Indoor falls and number of previous falls are independent risk factors for long-term mortality after a hip fracture

Hip fractures are almost always the result of a fall. Causes and circumstances of falls may differ between frail and vigorous patients. To describe the circumstances of falls causing hip fractures, number of falls during the previous year, and their association with long-term mortality. The study is a retrospective review conducted in a tertiary university hospital serving a population of 425,000 inhabitants in Barcelona. All patients admitted with hip fractures with medical records describing the circumstances and number of previous falls were included. The number of falls in the previous 12 months was recorded, including the one causing the fracture. The circumstances of the index fall were dichotomized according to whether it was from the patient's own height or above; day or night; indoors or outdoors, due to intrinsic or extrinsic causes. Cumulative mortality was recorded for almost 5 years after hip fracture. Indoor falls were strongly associated with shorter survival. Falling more than once in the previous year was also a risk factor for long-term mortality (hazard ratio 1.461, p < 0.001 and hazard ratio 1.035, p = 0.008 respectively). Indoor falls and falling more than once in the previous year are long-term risk factors for mortality after hip fractures. It is always essential to take a careful patient history on admission to determine the number of falls and their circumstances, and special care should be taken to reduce mortality in patients at high risk

Assessment of microbial community structure changes by amplified ribosomal DNA restriction analysis (ARDRA)

Amplified ribosomal DNA restriction analysis (ARDRA) is a simple method based on restriction endonuclease digestion of the amplified bacterial 16S rDNA. In this study we have evaluated the suitability of this method to detect differences in activated sludge bacterial communities fed on domestic or industrial wastewater, and subject to different operational conditions. The ability of ARDRA to detect these differences has been tested in modified Ludzack-Ettinger (MLE) configurations. Samples from three activated sludge wastewater treatment plants (WWTPs) with the MLE configuration were collected for both oxic and anoxic reactors, and ARDRA patterns using double enzyme digestions AluI+MspI were obtained. A matrix of Dice similarity coefficients was calculated and used to compare these restriction patterns. Differences in the community structure due to influent characteristics and temperature could be observed, but not between the oxic and anoxic reactors of each of the three MLE configurations. Other possible applications of ARDRA for detecting and monitoring changes in activated sludge systems are also discussed

The nature of memory impairment in multiple sclerosis: understanding different patterns over the course of the disease

IntroductionMemory deficit is one of the most common and severe cognitive impairments in patients with multiple sclerosis and can greatly affect their quality of life. However, there is currently no agreement as to the nature of memory deficit in multiple sclerosis.MethodsThis cross-sectional study, carried out at the Dr. Josep Trueta and Santa Caterina hospitals in Girona (Spain), was designed to determine the semiology of verbal memory deficit in the different stages of the disease. To this end, a modification of Rey’s verbal auditory test was created by introducing two recognition trials between the five learning trials, thus monitoring what happens in terms of acquisition versus the retrieval of information during the learning phase. Linear regression models were used to evaluate verbal episodic memory performance between-groups adjusting results by age, sex, educational level, and the presence of anxiety and/or depressive symptoms.Results133 patients with multiple sclerosis, clinically isolated syndrome, and radiologically isolated syndrome and 55 healthy controls aged 18–65 years were assessed. It was observed that the memory processes of multiple sclerosis patients worsen with the progression of the disease. In this respect, patients in pre-diagnostic phases (radiologically isolated syndrome and clinically isolated syndrome) show no differences in verbal episodic memory compared to the healthy controls. Patients in the inflammatory stage (relapsing–remitting multiple sclerosis) show a previously learned information retrieval deficit, while patients in progressive stages (secondary progressive multiple sclerosis and primary progressive multiple sclerosis) do not even correctly acquire information.DiscussionThese results provide significant information to assist in understanding the nature of memory deficits in multiple sclerosis over the course of the disease. These results are discussed in terms of possible cognitive rehabilitation strategies depending on the evolutive stage and are related to neuropathological mechanisms involved in the progression of the disease

A clinical registry of dementia based on the principle of epidemiological surveillance

