Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population

Background: High visit-to-visit blood pressure variability (BPV) has been associated with cognitive decline and cerebral small vessel disease (cSVD), in particular cerebrovascular lesions. Whether day-to-day BPV also relates to cSVD has not been investigated.Objective: To investigate the cross-sectional association between day-to-day BPV and total cSVD MRI burden in older memory clinic patients.Methods: We included outpatients referred to our memory clinic, who underwent cerebral MRI as part of their diagnostic assessment. We determined the validated total cSVD score (ranging from 0-4) by combining four markers of cSVD that were visually rated. Home blood pressure (BP) measurements were performed for one week, twice a day, according to international guidelines. BPV was defined as the within-subject coefficient of variation (CV; standard deviation/mean BP*100). We used multivariable ordinal logistic regression analyses adjusted for age, sex, smoking, diabetes, antihypertensive medication, history of cardiovascular disease, and mean BP.Results: For 82 patients (aged 71.2±7.9 years), mean home BP was 140/79±15/9 mmHg. Dementia and mild cognitive impairment were diagnosed in 46% and 34%, respectively. 78% had one or more markers of cSVD. Systolic CV was associated with cSVD burden (adjusted odds ratio per point increase in CV = 1.29, 95% confidence interval = 1.04-1.60, p = 0.022). There were no differences in diastolic CV and mean BP between the cSVD groups. When we differentiated between morning and evening BP, only evening BPV remained significantly associated with total cSVD burden.Conclusion: Day-to-day systolic BPV is associated with cSVD burden in memory clinic patients. Future research should indicate whether lowering BPV should be included in BP management in older people with memory complaints

Adequacy of hospitalizations in a highly complex pediatric hospital

Introducción. Para evaluar los pacientes internados sin necesidad, la herramienta de mayor utilidad para detectarlo, es el Protocolo de evaluación de la adecuación en pediatría o Pediatrics Appropriateness Evaluation Protocol (PAEP). El objetivo primario de este estudio es cuantificar los ingresos inadecuados que se producen en el área de un hospital pediátrico de la Ciudad de Buenos Aires, Argentina, el Hospital de Niños Ricardo Gutiérrez utilizando utilizando el PAEP. Población y métodos. Durante los meses de mayo y junio del año 2015 se analizaron un total de 441 niños menores de 18 años al ingreso, internados durante todos los días de la semana. Se recabaron datos filiatorios, diagnóstico, protocolo PAEP y necesidad de un hospital de alta complejidad. Resultados. La edad media de los pacientes internados fue 4,63 años (SD 4,9). Según la regla PAEP los criterios de internación fueron adecuados en 411/432 (95%), e inadecuados en 21/432 (4,8%). Esto fue inferior a la media de las series publicadas sobre criterios de internación. 151 (34%) podrían haberse internado en un hospital de baja complejidad. Los pacientes de menor complejidad según la necesidad de atención requerida, tenían una edad media de 2,3 años y los de mayor complejidad una edad media de 5.79 años. De acuerdo a la probabilidad de internación inadecuada las patologías asociadas más frecuentes fueron purpura trombótica inmune (PTI), gastroenteritis, anemia para estudio y estados convulsivos. Las patologías que tuvieron mayor probabilidad de requerir baja complejidad fueron, en orden decreciente síndromes bronquiales obstructivos agudos, patologías renales, neumonías y celulitis. Conclusiones. Se encontró una baja tasa de internación inadecuada en relación a otras series de casos con regla PAEP. Un tercio de la muestra podría haberse internado en un hospital general.Introduction. In order to evaluate the hospitalized patients without requirement the most useful tool, it is the Pediatrics Appropriateness Evaluation Protocol(PAEP). The primary objective of this study is to quantify the inadequate income that occurs in the clinical area in this Hospital using PAEP. Population and methods. Analyzed at admission, during the months of May and June of the year 2015, a total of 441 children under the age of 18 years were on all days of the week. A questionnaire with filiatory data, diagnosis, PAEP protocol and need for a hospital of high complexity was completed. Results. The mean age was 4.63 years (SD 4.9). According to the PAEP rule the adequate hospitalization criteria in 411/432 (95%), inadequate in 21/432 (4.8%). This was lower than the average of published series on admission criteria. 151 (34%) could have been hospitalized in a General Hospital. Patients of less complexity according to the need for required care had a mean age of 2.3 years and those of greater complexity had an average age of 5.79 years. According to the probability of inadequate hospitalization, the most frequent associated pathologies were immune thrombotic purpura (ITP), gastroenteritis, anemia for study and seizures. The pathologies that were most likely to require low complexity were, in descending order SBOA, renal pathologies, pneumonias and cellulitis. Conclusions. We found low rate of inadequate hospitalization with compare to other cases records with PAEP rules. A third of the sample may have been admitted to a general hospital.Fil: Bilkis, M.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Molise, C. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Stacha, P. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: García Bournissen, Facundo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Camberosa, M.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Rodriguez, A.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Martin, G.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Dartiguelongue, Josefina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Candido, G.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Mavrakis, P.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Sagradini, S.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Fiorentino, J.. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; Argentin

Spectrum of Clinical Features in X-Linked Myotubular Myopathy Carriers:An International Questionnaire Study

OBJECTIVE: To characterize the spectrum of clinical features in a cohort of X-linked myotubular myopathy (XL-MTM) carriers, including prevalence, genetic features, clinical symptoms, and signs, as well as associated disease burden. METHODS: We performed a cross-sectional online questionnaire study among XL-MTM carriers. Participants were recruited from patient associations, medical centers, and registries in the United Kingdom, Germany, and the Netherlands. We used a custom-made questionnaire, the Checklist Individual Strength (CIS), the Frenchay Activities Index (FAI), the Short Form 12 (SF-12) health survey, and the McGill Pain Questionnaire. Carriers were classified as manifesting or nonmanifesting on the basis of self-reported ambulation and muscle weakness. RESULTS: The prevalence of manifesting carriers in this study population (n = 76) was 51%, subdivided into mild (independent ambulation, 39%), moderate (assisted ambulation, 9%), and severe (wheelchair dependent, 3%) phenotypes. In addition to muscle weakness, manifesting carriers frequently reported fatigue (70%) and exercise intolerance (49%). Manifesting carriers scored higher on the overall CIS (p = 0.001), the fatigue subscale (p < 0.001), and least severe pain subscale (p = 0.005) than nonmanifesting carriers. They scored lower on the FAI (p = 0.005) and the physical component of the SF-12 health survey (p < 0.001). CONCLUSIONS: The prevalence of manifesting XL-MTM carriers may be higher than currently assumed, most having a mild phenotype and a wide variety of symptoms. Manifesting carriers are particularly affected by fatigue, limitations of daily activities, pain, and reduced quality of life. Our findings should increase awareness and provide useful information for health care providers and future clinical trials

Water Resources in Texas: The Need for a Water Research Agenda

Center for Water and the Environmen