Alzheimer disease and cognitive impairment associated with diabetes mellitus type 2: associations and a hypothesis.

INTRODUCTION: Epidemiological studies have demonstrated that patients with diabetes mellitus have an increased risk of developing Alzheimer disease, but the relationship between the 2 entities is not clear. DEVELOPMENT: Both diseases exhibit similar metabolic abnormalities: disordered glucose metabolism, abnormal insulin receptor signalling and insulin resistance, oxidative stress, and structural abnormalities in proteins and ß-amyloid deposits. Different hypotheses have emerged from experimental work in the last two decades. One of the most comprehensive relates the microvascular damage in diabetic polyneuritis with the central nervous system changes occurring in Alzheimer disease. Another hypothesis considers that cognitive impairment in both diabetes and Alzheimer disease is linked to a state of systemic oxidative stress. Recently, attenuation of cognitive impairment and normalisation of values in biochemical markers for oxidative stress were found in patients with Alzheimer disease and concomitant diabetes. Antidiabetic drugs may have a beneficial effect on glycolysis and its end products, and on other metabolic alterations. CONCLUSIONS: Diabetic patients are at increased risk for developing Alzheimer disease, but paradoxically, their biochemical alterations and cognitive impairment are less pronounced than in groups of dementia patients without diabetes. A deeper understanding of interactions between the pathogenic processes of both entities may lead to new therapeutic strategies that would slow or halt the progression of impairment.

Leprosy. An update: definition, pathogenesis, classification, diagnosis, and treatment.

Leprosy is a chronic granulomatous disease caused by the bacillus Mycobacterium leprae. It primarily affects the skin and peripheral nerves and is still endemic in various regions of the world. Clinical presentation depends on the patient's immune status at the time of infection and during the course of the disease. Leprosy is associated with disability and marginalization. Diagnosis is clinical and is made when the patient has at least 1 of the following cardinal signs specified by the World Health Organization: hypopigmented or erythematous macules with sensory loss; thickened peripheral nerves; or positive acid-fast skin smear or skin biopsy with loss of adnexa at affected sites. Leprosy is treated with a multidrug combination of rifampicin, clofazimine, and dapsone. Two main regimens are used depending on whether the patient has paucibacillary or multibacillary disease.

Colonization with vancomycin-resistant enterococci (VRE) in intensive care unit patients in Cordoba City, Argentina.

The purpose of this study was to determine the prevalence of colonization with vancomycin-resistant enterococci (VRE) among intensive care unit (ICU) patients in a hospital in Córdoba, Argentina. We collected 235 rectal swab specimens from 147 ICU patients. Resistance to vancomycin was screened with the disk diffusion method, and MICs were determined with the E-test method. Vancomycin-resistant genotypes were determined by PCR. The VRE strains were isolated from 18/147 patients (12.2%). The isolates were identified as Enterococcus faecium (94.4%), and Enterococcus gallinarum (5.6%). PCR showed that the E. faecium strains carried the vanA gene, and the E. gallinarum strain carried the vanC1 gene. Our study indicated that at least 12.2% of ICU patients were VRE carriers.

[Cerebrovascular disease and gait disorders: qualitative and quantitative analysis]. / Enfermedad cerebrovascular y alteraciones de la marcha: análisis cualitativo y cuantitativo.

