Eficacia de los inhibidores selectivos de recaptación de serotonina en síntomas no cognitivos del alzhéimer: revisión sistemática

Introducción: El Alzhéimer tiene una prevalencia de 1,6% en las personas mayores de 65 años. Se caracteriza por la pérdida de memoria y otras funciones cognoscitivas, pero más del 70% de los afectados presentan síntomas no cognitivos entre los que se encuentran alteraciones del afecto, comportamiento y psicosis. Estos síntomas están asociados a mayores tasas de institucionalización, morbilidad y mortalidad. Métodos: Revisión sistemática de la literatura de artículos que proporcionaron información sobre la eficacia de los inhibidores selectivos de recaptación de serotonina en síntomas no cognitivos del Alzhéimer. Resultados: La búsqueda inicial arrojó un total de 495 resultados, 64 artículos fueron preseleccionados y 7 se incluyeron en la revisión; éstos se clasificaron como nivel de evidencia Ib; citalopram mostró ser más eficaz que el placebo y similar a antipsicóticos para síntomas comportamentales y psicóticos asociados al Alzhéimer con un perfil de efectos adversos más tolerable; sertralina no mostró eficacia en depresión y sí una mayor incidencia de efectos adversos con respecto al placebo. Discusión: Se obtuvieron resultados favorables en síntomas comportamentales y psicóticos pero no en afectivos. Las diferencias metodológicas de los estudios le dan complejidad a la interpretación de los resultados. Conclusión: La evidencia sugiere que el tratamiento con citalopram es eficaz en síntomas comportamentales y psicóticos asociados al Alzhéimer; para el tratamiento de la depresión asociado a esta demencia aún no existe un antidepresivo que pueda considerarse de elección.

Caracterización de pacientes adultos mayores con epilepsia en dos hospitales de Bogotá (Colombia)

La prevalencia global de la epilepsia en Colombia es del 1,13% y en pacientes mayores de 65 años puede estar cercana al 1,5%. El objetivo de este trabajo ha sido el de describir las características demográficasy clínicas de la población mayor de 65 años que presenta epilepsia. Materiales y métodos: estudio descriptivo, de corte transversal en dos hospitales en Bogotá (Colombia), durante los años 2005-2008. Se revisaron las bases de datos y se seleccionaron las historias clínicas de los pacientes mayores de 65 años con epilepsia. Resultados: se revisaron 211 historias clínicas y se seleccionaron 179. La edad media fue de 75 años (65-98) y el inicio de la epilepsia fue a los 67,5 (7-93); el 64,4% inició la enfermedad después de los 65 años. El 84% de las crisis fueron clasificadas como focales. El diagnóstico más frecuente fue epilepsia focal sintomática (94,4%). 61 pacientes tuvieron como etiología una enfermedad cerebro-vascular. Los antiepilépticos de primera generación, especialmente fenitoína, fueron los más utilizados (99%), aunque 81 de 104 pacientes tratados no estaban libres de crisis. Conclusiones: la mayoría de las crisis son resultado de una epilepsia focal sintomática como consecuencia de una lesión vascular, por lo que se debe considerar el tratamiento farmacológico desde la primera crisis. Es recomendable iniciar el tratamiento con antiepilépticos de segunda generación como lamotrigina, gabapentin, levetiracetam, para minimizar efectos secundarios, y mantener el principio de inicio con dosis bajas y mantenimiento con dosis bajas. Si las condiciones económicas no lo permiten, se puede usar fenitoína o carbamacepina con precaución.

Brain Tumour, Mood Disorder and Encephalopathy. Discusion of the Clinical Case Presented in Volume 6, Number 2

We report a case of a 65 years old female patient, who was admitted to the hospital with non specific neurological symptoms and who had preliminary imagenological findings of an extra-axial tumor mass (a meningioma of the sphenoid’s wing), which was taken to complete surgical removal. Afterwards, she developed progressive neurologic deterioration until her death. The final diagnosis was acute spongiform encephalophaty, and was obtained by cerebral biopsy. Spongiform encephalopathy was described, almost a century ago, as the Creutzfeldt-Jakob Disease, poorly diagnosed in our environment because of its low frequency and uncommon onset, which starts with a mood disorder followed by a phase of dementia and a final fatal outcome. The gold standard for the diagnosis is based on a biopsy or an autopsy of the brain, with immunohistochemical stains for the prionic abnormal protein.