<p>Abstract</p> <p>Background</p> <p>Traditional epidemiological studies do not allow elucidating the reality of referral and diagnosis patterns of dementia in routine clinical practice within a defined territory. This information is useful and necessary in order to plan and allocate healthcare resources. This paper presents the results from a dementia case registry based on epidemiological surveillance fundamentals.</p> <p>Methods</p> <p>Standardised registry of dementia diagnoses made in 2007 by specialised care centres in the Health Region of Girona (RSG) (Spain), which encompasses an area of 5,517 sq. km and a reference population of 690,207 inhabitants.</p> <p>Results</p> <p>577 cases of dementia were registered, of which 60.7% corresponded to cases of Alzheimer's disease. Presenile dementia accounted for 9.3% of the cases. Mean time between the onset of symptoms and clinical diagnosis was 2.4 years and the severity of the dementia was mild in 60.7% of the cases. High blood pressure, a family history of dementia, dislipidemia, and a past history of depression were the most common conditions prior to the onset of the disease (>20%).</p> <p>Conclusion</p> <p>The ReDeGi is a viable epidemiological surveillance device that provides information about the clinical and demographic characteristics of patients diagnosed with dementia in a defined geographical area.</p

Assessing the presence of oligoclonal IgM bands as a prognostic biomarker of cognitive decline in the early stages of multiple sclerosis

Bandes oligoclonals; Esclerosi múltiple; Disfunció cognitivaBandas oligoclonales; Esclerosis múltiple; Disfunción cognitivaOligoclonal bands; Multiple sclerosis; Cognitive dysfunctionBackground: An association has been found between the presence of lipid-specific oligoclonal IgM bands (LS-OCMB) in cerebrospinal fluid and a more severe clinical multiple sclerosis course. Objective: To investigate lipid-specific oligoclonal IgM bands as a prognostic biomarker of cognitive impairment in the early stages of multiple sclerosis. Methods: Forty-four patients underwent neuropsychological assessment at baseline and 4 years. Cognitive performance at follow-up was compared adjusting by age, education, anxiety-depression, and baseline performance. Results: LS-OCMB+ patients only performed worse for Long-Term Storage in the Selective Reminding Test (p = .018). Conclusion: There are no remarkable cognitive differences between LS-OCMB- and LS-OCMB+ patients in the early stages of MS

Microbiota alterations in proline metabolism impact depression

The microbiota-gut-brain axis has emerged as a novel target in depression, a disorder with low treatment efficacy. However, the field is dominated by underpowered studies focusing on major depression not ad- dressing microbiome functionality, compositional nature, or confounding factors. We applied a multi-omics approach combining pre-clinical models with three human cohorts including patients with mild depression. Microbial functions and metabolites converging onto glutamate/GABA metabolism, particularly proline, were linked to depression. High proline consumption was the dietary factor with the strongest impact on depression. Whole-brain dynamics revealed rich club network disruptions associated with depression and circulating proline. Proline supplementation in mice exacerbated depression along with microbial translocation. Human microbiota transplantation induced an emotionally impaired phenotype in mice and alterations in GABA-, proline-, and extracellular matrix-related prefrontal cortex genes. RNAi-mediated knockdown of pro-line and GABA transporters in Drosophila and mono-association with L. plantarum, a high GABA producer, conferred protection against depression-like states. Targeting the microbiome and dietary proline may open new windows for efficient depression treatment

Pelvic MRI findings in relapsed prostate cancer after radical prostatectomy

Little is known about the clinical impact of using multiparametric MRI to plan early salvage radiotherapy after radical prostatectomy. We aimed to evaluate the incidence and location of recurrence based on pelvic multiparametric MRI findings and to identify clinical variables predictive of positive imaging results. We defined radiological criteria of local and lymph node malignancy and reviewed records and MRI studies of 70 patients with PSA recurrence after radical prostatectomy. We performed univariate and multivariate analysis to identify any association between clinical, pathological and treatment-related variables and imaging results. Multiparametric MRI was positive in 33/70 patients. We found local and lymph node recurrence in 27 patients and 7 patients, respectively, with a median PSA value of 0.38 ng/ml. We found no statistically significant differences between patients with positive and negative multiparametric MRI for any variable. Shorter PSADT was associated with positive lymph nodes (median PSADT: 5.12 vs 12.70 months; p: 0.017). Nearly half the patients had visible disease in multiparametric MRI despite low PSA. Positive lymph nodes incidence should be considered when planning salvage radiotherapy, particularly in patients with a short PSADT

Projecte EM-Line!: programa de rehabilitación cognitiva para pacientes afectados de esclerosis múltiple

