Validation of the Spanish version of Addenbrooke's Cognitive Examination III for diagnosing dementia.

INTRODUCTION: Addenbrooke's Cognitive Examination is a screening test used to diagnose dementia. The third edition of this test (ACE-III) was recently developed. The aim of this study was to translate and validate the ACE-III in Spanish. METHODS: The ACE-III was translated and adapted to Spanish. It was then administered to a group of healthy subjects as well as a group of patients with different types of mild dementia treated in 2 hospitals in Spain. RESULTS: Internal reliability (Cronbach's alpha = 0.927), inter-rater reliability (intraclass correlation coefficient = 0.976) and test-retest reliability (kappa 0.995) were excellent. Age (r = -0.512) and education (r = 0.659) showed a significant correlation with total test scores. The diagnostic accuracy of ACE-III was higher than that of the Mini-Mental State Examination, particularly for the group with the highest educational level. Researchers obtained normative data and cut-off points for the diagnosis of dementia. CONCLUSIONS: The Spanish version of the ACE-III is a reliable and valid test for diagnosing dementia. Its diagnostic accuracy is high, especially in patients with a higher level of education.

A pharmaco-economic analysis of second-line treatment with imatinib or sunitinib in patients with advanced gastrointestinal stromal tumours.

Second-line treatments recommended by the National Cancer Center Network to manage advanced-stage gastrointestinal stromal tumours (GIST) were evaluated to determine the cost and cost-effectiveness of each intervention in the Mexican insurance system, the Instituto Mexicano del Seguro Social (IMSS). Treatments examined over a 5-year temporal horizon to estimate long-term costs included 800 mg day(-1) of imatinib mesylate, 50 mg day(-1) of sunitinib malate (administered in a 4 week on/2 week rest schedule), and palliative care. The mean cost (MC), cost-effectiveness, and benefit of each intervention were compared to determine the best GIST treatment from the institutional perspective of the IMSS. As sunitinib was not reimbursed at the time of the study, a Markov model and sensitivity analysis were conducted to predict the MC and likelihood of reimbursement. Patients taking 800 mg day(-1) of imatinib had the highest MC (+/-s.d.) of treatment at $35,225.61 USD (+/-1253.65 USD); while sunitinib incurred a median MC of $17,805.87 USD (+/-694.83 USD); and palliative care had the least MC over treatment duration as the cost was $2071.86 USD (+/-472.88 USD). In comparison to palliative care, sunitinib is cost-effective for 38.9% of patients; however, sunitinib delivered the greatest survival benefit as 5.64 progression-free months (PFM) and 1.4 life-years gained (LYG) were obtained in the economic model. Conversely, patients on imatinib and palliative care saw a lower PFM of 5.28 months and 2.58 months and also fewer LYG (only 1.31 and 1.08 years, respectively). Therefore, economic modeling predicts that reimbursing sunitinib over high dose imatinib in the second-line GIST indication would deliver cost savings to the IMSS and greater survival benefits to patients.

Effect of calcium pidolate on biochemical and hormonal parameters in involutional osteoporosis.

The purpose of this study was to determine the value of calcium pidolate in the treatment of involutional osteoporosis. This compound has been reported to be better absorbed than other calcium salts, to lower the levels of parathyroid hormone (PTH) and to raise those of growth hormone (GH). We accordingly treated one group of 10 women suffering from involutional osteoporosis with the equivalent of 1 g elemental calcium and administered a placebo to a second group of 10 osteoporotic women whose mean age and body surface area were comparable. Basal sequential multiple analysis (SMA-12) was performed in all subjects to determine calcium, phosphorus, alkaline phosphatase (ALP) and total protein levels, the same blood samples being used for the evaluation of mean PTH, GH and osteocalcin (BGP). Urinary 24-h calcium excretion was determined and the calcium/creatinine (Ca/Cr) and hydroxyproline/Cr (HP/Cr) ratios were measured in 12-h fasting urine samples, the results being corrected for glomerular filtrate. The same parameters were measured again following a month of uninterrupted treatment. After 30 days, we observed no differences in either group as regards calcaemia, phosphataemia, ALP, total proteins, PTH, GH, BGP or 24-hour calciuria. The only noteworthy changes seen were significant decreases (P less than 0.001) in the Ca/Cr and HP/Cr ratios in the group treated with calcium pidolate. These results show that calcium pidolate at the dose administered inhibits bone resorption but does not affect the levels of PTH, GH, BGP or ALP in the medium term. Our findings indicate that it has no influence on bone formation.

[Prevalence of hyperalphalipoproteinemia in the general population]. / Prevalencia de las hiperalfalipoproteinemias en población general.