INTRODUCTION AND OBJECTIVE: Pyramidal gait impairment (GI) is a classical trait of cerebrovascular disease (CVD). To developed a method to quantify prospectively and transversely GI and disequilibrium, to be applied in the screening of pyramidal and non-pyramidal syndromes associated to different ethiological subtypes of CVD; using an Index of Gait and Equilibrium (IGE). PATIENTS AND METHODS: In constructing IGE, we used 14 equally weighted semiological variables: 6 measure balance, 6 gait, 1 sensitive abnormalities and 1 falls. Two neurologists separately examined each subject in the same day and repeating the evaluation after a week. Data analyses included Kruskal Wallis, chi 2, Spearman correlations and Principal Components. RESULTS: IGE was used in 90 subjects, 43 males, with a mean age of 70.6 years. 3 groups of people were formed: 1. CVD (A, 21 with silent vascular lesions diagnosed by imaging; B, 17 with vascular dementia; C, 21 with stroke); 2. 13 subjects with cautious gait, not associated to any disease; and 3. 18 normal control subjects (age 60-80 years). GI in the non-pyramidal syndrome were significantly related with small vessels disease (chi 2 = 16.37, dof = 1, p < 0.001). CONCLUSIONS: GI in CVD, pyramidal and non-pyramidal syndromes were equally frequent. Increased values of IGE caused by cautious gait in youngest non-stroke patients suggested high probability of silent CVD and significant association with small vessels disease. This preliminary assessment of IGE showed a reproducible and reliable tool for objectification and quantification of gait disorders.

[Group B streptococcal infections in adults, excluding genital infections]. / Infecciones por estreptococos grupo B en adultos excluyendo infecciones genitales.

Group B streptococcus (GBS) or Streptococcus agalactiae is recognized as a mayor cause of neonatal meningitis, sepsis and infections during pregnancy. However, in recent years there have been several reports concerning GBS infections in non pregnant adult population, specially in immunocompromised hosts and in patients with severe underlying diseases such as diabetes mellitus and cancer. We report a series of 45 cases which occurred in nonpregnant adult population during a period of two years. The average age was 50.8 years and most patients (38/44) had one or more risk factors: diabetes mellitus was the most significant underlying disease. The most frequent infection localization was skin and soft tissues followed by urinary tract infection. Several isolated cases of pneumonia, bacteremia, endocarditis, endometritis and peritonitis were observed. GBS infections should no longer be exclusively considered as perinatal and peripartum events. New clinical presentations are arising in non pregnant adult population with special incidence in immunocompromised hosts. We are obliged to keep this in mind and remember that SGB may be a possible etiologic agent for infections, particularly in skin and soft tissues of diabetic patients.

[Evaluation of topical calcipotriol in psoriasis]. / Evaluación de calcipotriol tópico en psoriasis.

Calcipotriol is an analogue of vitamin D3 with effect on epidermal keratinization, cellular division and modulation of immune response. An evaluation of its therapeutic effect when given in twenty-five psoriatic patient with less than 25% of their body surface affected was done. The medication was applied twice daily during six weeks on involved areas. The evolution was evaluated by the psoriatic area and severity index (PASI) analysis. The evaluation of initial and terminal PASI analysis revealed a decrease in the psoriatic activity that fluctuated from 25% to 100%, with a 61% average. A reactivation in the psoriatic lesion was noticed two weeks after the medication was halted; thereafter, the calcipotriol was restarted for an additional four weeks and a decrease in their PASI with a 74% average was achieved. There were no important side effects reported. Calcipotriol is effective in the treatment of psoriasis and it is an important addition to the therapeutic medications available to treat psoriasis. It is important to give the treatment for longer periods of time for evaluating the possibility to induce prolonged remissions.

Immunochemical and biological characterization of three capsular polysaccharides from a single Bacteroides fragilis strain.

Although Bacteroides fragilis accounts for only 0.5% of the normal human colonic flora, it is the anaerobic species most frequently isolated from intra-abdominal and other infections with an intestinal source. The capsular polysaccharides of B. fragilis are part of a complex of surface polysaccharides and are the organism's most important virulence factors in the formation of intra-abdominal abscesses. Two capsular polysaccharides from strain NCTC 9343, PS A1 and PS B1, have been characterized structurally. Their most striking feature is a zwitterionic charge motif consisting of both positively and negatively charged substituent groups on each repeating unit. This zwitterionic motif is essential for abscess formation. In this study, we sought to elucidate structural features of the capsular polysaccharide complex of a commonly studied B. fragilis strain, 638R, that is distinct from strain 9343. We sought a more general picture of the species to establish basic structure-activity and structure-biosynthesis relationships among abscess-inducing polysaccharides. Strain 638R was found to have a capsular polysaccharide complex from which three distinct carbohydrates could be isolated by a complex purification procedure. Compositional and immunochemical studies demonstrated a zwitterionic charge motif common to all of the capsular polysaccharides that correlated with their ability to induce experimental intra-abdominal abscesses. Of interest is the range of net charges of the isolated polysaccharides-from positive (PS C2) to balanced (PS A2) to negative (PS 3). Relationships among structural components of the zwitterionic polysaccharides and their molecular biosynthesis loci were identified.