The clinical manifestations of Multiple Sclerosis are motor, sensitive, cerebellar and cognitive alterations. It evolves with a high degree of physical and cognitive disability. The “EM-line! Project” has its origins in the need to provide effective treatment for cognitive problems given that a gap in cognitive treatment was detected, especially at the onset of the disease. For this reason, the main objective of the “EM-line! Project” was: To supply free cognitive rehabilitation materials that do not interfere in the professional activity of the patients for use at home from the onset of the disease. Patients participated in a 26 week prospective, randomized, single-blind intervention study and patients were found to improve specifically in the areas of visual memory (learning and long term memory), executive functions (working memory and access to vocabulary), attention, processing speed, and naming ability. The “EM-line Project” is effective in improving cognitive disorder in multiple sclerosis patients.Las manifestaciones de la esclerosis múltiple son alteraciones motoras, sensitivas, cerebelosas y cognitivas. Evoluciona con un alto grado de discapacidad física y cognitiva. El “Projecte EM-line!” surgió de la necesidad clínica de dar un tratamiento efectivo a los problemas cognitivos ya que se observó un vacío en el tratamiento cognitivo en el inicio de la enfermedad. El objetivo del “Projecte EM-line!” es: - Proporcionar un material de rehabilitación cognitiva gratuito para poder realizar en casa desde el inicio de la enfermedad, sin interferir en las actividades profesionales de los pacientes. Se realizó un estudio prospectivo de intervención , randomizado y simple ciego de 26 semanas de duración y los pacientes mejoraron en memoria visual (aprendizaje y memoria a largo plazo), funciones ejecutivas (memoria de trabajo y acceso al léxico), atención, velocidad de procesamiento y capacidad de denominación. El projecte EM-line es efectivo para mejorar el trastorno cognitivo en la EM

Validation of a spanish version of the schizotypal personality questionnaire (SPQ): psychometric characteristics aand underlying factor structure derived from a healthy university student sample

OBJECTIVE: The need for early detection, prevention and intervention in psychosis has prompted the study of prodromal and threshold syndromes. One strategy involves the assessment of schizotypy, a personality construct involving unusual perceptual experiences, magical thinking or bizarre behavior. Sensitive measurement instruments could potentially allow detection of signs heralding transition to psychosis in high-risk individuals, or risk of relapse in patients after a first psychotic episode. The Schizotypal Personality Questionnaire (SPQ) is a self-report scale, originally developed for English speakers, that covers the nine DSM-IV criteria for schizotypal personality disorder (SPD). Our aim was to validate a Spanish version of the SPQ and assess its psychometric properties. METHODS: The original SPQ was back-translated and administered to university students (n=250). We assessed the internal consistency, the convergent, discriminant and criterion validity of the instrument, and analyzed its factor structure. RESULTS: Our version of the SPQ showed good internal consistency, and convergent (O-LIFE), discriminant (P-scale of EPQ) and criterion validity (SCID-II). Factor analyses supported a four-factor structure in fitting SPQ data. CONCLUSIONS: Our Spanish version of the SPQ questionnaire preserved the psychometric properties of the original questionnaire. This adaptation will provide a useful tool for the early detection of prodromal schizophrenia symptoms and clinical relapse in Spanish-speaking populations

Differences in metacognition between multiple sclerosis phenotypes: cognitive impairment and fatigue are key factors

BackgroundCognitive impairment is present in 40–65% of patients with multiple sclerosis (pwMS). Objectively measured cognitive performance often does not match patients' subjective perception of their own performance.ObjectiveWe aimed to compare cognitive performance and subjective perception of cognitive deficits between pwMS and healthy controls (HCs), as well as the accuracy of subjective perception.MethodsIn total, 54 HC and 112 pwMS (relapsing–remitting, RRMS, and progressive PMS) underwent neuropsychological evaluation and completed perceived deficit, fatigue, and anxiety–depression scales. Participants were classified according to their consistency between subjective self-evaluation of cognitive abilities and objective cognitive performance to assess accuracy. Regression models were used to compare cognitive performance between groups and explore factors explaining inaccuracy in the estimation of cognitive performance.ResultsPMS showed greater and more widespread cognitive differences with HC than RRMS. No differences were found between pwMS and HC in the perception of deficit. PMS had higher ratios of overestimators. In explaining inaccuracy, fatigue and cognitive preservation were found to be risk factors for underestimation, whereas physical disability and cognitive impairment were risk factors for overestimation.ConclusionPwMS have metacognitive knowledge impairments. This study provides new information about metacognition, data on the prevalence of impairments over a relatively large sample of PwMS, and new insights into factors explaining it. Anosognosia, related to cognitive impairment, may be present in pwMS. Fatigue is a key factor in underestimating cognition