BACKGROUND: Hypercholesterolemia is often incorrectly treated with no normal consensus being followed. The same occurs with hyperalphalipoproteinemias (HAL). The aim of the present was to know the prevalence of HAL in a sample of an adult general population and the theoretical percentage of the same which would be treated as hypercholesterolemia if the above cited entity is not appropriately diagnosed. METHODS: A transversal study (November 1991-March 1992) was performed selecting a randomized sample representative of the adult population (13,224 individuals) from a basic health area (municipal census of 1991), and was stratified by groups of age and sex. The final sample was of 802 individuals who underwent anamnesis and in whom total cholesterol (TC), total triglycerides (TG), cHDL and cLDL were determined. In agreement with the percentile 90 of the results of the Lipid Research Clinic Programs for each group of age and sex with normal number of cLDL (3.84 mmol/l, < 150 mg/dl) and TG (2.27 mmol/l, < 200 mg/dl) the percentage of the population with HAL was established. The theoretical percentage of the population which would be treated as hypercholesterolemia was found following the recommendations of the Spanish consensus without the cHDL and cLDL being calculated. RESULTS: The prevalence of HAL was 7.8%, 92% being primary and 7.9 secondary. By ages the greatest frequency appeared in the group of 20-29 years (15.8%) and 30-39 years (8.4%) with male predominance (9%) with respect to females (6.8%). 63.5% had hypercholesterolemia. Treatment would be recommended to 661 individuals without need. CONCLUSIONS: Hyperalphalipoproteinemia is a frequent entity in general population. Correct diagnosis would avoid unnecessary treatment in 5% of the population. The determination of cHDL is required before any hypolipemic treatment is initiated.

Validación de la versión española del test Addenbrooke's Cognitive Examination III para el diagnóstico de demencia / Validation of the Spanish version of Addenbrooke's Cognitive Examination III for diagnosing dementia

Introducción: El Addenbrooke's Cognitive Examination (ACE) es un test de cribado para el diagnóstico de demencia. Recientemente, se ha desarrollado la tercera versión del test (ACE-III). El objetivo del estudio fue la traducción y adaptación del ACE-III al español y su validación. Material y métodos: El ACE-III fue traducido y adaptado al español. Se administró a un grupo de sujetos cognitivamente sanos y a pacientes con demencia leve de diferentes tipos en 2 centros españoles. Resultados: La consistencia interna del test (alfa de Cronbach = 0,927), la fiabilidad interevaluador (coeficiente de correlación intraclase = 0,976) y la fiabilidad test-retest (kappa = 0,995) fueron elevadas. Edad (r = –0,512) y escolaridad (r = 0,659) se correlacionaron significativamente con la puntuación total del test. La capacidad diagnóstica del ACE-III fue superior al Mini-Mental State Examination, especialmente en el grupo con mayor escolaridad. Se obtuvieron datos normativos por edad, y puntos de corte para la detección de demencia. Conclusiones: La versión española del test ACE-III es un instrumento válido para el diagnóstico de demencia, con una alta capacidad discriminatoria especialmente en pacientes con un mayor nivel educativo

Introduction: Addenbrooke's Cognitive Examination is a screening test used to diagnose dementia. The third edition of this test (ACE-III) was recently developed. The aim of this study was to translate and validate the ACE-III in Spanish. Methods: The ACE-III was translated and adapted to Spanish. It was then administered to a group of healthy subjects as well as a group of patients with different types of mild dementia treated in 2 hospitals in Spain. Results: Internal reliability (Cronbach's alpha = 0.927), inter-rater reliability (intraclass correlation coefficient = 0.976) and test-retest reliability (kappa 0.995) were excellent. Age (r = -0.512) and education (r = 0.659) showed a significant correlation with total test scores. The diagnostic accuracy of ACE-III was higher than that of the Mini-Mental State Examination, particularly for the group with the highest educational level. Researchers obtained normative data and cut-off points for the diagnosis of dementia. Conclusions: The Spanish version of the ACE-III is a reliable and valid test for diagnosing dementia. Its diagnostic accuracy is high, especially in patients with a higher level of education

[Treatment of children with acute diarrheal disease. Knowledge and attitudes of the health personnel]. / Tratamiento de niños con enfermedad diarreica aguda. Conocimiento y actitudes del personal de salud.