Brain Tumour, Mood Disorder and Encephalopathy. Discusion of the Clinical Case Presented in Volume 6, Number 2

We report a case of a 65 years old female patient, who was admitted to the hospital with non specific neurological symptoms and who had preliminary imagenological findings of an extra-axial tumor mass (a meningioma of the sphenoid’s wing), which was taken to complete surgical removal. Afterwards, she developed progressive neurologic deterioration until her death. The final diagnosis was acute spongiform encephalophaty, and was obtained by cerebral biopsy. Spongiform encephalopathy was described, almost a century ago, as the Creutzfeldt-Jakob Disease, poorly diagnosed in our environment because of its low frequency and uncommon onset, which starts with a mood disorder followed by a phase of dementia and a final fatal outcome. The gold standard for the diagnosis is based on a biopsy or an autopsy of the brain, with immunohistochemical stains for the prionic abnormal protein.

Brain Tumor, Mood Disorder and Encephalopathy

Brain Tumor, Mood Disorder and EncephalopathyWe report a case of a patient was 65 years old, who was admitted with neurologic symptoms ill-defined by imaging findings that initial meningioma wing of the sphenoid, tumor resection, is performed. She presented torpid evolution, progressive neurological deterioration, until her death.

Grado de pérdida de capacidad laboral asociada a la comorbilidad de los desórdenes músculo esqueléticos en la junta de calificación de invalidez regional Huila, 2009-2012

Resumen: Los desórdenes músculo esqueléticos son entidades que generan un efecto en la salud relacionados con la calidad de vida, dado al impacto global en la condición física, el bienestar psicológico y funcional. Estas entidades generan un gran número de indemnizaciones y en algunas oportunidades según el grado de pérdida de capacidad laboral la invalidez. Objetivo: Determinar la asociación del grado de perdida de la capacidad laboral con la comorbilidad de los desórdenes músculo esqueléticos y otros factores asociados. Materiales y métodos: Se realizó un estudio de corte transversal, basado en registros e historias clínicas. Los registros iniciales fueron 1427 casos, de los cuales 513 presentaban diagnóstico de DME y de estos 240 solicitaron la pérdida de capacidad laboral a la junta de invalidez regional Huila en el periodo comprendido del 2009 al 2012. Resultados: La distribución del grado de la pérdida de capacidad laboral generada de los DME por incapacidad permanente parcial fue del 73,3% y por invalidez el 26,7%. Se encontró una asociación significativa con respecto a la edad (p=0,002), donde el rango de 50-65 años presento mayor pérdida de capacidad laboral; con el género (p=0,047), siendo el femenino más prevalente la invalidez (34,7%) que en el masculino (23,2%) y la comorbilidad (p=0,019), donde los desórdenes músculo esqueléticos y los trastornos depresivos generaron mayor pérdida de capacidad laboral. No se encontró asociación significativa con la escolaridad (p=0,167), oficio (p=0,442) y actividad económica (p=0,118). En el análisis multivariado se encontró asociación significativa con el origen común (OR=4.028, IC 95%: 2.010, 8.072), el sexo femenino (OR=2.565, IC 95%: 1.140, 5.771), y el nivel de escolaridad técnico (OR=12.208, IC 95%: 1.372, 108.634). Conclusiones: La comorbilidad generó mayor pérdida de capacidad laboral, aunque los factores que en conjunto mostraron asociación fueron la edad avanzada, el género femenino, el origen común y el menor nivel educativo.

