[Moyamoya in Aragon: epidemiology and self-perception of quality of life]. / Moyamoya en Aragón. Epidemiología y calidad de vida autopercibida.

INTRODUCTION: Moyamoya angiopathy is a vasculopathy caused by stenosis/occlusion of one or both intracranial internal carotid arteries. Although more common in Eastern countries, its prevalence is increasing in the West. An angioresonance or angiography is essential for its diagnosis. There are two options for treatment: conservative (medical) treatment or surgical bypass techniques. PATIENTS AND METHODS: Nineteen patients were selected using International Classification of Diseases codes, and their demographic characteristics and health outcomes were studied. They were administered a scale for the screening of anxious-depressive syndrome (the Hospital Anxiety and Depression Scale - HADS) and another scale for self-perceived quality of life (SF-36). After applying the inclusion/exclusion criteria, eight of these patients were studied. RESULTS: Nineteen patients were studied (52.63% male, 57.89% European) and the Aragonese prevalence was estimated at 1.37/100,000 inhabitants. The most frequent clinical presentation was ischaemic stroke (73.68%). The HADS detected two positive cases of anxiety and one case of depression. According to the SF-36, the worst self-rated aspects were vitality (median: 35/100) and general health (median: 42.5/100), while the best rated was physical function (mean: 93.57/100). CONCLUSIONS: This is the Spanish series with the highest prevalence and the only one that addresses self-perceived health and screening of the anxious-depressive syndrome. Further research is needed to address this entity and determine its true prevalence in the West.

TITLE: Moyamoya en Aragón. Epidemiología y calidad de vida autopercibida.Introducción. La angiopatía de moyamoya es una vasculopatía originada por la estenosis/oclusión de una o ambas carótidas internas intracraneales. Aunque es más frecuente en países orientales, está aumentando su prevalencia en Occidente. Para su diagnóstico es imprescindible una angiorresonancia o una angiografía. En su tratamiento hay dos opciones: el tratamiento conservador (médico) o las técnicas quirúrgicas de bypass. Pacientes y métodos. Se seleccionó a 19 pacientes mediante códigos de la Clasificación internacional de enfermedades, y se estudiaron sus características demográficas y resultados en salud. Se les administró una escala para el cribado de síndrome ansiosodepresivo ­escala de ansiedad y depresión hospitalaria (HADS)­ y otra de autopercepción de calidad de vida (SF-36). De estos pacientes, se estudió a ocho al aplicar los criterios de inclusión/exclusión. Resultados. Se estudió a 19 pacientes (52,63%, hombres; 57,89%, europeos) y se estimó la prevalencia aragonesa en 1,37/100.000 habitantes. La clínica más frecuente fue el ictus isquémico (73,68%). La HADS detectó dos casos positivos para ansiedad y un caso de depresión. Según el SF-36, los aspectos peor autopercibidos fueron la vitalidad (mediana: 35/100) y la salud general (mediana: 42,5/100); mientras que el mejor valorado fue la función física (media: 93,57/100). Conclusiones. Se trata de la serie española con mayor prevalencia y la única que aborda la salud autopercibida y el cribado del síndrome ansiosodepresivo. Son necesarios más estudios que permitan abordar esta entidad y cuál es la verdadera prevalencia en Occidente.

Sodium balance during U. S. football training in the heat: cramp-prone vs. reference players.

U. S. football players with a history of heat cramps were evaluated for the effect of physical training, sodium intake, and loss of sweat sodium on whole blood sodium concentration (BNa). Athletes (n=14 males, 24+/-1 y) were recruited and studied based on medical history, age, and position. The reference group (R, n=8 without a cramping history) and cramp-prone group (C, n=6, history of whole-body cramps associated with extensive sweat loss during exercise in the heat) were measured for body mass and BNa (ISTAT) before and after team training of 2.2 h in hot conditions (WBGT=29-32 degrees C). Intake and loss of fluid and sodium were also measured to determine respective acute balance. In R, BNa was stable pre- to post-training (138.9+/-1.8 to 139.0+/-2.0 mmol/L) while it tended to decline in C (137.8+/-2.3 to 135.7+/-4.9 mmol/L), and three subjects in C had BNa values below 135 mmol/L (131.7+/-2.9 mmol/L). C consumed a greater percentage of total fluid as water (p<0.05). Mean sweat sodium concentration was (52.6+/-29.2 mmol/L for C and 38.3+/-18.3 mmol/L for R (p>0.05). Compared to R, C tended to experience a decline in BNa and greater acute sodium imbalance. These changes may place cramp-prone players at greater risks for developing acute sodium deficits during training.

