular approach to kyphoplasty. SUMMARY OF BACKGROUND DATA: Osteoporotic vertebral compression fractures are a common ailment of the elderly that can lead to chronic pain and deformity. Recently developed treatments known as vertebroplasty and kyphoplasty provide pain relief by percutaneously augmenting the fractured vertebral body with polymethyl methacrylate via a transpedicular approach. Vertebroplasty via a unipedicular approach has been shown to provide comparable restoration of vertebral body stiffness when compared to a bipedicular approach. The anticipated benefits of a unipedicular approach include reduction in patient risk, operative time, radiation exposure, and cost. No studies have evaluated the efficacy of unipedicular kyphoplasty. MATERIAL AND METHODS: Two fresh-frozen human cadaveric spines (T3-L5) were disarticulated, and the vertebral bodies (n = 30) were compressed using an Instron 8521 machine, recording load versus displacement. The fractured vertebral bodies then underwent kyphoplasty via either a unipedicular or bipedicular approach. The augmented vertebral bodies were then recompressed. The strength, stiffness, and height restoration of the groups were compared. Following recompression, the risk for lateral wedging was evaluated by comparing lateral height measurements. RESULTS: Following fracture and subsequent kyphoplasty augmentation, the mean strength of the bipedicular group was 1.40 kN (+/- 0.38) versus 1.57 kN (+/- 0.55) in the unipedicular group. Average stiffness in the bipedicular group was 0.4387 kN/mm (+/- 0.2095) compared to 0.6880 kN/mm (+/- 0.3179) in the unipedicular group. Postcompression vertebral body height was restored to 96% of prefracture height in the bipedicular group and 94% of prefracture height in the unipedicular group. The mean absolute value of the difference in height between right and left side of the vertebral bodies was 1.06 mm (+/- 1.01) in the bipedicular group, whereas the unipedicular group had a mean of 1.78 mm (+/- 1.84). Statistical analysis using 1-way analysis of variance revealed no significant difference in any of the outcome measurements between the unipedicular and bipedicular groups (P < 0.05). CONCLUSIONS: Unipedicular kyphoplasty is comparable to bipedicular kyphoplasty in the restoration of vertebral body strength, stiffness, and height in experimentally induced vertebral compression fractures. There was no greater risk for lateral wedging in the unipedicular group compared to the bipedicular group. Given the advantages of a unipedicular approach with respect to vertebral pedicle cannulation risk, operative time, radiation exposure, and cost, this study would support the use of a unipedicular approach to kyphoplasty in the treatment of vertebral compression fractures.

Coexistencia de problemas nutricionales en niños de 6 a 9 años de edad, de centros educativos estatales de Matucana, Santa Eulalia y Lima / Coexistence of nutritional problems in 6 to 9 year-old students at, Matucana, Santa Eulalia and Lima state educactional centers

Objetivo: Conocer la coexistencia de problemas nutricionales en niños de 6 a 9 años de edad de centros educativos estatales. Material y Métodos: Se estudió 241 niños de Matucana, Santa Eulalia y Lima. Para el diagnóstico nutricional se usó el índice de masa corporal (IMC) con la clasificación de Must y col. con los siguientes criterios diagnósticos, menor de 5, entre 5 y 15, 15 a 85, 85 a 95 y mayor del 95 percentil, para definir el déficit, bajo peso, normal, sobrepeso y obesidad respectivamente. La desnutrición crónica fue determinada usando el National Center for Health Statistics (NCSH) y el menor de menos dos desvío estandar. Se dosó hemoglobina en sangre y como criterio diagnóstico la menor de 12 g/dL, agregándole 0,4 g/dL por cada 1000 msnm. Resultados: El 22,4, 14,1, 10,0, y 69,3 por ciento de los niños presentan desnutrición crónica, sobrepeso, obesidad y anemia nutricional, respectivamente. De los que tienen desnutrición crónica, 11,1, 9,3 y 66,7 por ciento están con sobrepeso, obesidad y anemia; y de los anémicos, 16,8 y 12,6 por ciento se encuentran con sobrepeso y obesidad. Existe un 2,1 por ciento de niños con desnutrición crónica, sobrepeso y anemia y un porcentaje similar con desnutrición crónica, obesidad y anemia. Conclusión: La presencia de dos e incluso tres enfermedades nutricionales en un mismo niño amerita implementar políticas cuyas estrategias contemplen esta posibilidad.