Evaluación de intervención de alertas para riesgo cardiovascular por diclofenaco en afiliados al régimen contributivo 2014 -2015

El objetivo fue evaluar la intervención de las alertas en la prescripción de diclofenaco. Estudio observacional, comparativo, post intervención, de un antes después, en pacientes con prescripción de diclofenaco. Se evaluó la intervención de las alertas restrictivas antes y después de su implementación en los pacientes prescritos con diclofenaco y que tenían asociado un diagnóstico de riesgo cardiovascular según CIE 10 o eran mayores de 65 años. Un total de 315.135 transacciones con prescripción de diclofenaco, en 49.355 pacientes promedio mes. El 94,8% (298.674) de las transacciones fueron prescritas por médicos generales.

Lumbar estrecho: experiencia de 10 años en la fundación santa fé de Bogotá

El canal lumbar estrecho de tipo degenerativo, es una enfermedad que se presenta en pacientes entre la quinta y la sexta década de vida; es la causa más común de cirugía lumbar después de los 65 años. Este trabajo busca determinar cuáles son los factores asociados a la presentación de eventos adversos o re-intervención en cirugía de canal lumbar estrecho en la Fundación Santa Fe de Bogotá en los años comprendidos entre 2003 y 2013. Métodos: se realizó un estudio de prevalencia de tipo analítico, en donde se analizaron 249 pacientes sometidos a intervención quirúrgica por cirugía de canal lumbar estrecho.

Breast cancer incidence and overdiagnosis in Catalonia (Spain)

Early detection of breast cancer (BC) with mammography may cause overdiagnosis and overtreatment, detecting tumors which would remain undiagnosed during a lifetime. The aims of this study were: first, to model invasive BC incidence trends in Catalonia (Spain) taking into account reproductive and screening data; and second, to quantify the extent of BC overdiagnosis. We modeled the incidence of invasive BC using a Poisson regression model. Explanatory variables were: age at diagnosis and cohort characteristics (completed fertility rate, percentage of women that use mammography at age 50, and year of birth). This model also was used to estimate the background incidence in the absence of screening. We used a probabilistic model to estimate the expected BC incidence if women in the population used mammography as reported in health surveys. The difference between the observed and expected cumulative incidences provided an estimate of overdiagnosis.Incidence of invasive BC increased, especially in cohorts born from 1940 to 1955. The biggest increase was observed in these cohorts between the ages of 50 to 65 years, where the final BC incidence rates more than doubled the initial ones. Dissemination of mammography was significantly associated with BC incidence and overdiagnosis. Our estimates of overdiagnosis ranged from 0.4% to 46.6%, for women born around 1935 and 1950, respectively.Our results support the existence of overdiagnosis in Catalonia attributed to mammography usage, and the limited malignant potential of some tumors may play an important role. Women should be better informed about this risk. Research should be oriented towards personalized screening and risk assessment tools

A qualidade de vida na população idosa do concelho da Sertã : estudo exploratório

O presente estudo debruçou-se sobre a Qualidade de Vida na População Idosa do Concelho da Sertã, em diferentes contextos habitacionais: em regime de instituição (lar ou centro de dia) e em regime de residência própria sem estarem associados a qualquer instituição. Trata-se de um estudo exploratório, com dois objectivos principais: 1) conhecer e comparar a qualidade de vida dos idosos do concelho da Sertã em diferentes regimes habitacionais; 2) construir um questionário de avaliação da qualidade de vida no idosos, que englobe as 8 grandes dimensões da qualidade de vida no idoso: 1) Bem Estar Emocional, 2) Relações Interpessoais, 3) Bem Estar Material 4) Desenvolvimento Pessoal, 5) Bem Estar Físico, 6) Auto-determinação 7) Inclusão Social, 8) Direitos e, a avaliação global da qualidade de vida. Foi utilizada uma amostra de 60 idosos do concelho da Sertã, escolhidos aleatoriamente, com idade superior a 65 anos. Foram entrevistados, através do questionário construído pela investigadora, 30 idosos institucionalizados (idade média: 82; 40% mulheres) e 30 idosos sem estarem associados a qualquer instituição (idade média: 75,23; 33,3% mulheres). Os primeiros revelam maior percepção de boa qualidade de vida, atribuindo à Instituição um contributo positivo e fundamental no seu “bem-estar físico” e nas “relações interpessoais”. Os idosos que se encontram sem qualquer apoio institucional, revelam menor satisfação na sua qualidade de vida, principalmente no âmbito do “bem-estar físico”, do “bem-estar emocional”, da “inclusão social” e das “relações interpessoais”.