Diarrheal diseases are still one of the most frequent causes of death due to dehydration in children; lack of information regarding the adequate treatment of diarrhea is the main cause. The results of an inquire sent to 620 physicians and nurses were analyzed to determine the knowledge and attitudes of the health care workers that reside in different diarrheal mortality areas in Mexico. The less professional experience time was correlated with more knowledge in etiology of diarrhea. More physicians than nurses had correct answers regarding the place of diarrheal diseases in child mortality and the correct use of antimicrobial, and other drugs and liquids to prevent and treat dehydration. Most workers did not know the inconvenience of hypertonic solutions to prevent dehydration and the importance of the oral solution flavor. This results suggest that nurses will, be included in clinical training by means of seminars in oral hydration therapy. Furthermore it seems convenient to increase the access to oral hydration solutions as well as the diffusion of its advantages.

[Reye's syndrome in Spain, 1980-1984 (A cooperative study: Pediatric Intensive Care Section of the Asociación Española de Pediatría)]. / Síndrome de Reye en España, 1980-1984. (Estudio cooperativo. Sección de CIP de la AEP).

The incidence of the Reye syndrome in Spain has been retrospectively reviewed from 1980 to 1984. A survey of 57 cases has been available to study. It is pointed out the low frequency (0.12/10(5) 15 years); the low mean age (12 month) due to a higher prevalence in infants; the high mortality rate (49%), proportional to the great number of III and IV Lovejoy's stages; the low correlation with chicken-pox and salycilate-intake in the prodromic period and a better prognosis in patients when barbituric coma was established along with other measures.

Pathogenesis of infection by clinical and environmental strains of Vibrio vulnificus in iron-dextran-treated mice.

Vibrio vulnificus is an opportunistic pathogen that contaminates oysters harvested from the Gulf of Mexico. In humans with compromising conditions, especially excess levels of iron in plasma and tissues, consumption of contaminated seafood or exposure of wounds to contaminated water can lead to systemic infection and disfiguring skin infection with extremely high mortality. V. vulnificus-associated diseases are noted for the rapid replication of the bacteria in host tissues, with extensive tissue damage. In this study we examined the virulence attributes of three virulent clinical strains and three attenuated oyster or seawater isolates in mouse models of systemic disease. All six V. vulnificus strains caused identical skin lesions in subcutaneously (s.c.) inoculated iron dextran-treated mice in terms of numbers of recovered CFU and histopathology; however, the inocula required for identical frequency and magnitude of infection were at least 350-fold higher for the environmental strains. At lethal doses, all strains caused s. c. skin lesions with extensive edema, necrosis of proximate host cells, vasodilation, and as many as 10(8) CFU/g, especially in perivascular regions. These data suggest that the differences between these clinical and environmental strains may be related to growth in the host or susceptibility to host defenses. In non-iron dextran-treated mice, strains required 10(5)-fold-higher inocula to cause an identical disease process as with iron dextran treatment. These results demonstrate that s.c. inoculation of iron dextran-treated mice is a useful model for studying systemic disease caused by V. vulnificus.

Construction and phenotypic evaluation of a Vibrio vulnificus vvpE mutant for elastolytic protease.

Vibrio vulnificus is an opportunistic gram-negative pathogen that commonly contaminates oysters. Predisposed individuals who consume raw oysters can die within days from sepsis, and even otherwise healthy people are susceptible to serious wound infection after contact with contaminated seafood or seawater. Numerous secreted and cell-associated virulence factors have been proposed to account for the fulminating and destructive nature of V. vulnificus infections. Among the putative virulence factors is an elastolytic metalloprotease. We cloned and sequenced the vvpE gene encoding an elastase of V. vulnificus ATCC 29307. The functions of the elastase were assessed by constructing vvpE insertional knockout mutants and evaluating phenotypic changes in vitro and in mice. Although other types of protease activity were still observed in vvpE mutants, elastase activity was completely absent in the mutants and was restored by reintroducing the recombinant vvpE gene. In contrast to previous characterization of elastase as a potential virulence factor, which was demonstrated by injecting the purified protein into animals, inactivation of the V. vulnificus vvpE gene did not affect the ability of the bacteria to infect mice and cause damage, either locally in subcutaneous tissues or systemically in the liver, in both iron-treated and normal mice. Furthermore, a vvpE mutant was not affected with regard to cytolytic activity toward INT407 epithelial cells or detachment of INT407 cells from culture dishes in vitro. Therefore, it appears that elastase is less important in the pathogenesis of V. vulnificus than would have been predicted by examining the effects of administering purified proteins to animals. However, V. vulnificus utilizes a variety of virulence factors; hence, the effects of inactivation of elastase alone could be masked by other compensatory virulence factors.

