Indicadores cognitivos del proceso de envejecimiento en las personas con síndrome de Down

Fundamentos: el aumento de la esperanza de vida en las personas con síndrome de Down plantea nuevos interrogantes sobre el proceso de su envejecimiento. La revisión bibliográfica sobre el tema muestra acuerdo sobre algunos aspectos diferenciales respecto a la población con discapacidad psíquica y la población general. Entre ellos, destacamos dos: a) la precocidad del inicio del proceso y b) el aumento de la probabilidad de desarrollar un envejecimiento patológico a causa de la demencia tipo Alzheimer. El objetivo del presente estudio se centra en la aportación de datos que ayuden a delimitar los posibles indicadores del declive cognitivo de las personas adultas con síndrome de Down relacionados con un posible deterioro propio de la demencia tipo Alzheimer. Método: el estudio se realiza en una muestra de 84 personas adultas con discapacidad psíquica, 42 de las cuales presentan el síndrome de Down. La media de edad se sitúa entorno a los 40 años y su nivel de retraso mental es medio. Se aplica de forma longitudinal en un período de dos años el test d’Aptituds Cognitives per a Deficiència del 65% (Castelló, Carrillo y Barnosell, 1996). Se utiliza un diseño factorial mixto de medidas repetidas controlando las variables etiología, edad cronológica, nivel de retraso mental y paso del tiempo. Resultados: se observa con el paso del tiempo, un declive cognitivo significativo de las personas con síndrome de Down de más de 38 años y nivel de retraso mental ligero respecto al grupo con discapacidad psíquica de referencia. Los indicadores cognitivos se sitúan preferentemente en las áreas de lenguaje y coordinación visomotora. Conclusiones: las personas con síndrome de Down de más de 38 años y nivel de retraso mental ligero manifiestan una probabilidad mayor de desarrollar un declive cognitivo relacionado con un probable deterioro propio de la demencia Alzheimer.

Barley Yellow Dwarf Virus (BYDV) y los áfidos en los arrozales levantinos: una prospección

Se ha llevado a cabo una prospección de las poblaciones emigrantes de áfidos alados en el área de La Albufera de Valencia, zona donde se da el «enrojat» del arroz, enfermedad causada por una raza del Barley Yellow Dwarf Virus, y se discute aquí el potencial presumible de las distintas especies como vectores de la enfermedad. Se muestrearon dos áreas con diferente incidencia de la enfermedad, obteniéndose 30 especies, de las que ocho están descritas como vectores de tales virus. Fueron mayores las capturas en las áreas donde se cultivaba el arroz por plantel y transplante con incidencia marcada de la enfermedad, que en otras de menor incidencia. La aparente homogeneidad de la zona hace difícil comprender la razón de tales diferencias. Entre los vectores conocidos de BYDV, sólo Rhopalosiphon padi L. y Hyaiopterus pruni (L) Geof. aparecieron al principio de la estación, cuando tiene lugar la infección, con poblaciones considerables. E1 primero es el vector conocido de la enfermedad. El segundo, es de las pocas especies que tiene niveles similares de captura en ambas áreas. Ninguno de los otros áfidos vectores capturados como alados parece verdaderamente importante para la transmisión a pleno campo por lo tardío de su llegada a los campos o por razones de su ciclo vital. Se ha intentado estudiar el potencial de Hyalopterus pruni, pulgón muy abundante en los carrizos como transmisor a corta distancia a partir de estas plantas. No se han obtenido resultados positivos ni a partir de la planta, ni a partir de áfidos alimentados en arroz o avena infectadas previamente con la enfermedad.

Clinical management and burden of bipolar disorder: a multinational longitudinal study (WAVE-bd Study)

BACKGROUND: Studies in bipolar disorder (BD) to date are limited in their ability to provide a whole-disease perspective--their scope has generally been confined to a single disease phase and/or a specific treatment. Moreover, most clinical trials have focused on the manic phase of disease, and not on depression, which is associated with the greatest disease burden. There are few longitudinal studies covering both types of patients with BD (I and II) and the whole course of the disease, regardless of patients' symptomatology. Therefore, the Wide AmbispectiVE study of the clinical management and burden of Bipolar Disorder (WAVE-bd) (NCT01062607) aims to provide reliable information on the management of patients with BD in daily clinical practice. It also seeks to determine factors influencing clinical outcomes and resource use in relation to the management of BD. METHODS: WAVE-bd is a multinational, multicentre, non-interventional, longitudinal study. Approximately 3000 patients diagnosed with BD type I or II with at least one mood event in the preceding 12 months were recruited at centres in Austria, Belgium, Brazil, France, Germany, Portugal, Romania, Turkey, Ukraine and Venezuela. Site selection methodology aimed to provide a balanced cross-section of patients cared for by different types of providers of medical aid (e.g. academic hospitals, private practices) in each country. Target recruitment percentages were derived either from scientific publications or from expert panels in each participating country. The minimum follow-up period will be 12 months, with a maximum of 27 months, taking into account the retrospective and the prospective parts of the study. Data on demographics, diagnosis, medical history, clinical management, clinical and functional outcomes (CGI-BP and FAST scales), adherence to treatment (DAI-10 scale and Medication Possession Ratio), quality of life (EQ-5D scale), healthcare resources, and caregiver burden (BAS scale) will be collected. Descriptive analysis with common statistics will be performed. DISCUSSION: This study will provide detailed descriptions of the management of BD in different countries, particularly in terms of clinical outcomes and resources used. Thus, it should provide psychiatrists with reliable and up-to-date information about those factors associated with different management patterns of BD. TRIAL REGISTRATION NO: ClinicalTrials.gov: NCT01062607.