Abrupt climate change: ice sheets and oceans in action

Large temperature variations on land, in the air, and at the ocean surface, and highly variable flux of ice-rafted debris (IRD) delivered to the North Atlantic Ocean show that rapid climate fluctuations took place during the last glacial period. These quasi-periodic, high-amplitude climate variations followed a sequence of events recognized as a rapid warming, followed by a phase of gradual cooling, and terminating with more rapid cooling and increased flux of IRD to the north Atlantic Ocean. Each cycle lasted ˜1500 years, and was followed by an almost identical sequence. These cycles are referred to as Dansgaard/Oechger cycles (D/O cycles), and approximately every fourth cycle culminated in a more pronounced cooling with a massive discharge of IRD into the north Atlantic Ocean over an interval of ˜500 years. These massive discharges of IRD are known as Heinrich layers. “Heinrich events” are thus characterized as a rapid transfer of IRD from a “source,” the bed of the Laurentide Ice Sheet (LIS), to a “sink,” the North Atlantic.

Forest fire plumes over the North Atlantic: p-TOMCAT model simulations with aircraft and satellite measurements from the ITOP/ICARTT campaign

Intercontinental Transport of Ozone and Precursors (ITOP) (part of International Consortium for Atmospheric Research on Transport and Transformation (ICARTT)) was an intense research effort to measure long-range transport of pollution across the North Atlantic and its impact on O3 production. During the aircraft campaign plumes were encountered containing large concentrations of CO plus other tracers and aerosols from forest fires in Alaska and Canada. A chemical transport model, p-TOMCAT, and new biomass burning emissions inventories are used to study the emissions long-range transport and their impact on the troposphere O3 budget. The fire plume structure is modeled well over long distances until it encounters convection over Europe. The CO values within the simulated plumes closely match aircraft measurements near North America and over the Atlantic and have good agreement with MOPITT CO data. O3 and NOx values were initially too great in the model plumes. However, by including additional vertical mixing of O3 above the fires, and using a lower NO2/CO emission ratio (0.008) for boreal fires, O3 concentrations are reduced closer to aircraft measurements, with NO2 closer to SCIAMACHY data. Too little PAN is produced within the simulated plumes, and our VOC scheme's simplicity may be another reason for O3 and NOx model-data discrepancies. In the p-TOMCAT simulations the fire emissions lead to increased tropospheric O3 over North America, the north Atlantic and western Europe from photochemical production and transport. The increased O3 over the Northern Hemisphere in the simulations reaches a peak in July 2004 in the range 2.0 to 6.2 Tg over a baseline of about 150 Tg.

The effects of irrigation, nitrogen fertilizer and grain size on Hagberg falling number, specific weight and blackpoint of winter wheat

The effects of irrigation and nitrogen (N) fertilizer on Hagberg falling number (HFN), specific weight (SW) and blackpoint (BP) of winter wheat (Triticum aestivum L) were investigated. Mains water (+50 and +100 mm month(-1), containing 44 mg NO3- litre(-1) and 28 mg SO42- litre(-1)) was applied with trickle irrigation during winter (17 January-17 March), spring (21 March-20 May) or summer (24 May-23 July). In 1999/2000 these treatments were factorially combined with three N levels (0, 200, 400 kg N ha(-1)), applied to cv Hereward. In 2000/01 the 400 kg N ha(-1) treatment was replaced with cv Malacca given 200 kg N ha(-1). Irrigation increased grain yield, mostly by increasing grain numbers when applied in winter and spring, and by increasing mean grain weight when applied in summer. Nitrogen increased grain numbers and SW, and reduced BP in both years. Nitrogen increased HFN in 1999/2000 and reduced HFN in 2000/01. Effects of irrigation on HFN, SW and BP were smaller and inconsistent over year and nitrogen level. Irrigation interacted with N on mean grain weight: negatively for winter and spring irrigation, and positively for summer irrigation. Ten variables derived from digital image analysis of harvested grain were included with mean grain weight in a principal components analysis. The first principal component ('size') was negatively related to HFN (in two years) and BP (one year), and positively related to SW (two years). Treatment effects on dimensions of harvested grain could not explain all of the effects on HFN, BP and SW but the results were consistent with the hypothesis that water and nutrient availability, even when they were affected early in the season, could influence final grain quality if they influenced grain numbers and size. (C) 2004 Society of Chemical Industry