Determination of chlorotriazines, methylthiotriazines and one methoxytriazine by SPE-LC-UV in water samples.

Triazine herbicides form a wide group of substances that belong among the most common agrochemicals applied for pre- and post-emergence weed control. So, they can be found in the environment at trace level. In order to determine their concentrations in water samples by the usual analytical techniques, a preconcentration step is commonly necessary. In this paper, a simple analytical method for the quantification of eight triazines (three chlorotriazines, four methylthiotriazines and one methoxytriazine) in water samples by solid phase extraction-reversed phase liquid chromatography (LC) has been developed. LC shows good analytical performance for simultaneous multiple triazine analysis (repeatability <2%, reproducibility <3%), except for prometon (repeatability 5.52%, reproducibility 16%). The results, obtained by using carbograph and polymeric sorbents for solid phase extraction (SPE), have been compared. The limits of quantification achieved permit the application of the proposed SPE-LC method for the determination of eight triazines in water samples (0.0065-0.028 mug l(-1)).

Lepra: puesta al día. Definición, patogénesis, clasificación, diagnóstico y tratamiento / Leprosy. An Update: Definition, Pathogenesis, Classification, Diagnosis, and Treatmen

La lepra es una enfermedad granulomatosa crónica causada por una micobacteria (M. leprae) que presenta predisposición por la piel y los nervios periféricos. La lepra continúa siendo endémica en distintas regiones del mundo. La presentación clínica de la enfermedad depende del estado inmunológico del paciente al adquirirla y de la evolución de la misma. Es una infección que se asocia a discapacidad y marginación. El diagnóstico de lepra es clínico y se hace al tener uno o más de los signos cardinales establecidos por la OMS: máculas hipopigmentadas o eritematosas con disminución de la sensibilidad, engrosamiento de los nervios periféricos y la demostración de bacilos ácido alcohol resistentes en una baciloscopia o biopsia de piel, con pérdida de anexos en los sitios afectados. El tratamiento consta de tres fármacos: rifampicina, clofazimina y dapsona. Existen principalmente dos modalidades de tratamiento dependiendo de la presentación clínica del paciente: paucibacilar o multibacilar (AU)

Leprosy is a chronic granulomatous disease caused by the bacillus Mycobacterium leprae. It primarily affects the skin and peripheral nerves and is still endemic in various regions of the world. Clinical presentation depends on the patient's immune status at the time of infection and during the course of the disease. Leprosy is associated with disability and marginalization. Diagnosis is clinical and is made when the patient has at least 1 of the following cardinal signs specified by the World Health Organization: hypopigmented or erythematous macules with sensory loss; thickened peripheral nerves; or positive acid-fast skin smear or skin biopsy with loss of adnexa at affected sites. Leprosy is treated with a multidrug combination of rifampicin, clofazimine, and dapsone. Two main regimens are used depending on whether the patient has paucibacillary or multibacillary disease (AU)

Enfermedad cerebrovascular y alteraciones de la marcha: análisis cualitativo y cuantitativo / Cerebrovascular disease and gait disorders: qualitative and quantitative analysis