[Mortality in patients with multiple injuries: analysis using the trauma and injury severity score in a referral hospital]. / Análisis de la mortalidad en los pacientes politraumatizados según la metodología TRISS en un hospital traumatológico de referencia.

BACKGROUND AND OBJECTIVES: A growing number of patients with multiple injuries are being treated. Injury severity scales can be used to assess outcomes objectively. This study aimed to assess our hospital's cases on the basis of the Trauma and Injury Severity Score (TRISS) and compare outcomes to those reported in the Major Trauma Outcome Study, as well as to determine preventable mortality and analyze causes of death and associated factors. PATIENTS AND METHODS: Data were extracted from the records of patients admitted with multiple injuries in 2005 and were used to calculate the Revised Trauma Score (RTS), the Injury Severity Score (ISS), and the TRISS or probability of survival. Hospital mortality was also calculated. A TRISS between 25 and 50 was considered to indicate a preventable avoidable death; a TRISS over 50 indicated a preventable death. Logistic regression analysis was used to identify factors associated with mortality. RESULTS: We studied the cases of 198 patients with a mean (SD) age of 43.9 (19) years. Ninety-three percent had suffered blunt trauma. The mean ISS, the prehospital RTS, and the TRISS were 16.9 (11.2), 10.8 (2.5), and 0.95 (0.2), respectively. Twenty-five patients died. Fifteen deaths were classified as preventable or potentially preventable. Factors related to exitus were head injury and age (odds ratios, 4.6 and 4.0, respectively). CONCLUSIONS: The rate of preventable death in our hospital was higher than expected. Mortality was strongly associated with head injury and age. The TRISS model can identify preventable deaths objectively.

Prevention of Alzheimer's disease: a global challenge for next generation neuroscientists.

The incidence of dementia is rapidly increasing in developed countries due to social and demographic changes. This trend is expected to worsen in the coming decades, with the number of cases possibly even tripling in the next 25 years. Therefore Alzheimer's disease (AD) prevention is becoming a global health priority. Our knowledge of the pathophysiological process leading to the development of pathological brain lesions that characterize AD has increased exponentially in recent years. However, the phenotypic expression of AD not only depends on the development of senile plaques and neurofibrillary tangles but other factors also play a role. Thus, over the last few decades, epidemiological studies have revealed several risk factors for developing AD, such as vascular or lifestyle related factors. Having the current knowledge on AD, two different strategies have been developed for the prevention of AD: one is based on primary prevention by acting on modifiable risk factors, the other is a pathophysiology-driven approach aimed to identify individuals in a preclinical stage of the disease and treating them with drugs purporting to act on molecular targets of the amyloid cascade. Several promising trials with these approaches are currently ongoing and results are expected in the next few years. The intrinsic limitations in the design of preventive trials should be overcome through a global effort involving healthy population, healthcare professionals, governments, industry, and scientific institutions. This exertion will be more than compensated if we can make AD a preventable disease.

[Encephalitis associated to anti-NMDA receptor antibodies: a description of two cases in the child/youth population]. / Encefalitis asociada a anticuerpos antirreceptor de NMDA: descripcion de dos casos en poblacion infantojuvenil.