Psoriasis pustulosa generalizada inducida por prueba de la tuberculina / Generalized pustular psoriasis induced by tuberculin testing

No disponible

No disponible

Sistema integral de urgencias: funcionamiento de los equipos de emergencias en España / Emergency care integral system: working of the out-of hospital emergency teams in Spain

Hoy día, la asistencia a las urgencias sanitarias se entiende dentro del concepto de sistema integral de urgencias, el cual unifica los diferentes niveles asistenciales implicados en la resolución de éstas, en un único proceso asistencial. Uno de los últimos eslabones incorporados a esta cadena han sido los equipos de emergencias (EE) extrahospitalarios, implantados en la actualidad en casi toda la geografía española. Estos EE, por sus peculiaridades en cuanto a su composición, funcionamiento y en torno de trabajo, tienen una entidad propia dentro de la cadena asistencial de las urgencias y emergencias sanitarias (AU)

Peso del recién nacido y su correlación con la edad cronológica y ginecológica de las madres / New born weight and its correlation with the chronological and gynecological age of the mothers

El embarazo en adolescentes de hasta 15 años inclusive, o 3 años o menos de edad ginecológica, es considerado como de alto riesgo por el perfil biopsíquico de las madres. Las complicaciones que se asocian más frecuentemente al embarazo en éste grupo etáreo son: eclampsia, hipertensión arterial, partos prematuros, infecciones urinarias, mayor número de distosias de presentación y posición, mayor número de cesáreas y mayor frecuencia de recién nacidos de bajo peso, si las comparamos con las adultas. Objetivo: Estudiar la relación entre los pesos de hijos de madres adolescentes y la edad cronológica y genecológica de las mismas. Materiales y métodos: Se investigaron 106 historias clínicas pertenecientes a adolescentes de ó15 años, las que tuvieron sus partos entre el 01-01-98 al 31-12-1999 en el Hospital "Evita Pueblo" de Berazategui. Se realizó un estudio longitudinal, retrospectivo y de correlación. Las variables estudiadas fueron: edad cronológica de la madre, edad ginecológica, pesos de los recién nacidos. Se utilizó el programa estadístico: EPI-INFO-6.04C. Octubre 1997. CDC.EPO. Se aplicó el coeficiente de Correlación lineal de Pearson y el de determinación (RZ), Ó y ß seleccionados: 0,05. Resultados: Al estudiar la edad cronológica de la madre en relación al peso del recién nacido el R obtenido fue 0.13 y el R² 0.02, no significativo. Para edad ginecológica y peso del recién nacido el R y R² fueron 0.02 y 0,004 respectivamente. No significativos. Conclusión: No se halló correlación significativa entre edad cronológica, ginecológica de las madres y el peso de los recién nacidos per se. Los factores externos que pueden afectar los resultados perinatales pueden ser evitados con un buen control prenatal y un abordaje interdisciplinario

Peso del recién nacido y su correlación con la edad cronológica y ginecológica de las madres / New born weight and its correlation with the chronological and gynecological age of the mothers

El embarazo en adolescentes de hasta 15 años inclusive, o 3 años o menos de edad ginecológica, es considerado como de alto riesgo por el perfil biopsíquico de las madres. Las complicaciones que se asocian más frecuentemente al embarazo en éste grupo etáreo son: eclampsia, hipertensión arterial, partos prematuros, infecciones urinarias, mayor número de distosias de presentación y posición, mayor número de cesáreas y mayor frecuencia de recién nacidos de bajo peso, si las comparamos con las adultas. Objetivo: Estudiar la relación entre los pesos de hijos de madres adolescentes y la edad cronológica y genecológica de las mismas. Materiales y métodos: Se investigaron 106 historias clínicas pertenecientes a adolescentes de ó15 años, las que tuvieron sus partos entre el 01-01-98 al 31-12-1999 en el Hospital "Evita Pueblo" de Berazategui. Se realizó un estudio longitudinal, retrospectivo y de correlación. Las variables estudiadas fueron: edad cronológica de la madre, edad ginecológica, pesos de los recién nacidos. Se utilizó el programa estadístico: EPI-INFO-6.04C. Octubre 1997. CDC.EPO. Se aplicó el coeficiente de Correlación lineal de Pearson y el de determinación (RZ), O y ß seleccionados: 0,05. Resultados: Al estudiar la edad cronológica de la madre en relación al peso del recién nacido el R obtenido fue 0.13 y el R² 0.02, no significativo. Para edad ginecológica y peso del recién nacido el R y R² fueron 0.02 y 0,004 respectivamente. No significativos. Conclusión: No se halló correlación significativa entre edad cronológica, ginecológica de las madres y el peso de los recién nacidos per se. Los factores externos que pueden afectar los resultados perinatales pueden ser evitados con un buen control prenatal y un abordaje interdisciplinario (AU)