Introducción y objetivos. Las alteraciones de la marcha (AM) de tipo piramidal son clásicamente conocidas en la enfermedad cerebrovascular (ECV). Nuestro objetivo ha sido desarrollar un análisis de las AM piramidales y no piramidales, prospectivo y transversal, cualitativo y cuantitativo, vinculado con los diferentes subtipos de la ECV, utilizando una escala de marcha y equilibrio (EME).Pacientes y métodos. Para conformar la EME se utilizaron 14 variables semiológicas, 6 de postura y equilibrio, 6 de marcha, 1 de trastornos sensitivos y 1 de caídas. Dos neurólogos examinaron separadamente a cada persona, y repitieron las determinaciones a la semana siguiente. Los datos fueron evaluados con el test de Kruskal Wallis, coeficiente de Spearman, test de la ji al cuadrado y componentes principales. Resultados. Noventa sujetos, con una edad media de 70,6 años, conformaron tres grupos: 1. ECV: 21 con lesiones vasculares silentes en neuroimagen, 17 con demencia vascular probable y 21 con ataque clínico vascular cerebral agudo; 2. Trece con marcha cautelosa sin enfermedad evidente; 3. Dieciocho controles normales de 60 a 80 años. Las AM con síndrome no piramidal se relacionaron significativamente con la enfermedad de las pequeñas arterias ( c2= 16,37, gdl= 1, p< 0,0001). Conclusiones. En la ECV, las AM no piramidales fueron tan frecuentes como las piramidales. Un valor aumentado de EME provocado por una marcha cautelosa, en pacientes más jóvenes, sugirió una alta probabilidad de ECV silente y una significativa asociación con las lesiones de pequeña arteria. Estos resultados preliminares sugieren que la EME es un instrumento útil para objetivar y cuantificar las AM (AU)

Infecciones por estreptococos grupo B en adultos excluyendo infecciones genitales. / [Group B streptococcal infections in adults, excluding genital infections]

Group B streptococcus (GBS) or Streptococcus agalactiae is recognized as a mayor cause of neonatal meningitis, sepsis and infections during pregnancy. However, in recent years there have been several reports concerning GBS infections in non pregnant adult population, specially in immunocompromised hosts and in patients with severe underlying diseases such as diabetes mellitus and cancer. We report a series of 45 cases which occurred in nonpregnant adult population during a period of two years. The average age was 50.8 years and most patients (38/44) had one or more risk factors: diabetes mellitus was the most significant underlying disease. The most frequent infection localization was skin and soft tissues followed by urinary tract infection. Several isolated cases of pneumonia, bacteremia, endocarditis, endometritis and peritonitis were observed. GBS infections should no longer be exclusively considered as perinatal and peripartum events. New clinical presentations are arising in non pregnant adult population with special incidence in immunocompromised hosts. We are obliged to keep this in mind and remember that SGB may be a possible etiologic agent for infections, particularly in skin and soft tissues of diabetic patients.

Infecciones por estreptococos grupo B en adultos excluyendo infecciones genitales / [Group B streptococcal infections in adults, excluding genital infections]

Group B streptococcus (GBS) or Streptococcus agalactiae is recognized as a mayor cause of neonatal meningitis, sepsis and infections during pregnancy. However, in recent years there have been several reports concerning GBS infections in non pregnant adult population, specially in immunocompromised hosts and in patients with severe underlying diseases such as diabetes mellitus and cancer. We report a series of 45 cases which occurred in nonpregnant adult population during a period of two years. The average age was 50.8 years and most patients (38/44) had one or more risk factors: diabetes mellitus was the most significant underlying disease. The most frequent infection localization was skin and soft tissues followed by urinary tract infection. Several isolated cases of pneumonia, bacteremia, endocarditis, endometritis and peritonitis were observed. GBS infections should no longer be exclusively considered as perinatal and peripartum events. New clinical presentations are arising in non pregnant adult population with special incidence in immunocompromised hosts. We are obliged to keep this in mind and remember that SGB may be a possible etiologic agent for infections, particularly in skin and soft tissues of diabetic patients.