INTRODUCTION: The clinical diagnosis of encephalitis due to anti-glutamate receptor N-methyl D-aspartate (NMDA) antibodies (anti-NMDA encephalitis) is made more complex by the fact that psychiatric clinical features are usually predominant in the early stages. This can lead to a delay in the diagnosis, treatment and prognosis of the disease. CASE REPORTS: We report on two clinical cases attended by the Child/Youth Psychiatry Section of our hospital, in collaboration with the Paediatric and Neurology services. Case 1: a 4-year-old male who was referred owing to behavioural alterations and the regression of previously acquired skills. Case 2: a 13-year-old female who was admitted due to a behavioural disorder within the context of a possible initial psychotic episode. In both cases appropriate complementary tests were performed, including lumbar puncture and anti-NMDA antibodies, which were positive. Once the diagnosis of anti-NMDA encephalitis had been reached, treatment was started: in the first case, with intravenous perfusion of corticoids and immunoglobulins, while in the second rituximab had to be associated. Both patients progressed towards clinical improvement. CONCLUSIONS: Over the last two years there has been an increase in the number of cases of anti-NMDA encephalitis diagnosed in the child/youth population. It is a neuropsychiatric, autoimmune condition, which can correspond to a paraneoplastic syndrome. Follow-up and transvaginal ultrasonography as well as thoracoabdominal computerised axial tomography scans are recommended for at least two years after diagnosis. Early diagnosis and treatment are important, which means that a multi- and interdisciplinary approach is required.

Application of the Technology Web 2.0 in a drug information centre.

OBJECTIVE: To develop a Web 2.0 resource map and select those that may be useful in a Drug Information Centre at a Hospital Pharmacy Department (CIMSF). METHOD: A multidisciplinary working group under the Biomedical Information Commission selected some of the Web 2.0 resources included in the Guía d'usos i estil a les xarxes Socials guide of the Catalonian Government. RESULTS: Six resources were selected: Netvibes, Delicious, Google groups, Google Docs, Slideshare and Twitter. These tools were used for 5 months to manage biomedical information for the medical staff, and to provide external visibility by providing information to other health professionals. More than a thousand hits were recorded on the portal Netvibes and more than 100 professionals followed CIMSF on Twitter. CONCLUSIONS: The Web 2.0 offers useful, user-friendly and cost-efficient tools which could be implemented in a CIMSF, while also enabling participation in external networks of pharmacotherapeutic interest, increasing its visibility to other professionals.

Evaluation of the VALAB expert system.

The validation of a clinical laboratory report is a process that guarantees the results contained in the report have been obtained under satisfactory metrological conditions and that they are compatible with the information available on the patient. This validation is generally carried out manually by a clinical laboratory professional, but also may be done by an expert system properly programmed, such as the VALAB system. The evaluation presented in this article consists of comparing human and system decisions of validation for 500 randomly selected clinical laboratory reports from hospitalized patients. In this evaluation, 84.8% of the reports examined by the VALAB are accepted directly without any human aid, and only 15.2% require examination by clinical biochemists.

Pre-metrological (pre-analytical) variation of some biochemical quantities.

It is customary to assume that pre-metrological variation is negligible if all pre-metrological sources of variation have been standardised. The aim of this study was to quantify the pre-metrological variation of some biochemical quantities frequently measured in clinical laboratories. The experimental design considers the different sources of pre-metrological variation that usually act day-to-day on samples from patients. The results demonstrate that, for many quantities, the pre-metrological variance is not negligible; consequently, it is suggested that these variances should be taken into account when estimating the uncertainty of measurement of patients' results.

Multicentric reference values: shared reference limits.

In order to obtain shared reference limits, three laboratories in the same geographical area with a homogeneous population have developed a proposal to produce multicentric reference values. The strategy simulates a virtual laboratory, actually formed by the laboratories involved; the reference limits produced in the virtual laboratory are in fact derived from the blend of reference values obtained by each laboratory. Each laboratory has chosen its own reference sample and has measured the biochemical quantities under study. Reference individuals (n = 171) and 15 biochemical quantities among the most measured in clinical laboratories were selected. The reference values obtained in each laboratory were blended when permitted by the Harris & Boyd test (Clin Chem 1990; 36:265-70). The multicentric reference limits obtained by the virtual laboratory for each quantity were estimated according to the recommendations of the International Federation of Clinical Chemistry. For each quantity, each laboratory, with the results observed in their reference sample, estimated the diagnostic specificity, using as cut-off values the corresponding multicentric reference limits. Each observed value of diagnostic specificity was compared with the theoretical diagnostic specificity value, equal to 0.975, that should be observed when a reference limit is used as cut-off value. The multicentric reference limits obtained by the virtual laboratory are valid in all cases with the exception of the upper reference limit for the concentrations of calcium(II) and urate in serum in one of the laboratories.