Mitigation options for sediment and phosphorus loss from winter-sown arable crops

Sediment and P inputs to freshwaters from agriculture are a major problem in the United Kingdom (UK). This study investigated mitigation options for diffuse pollution losses from arable land. Field trials were undertaken at the hillslope scale over three winters at three UK sites with silt (Oxyaquic Hapludalf), sand (Udic Haplustept), and clay (Typic Haplaquept) soils. None of the mitigation treatments was effective in every year trialled, but each showed overall average reductions in losses. Over five site years, breaking up the compaction in tramlines (tractor wheel tracks) using a tine reduced losses of sediment and P to losses similar to those observed from areas without tramlines, with an average reduction in P loss of 1.06 kg TP ha(-1) Compared to traditional plowing, TP losses under minimum tillage were reduced by 0.30 kg TT ha(-1) over five site years, TP losses under contour cultivation were reduced by 0.30 kg TP ha(-1) over two site years, and TP losses using in-field barriers were reduced by 0.24 kg TP ha(-1) over two site years. In one site year, reductions in losses due to crop residue incorporation were nor significant. Each of the mitigation options trialled. is associated with a small cost at the farm-scale of up to 5 pound ha(-1), or with cost savings. The results indicate that each of the treatments his the potential to be a cost-effective mitigation option, but that tramline management is the most promising treatment, because tramlines dominate sediment and P transfer in surface runoff from arable hillslopes.

Temperature sensitivity of the low-moisture-content limit to negative seed longevity-moisture content relationships in hermetic storage

Background and Aims The negative logarithmic relationship between orthodox seed longevity and moisture content in hermetic storage is subject to a low-moisture-content limit (m(c)), but is m(c) affected by temperature? Methods Red clover (Trifolium pratense) and alfalfa (Medicago sativa) seeds were stored hermetically at 12 moisture contents (2-15 %) and five temperatures (-20, 30, 40, 50 and 65 degrees C) for up to 14.5 years, and loss in viability was estimated. Key Results Viability did not change during 14.5 years hermetic storage at -20 degrees C with moisture contents from 2.2 to 14.9 % for red clover, or 2.0 to 12.0 % for alfalfa. Negative logarithmic relationships between longevity and moisture contents > m(c) were detected at 30-65 degrees C, with discontinuities at low moisture contents; m(c) varied between 4.0 and 5.4 % (red clover) or 4.2 and 5.5 % (alfalfa), depending upon storage temperature. Within the ranges investigated, a reduction in moisture content below m(c) at any one temperature had no effect on longevity. Estimates of m(c) were greater the cooler the temperature, the relationship (P < 0.01) being curvilinear. Above m(c), the estimates of C-H and C-Q (i.e. the temperature term of the seed viability equation) did not differ (P > 0.10) between species, whereas those of K-E and C-W did (P < 0.001). Conclusions The low-moisture-content limit to negative logarithmic relationships between seed longevity and moisture content in hermetic storage increased the cooler the storage temperature, by approx. 1.5 % over 35 degrees C (4.0-4.2 % at 65 degrees C to 5.4-5.5 % at 30-40 degrees C) in these species. Further reduction in moisture content was not damaging. The variation in m(c) implies greater sensitivity of longevity to temperature above, compared with below, m(c). This was confirmed (P < 0.005).