El médico de familia ante la Esclerosis Lateral Amiotrófica

La esclerosis lateral amiotrófica (ELA) es una enfermedad neurodegenerativa con una incidencia de 1-2 casos por 100.000 habitantes/año y una prevalencia de 4-6 casos por 100.000 habitantes (3,5 casos por 100.000 habitantes en España). La mayoría de los casos de ELA son esporádicos, pero el 5-10 % son familiares con herencia autosómica dominante. La edad media de aparición para ELA esporádica es de alrededor de los 60 años. El objetivo del presente estudio de casos ha sido analizar la importancia del papel del médico de atención primaria en la sospecha diagnóstica, derivación, seguimiento y acompañamiento del paciente con ELA y su familia. Para ello se han analizado dos casos clínicos de los tipos más característicos de ELA y las actuaciones de los médicos de atención primaria que los han atendido, reflejando que una mayor difusión de los síntomas y signos de ELA podrían contribuir a un diagnóstico más precoz y con mayor grado de certeza.

The influence of the initial state of nutrition on the lifespan of patients with amyotrophic lateral sclerosis (ALS) during home enteral nutrition

Aim: Amyotrophic lateral sclerosis (ALS) is a chronic, neurodegenerative disease, which leads to development of malnutrition. The main purpose of this research was to analyze the impact of malnutrition on the course of the disease and long-term survival. Material and methods: A retrospective analysis has been performed on 48 patients (22 F [45,83%] and 26 M [54,17%], the average age of patients: 66,2 [43-83]) in 2008-2014.The analysis of the initial state of nutrition was measured by body mass index (BMI), nutritional status according to NRS 2002, SGA and concentration of albumin in blood serum. Patients were divided into two groups, depending on the state of nutrition: well-nourished and malnourished. The groups were created separately for each of these, which allowed an additional comparative analysis of techniques used for the assessment of nutritional status. Results: Proper state of nutrition was interrelated with longer survival (SGA: 456 vs. 679 days, NRS: 312 vs. 659 vs. 835 days, BMI: respectively, 411, 541, 631 days, results were statistically significant for NRS and BMI). Concentration of albumin was not a prognostic factor, but longer survival was observed when level of albumin was increased during nutritional therapy. Conclusions: The initial nutrition state and positive response to enteral feeding is associated with better survival among patients with ALS. For this reason, nutritional therapy should be introduced as soon as possible.

Evidence for reductive genome evolution and lateral acquisition of virulence functions in two Corynebacterium pseudotuberculosis strains.

2011

Stairway Uniformity Measurement: What Lateral Location Should Be Measured?

BACKGROUND: This project addressed an unresolved issue involving measurement methods for determining step uniformity. Leading experts on stairway safety agree that lack of step uniformity within a flight contributes to risk of missteps. A relatively new method for precisely measuring step dimensions is the nosing-to-nosing method. An issue in applying the method is lack of agreement on the lateral location to make the measurements. That location depends on where stairway users ascend and descend relative to the width of the steps. A prior investigator examined people descending to determine the lateral distance between the handrail center and the mid-line of the person’s body. He found the median was 44 cm. AIM: The two objectives of the experiment were to: (1) determine if a different set of stairway users will have the same median lateral distance from the handrail as those described in the prior observational study, and (2) determine if the lateral distance of participants is affected by their direction of travel and use of a handrail. METHODS: The investigators established visible distance markers on one stairway in a campus building and videotaped volunteer students ascending and descending the flight of stairs. Each of the 16 participant ascended with and without using the handrail, and each descended with and without using the handrail. Images were printed and analyzed to determine their lateral distance between the inner edge of the handrail and a point midway between the participant’s knees. Results were analyzed statistically to test hypotheses corresponding to the two objectives. RESULTS: The previous study found a median lateral distance of 44 cm when measured from the center of the handrail. Using comparable data, the median found in this study was 25 cm. Results of this study indicated that lateral distance from the handrail is significantly affected by the direction of travel and by use of the handrail. The greatest lateral distance was for ascending with the handrail. The shortest lateral distance was for descending without the handrail. VALUE: Committees develop and periodically revise standards for stairways leading to fire exits and workplace facilities. The practical value of this project is providing empirical evidence that standard developing committees may consider when convening to update their requirements and guidelines on how to measure step uniformity.