Available evidence and outcome of off-label use of rituximab in clinical practice

Purpose: To analyze the therapeutic indications for off-label use of rituximab, the available evidence for its use, the outcomes, and the cost. Methods: This was a retrospective analysis of patients treated with rituximab for off-label indications from January 2007 to December 2009 in two tertiary hospitals. Information on patient characteristics, medical conditions, and therapeutic responses was collected from medical records. Available evidence for the efficacy of rituximab in each condition was reviewed, and the cost of treatment was calculated. Results: A total of 101 cases of off-label rituximab use were analyzed. The median age of the patients involved was 53 [interquartile range (IQR) 37.5-68.0] years; 55.4 % were women. The indications for prescribing rituximab were primarily hematological diseases (46 %), systemic connective tissue disorders (27 %), and kidney diseases (20 %). Available evidence supporting rituximab treatment for these indications mainly came from individual cohort studies (53.5 % of cases) and case series (25.7 %). The short-term outcome (median 3 months, IQR 2-4 months) was a complete response in 38 % of cases and partial response in 32.6 %. The highest short-term responses were observed for systemic lupus erythematosus and membranous glomerulonephritis, and the lowest was for neuromyelitis optica, idiopathic thrombocytopenic purpura, and miscellaneous indications. Some response was maintained in long-term follow-up (median 23 months IQR 12-30months) in 69.2%of patients showing a short-term response. Median cost per patient was 5,187.5 (IQR 5,187.5-7,781.3). Conclusions: In our study, off-label rituximab was mainly used for the treatment of hematological, kidney, and systemic connective tissue disorders, and the response among our patient cohort was variable depending on the specific disease. The level of evidence supporting the use of rituximab for these indications was low and the cost was very high. We conclude that more clinical trials on the off-label use of rituximab are needed, although these may be difficult to conduct in some rare diseases. Data from observational studies may provide useful information to assist prescribing in clinical practice.

Sponge Mass Mortalities in a Warming Mediterranean Sea: Are Cyanobacteria-Harboring Species Worse Off?

Mass mortality events are increasing dramatically in all coastal marine environments. Determining the underlying causes of mass mortality events has proven difficult in the past because of the lack of prior quantitative data on populations and environmental variables. Four-year surveys of two shallow-water sponge species, Ircinia fasciculata and Sarcotragus spinosulum, were carried out in the western Mediterranean Sea. These surveys provided evidence of two severe sponge die-offs (total mortality ranging from 80 to 95% of specimens) occurring in the summers of 2008 and 2009. These events primarily affected I. fasciculata, which hosts both phototrophic and heterotrophic microsymbionts, while they did not affect S. spinosulum, which harbors only heterotrophic bacteria. We observed a significant positive correlation between the percentage of injured I. fasciculata specimens and exposure time to elevated temperature conditions in all populations, suggesting a key role of temperature in triggering mortality events. A comparative ultrastructural study of injured and healthy I. fasciculata specimens showed that cyanobacteria disappeared from injured specimens, which suggests that cyanobacterial decay could be involved in I. fasciculata mortality. A laboratory experiment confirmed that the cyanobacteria harbored by I. fasciculata displayed a significant reduction in photosynthetic efficiency in the highest temperature treatment. The sponge disease reported here led to a severe decrease in the abundance of the surveyed populations. It represents one of the most dramatic mass mortality events to date in the Mediterranean Sea

Atenció a l'ictus agut: comparació del sistema català amb el sistema finlandès

L’ictus és un problema de salut pública on les malalties cerebrovasculars representen la tercera causa de mort del nostre país, la primera causa de discapacitat física en adults i la segona de demència. Segons la OMS es preveu que la malaltia cerebrovascular s’ incrementi un 27% en relació a l’envelliment de la població entre els anys 2000 i 2025Objectius: Conèixer i comparar l’atenció i la organització de les persones afectades per ictus a Catalunya i a Finlàndia, específicament a l’Hospital Universitari Doctor Josep Trueta (Girona) i a l’Hospital Universitari de Kuopio (Finlàndia) Metodologia: Estudi observacional quantitatiu i qualitatiu que compara les diferents atencions a la fase pre-hospitalària, hospitalària i sub-aguda a Girona (Catalunya) i a Kuopio (Finlàndia). S’han estudiat variables relacionades amb l’atenció pre-hospitalària, hospitalària i post-hospitalària específicament, s’han estudiat variables relacionades amb cures d’infermeria. S’han realitzat tècniques qualitatives utilitzant la observació directa en els dos centres estudiats, i tècniques quantitatives mitjançant un qüestionari als responsables d’infermeria