Estudio de la memoria episódica en la E.A. : detección temprana de la Enfermedad de Alzheimer

Fil: Labos, Edith. Universidad de Buenos Aires. Facultad de Medicina; Argentina.Si bien aún no existe la cura definitiva para la Enfermedad de Alzheimer (E.A.), existen recursos que\npermiten optimizar la vida cotidiana de los pacientes. El diagnóstico temprano y la detección de\npoblaciones de riesgo es fundamental para la aplicación de diferentes paliativos. En nuestro país se\nestán elaborando instrumentos propios adaptados a las características de nuestra población, con el\nobjetivo de contar con herramientas válidas de diagnóstico neuropsicológico capaces de predecir las\nfunciones cognitivas de los sujetos

Pancytopenia and atrial fibrillation associated with chronic hepatitis C infection and presumed hepatocellular carcinoma: a case report

<p>Abstract</p> <p>Introduction</p> <p>Pancytopenia secondary to hepatitis viral infection is a rare but noted clinical entity. An acute aplastic crisis usually occurs shortly after viral infection, however, viral serologies are usually negative and the pancytopenia is often fatal if left untreated.</p> <p>Case presentation</p> <p>A 66-year-old woman presented to the emergency department with shortness of breath and palpitations. She was found to have pulmonary edema secondary to a newly diagnosed atrial fibrillation and was treated with rate control and anticoagulation. She was found to have an anemia that was reported to be longstanding and that was apparently being investigated by a hematologist, although no diagnosis had yet been achieved. Her blood work also revealed a mild leucopenia and pronounced thrombocytopenia. The patient was admitted to ensure appropriate rate control of her atrial fibrillation and for work-up of her pancytopenia. Review of the bone marrow biopsy performed by the hematologist revealed a normal marrow with no infiltrative process. The results of the patient's blood tests ruled out a hemolytic process. There was also no evidence of infection, toxin ingestion, or recent medication that could be associated with pancytopenia. An abdominal ultrasound was ordered to rule out enlargement of the spleen and a possible consumptive coagulopathy. The spleen was mildly enlarged with a diameter of 13 cm. The liver, however, was mildly cirrhotic and a small solitary liver lesion was seen. A magnetic resonance imaging scan of the liver confirmed a single solitary solid mass and the α-fetal protein level in the serum was elevated. The patient's preliminary viral serologies were positive for hepatitis C. The patient was diagnosed with presumed hepatocellular carcinoma and referred to a hepatic surgeon for evaluation of treatment options.</p> <p>Conclusion</p> <p>Hepatitis associated aplastic anemia is an acute condition while milder more chronic presentations, such as this case, likely result from increased portal pressure generated from the resulting cirrhosis, which leads to a relative hypersplenism.</p

AGING AND FUNCTIONAL COMPLEX ACTIVITIES: CLINICAL AND SOCIAL PERSPECTIVES

Background: Several papers describe functional changes in the aging population, and its relevance in early detection.Objectives: In order to count on a tool to evaluate the performance in the use of new technologies we have designed a new protocol - Complex Functional Study (CFS)-that quantifies performance and functional changes related to previous states.Our objectives are to study the aging population with this lately developed tool.Methods: We evaluated 350 healthy subjects grouped according to age and instruction levels. We administered a General Cognitive Screening and the CFS. We used ANOVA Test, and Regression Analysis and Principal Components.Results: Our finding verifies that the 15.75% registered functional loss and the 2.8%, registered changes in performance. The differences in the averages were higher at the age range 80-90. The measure of change proved to have less impact in groups with higher instruction level. A greater functional loss has been registered in older participants with less instruction level.Conclusions: This study enables the use of the CFS as a tool of clinical interest for the detection of incipient impairment in daily living complex functional skills.The results obtained verify a good performance in those skills in most of the studied population. On the other hand, this study has also a psycho-social perspective insofar as it fosters significant learning processes. In this way it will be possible to implement strategies to develop social awareness about the learning capacity in the elderly to impact in the social net and on their wellbeing.&nbsp

Los conceptos innatos en la obra de Chomsky: definición y propuesta de un método empírico para su estudio

Este artículo versa sobre los conceptos innatos: su definición, de acuerdo a la obra lingüística de Noam Chomsky, y el esbozo de un método que permita su estudio. A manera de introducción se refieren algunas concepciones académicas sobre la adquisición conceptual y se comenta la falta de un método de estudio empírico de los conceptos nativos. Enseguida, se presenta la definición que a lo largo del tiempo ha defendido Chomsky sobre dichos conceptos. Finalmente, se instauran de manera teórica las condiciones de un procedimiento empírico para el estudio de los conceptos innatos, titulado análisis semántico de corpus

Os conceitos na obra de Chomsky: definição e proposta de um método empírico para o seu estudo

This article focuses on innate concepts: their definition, according to the linguistic work of Noam Chomsky, and the outline of a method for their study. As an introduction to the subject some academic conceptions of the concept acquisition are pointed out, and it is claimed that there is a lack of an empirical method for the study of innate concepts. Next, the article presents the definition that Chomsky has defended over time about such concepts. Finally, in a theoretical way, it presents the conditions for an empirical procedure for the study of innate concepts, called semantic analysis of corpusEste artículo versa sobre los conceptos innatos: su definición, de acuerdo a la obra lingüística de Noam Chomsky, y el esbozo de un método que permita su estudio. A manera de introducción se refieren algunas concepciones académicas sobre la adquisición conceptual y se comenta la falta de un método de estudio empírico de los conceptos nativos. Enseguida, se presenta la definición que a lo largo del tiempo ha defendido Chomsky sobre dichos conceptos. Finalmente, se instauran de manera teórica las condiciones de un procedimiento empírico para el estudio de los conceptos innatos, titulado análisis semántico de corpus.Este artigo versa sobre os conceitos inatos: sua definição, de acordo com o trabalho linguístico de Noam Chomsky, e o esboço de um método para seu estudo. Inicialmente, apresentam-se alguns conceitos acadêmicos sobre aquisição conceitual e se discute a falta de um método de estudo empírico dos conceitos nativos. Em seguida, apresenta-se a definição que ao longo do tempo tem defendido Chomsky sobre esses conceitos. Finalmente, estabelecem-se de maneira teórica as características de um procedimento empírico para o estudo de conceitos inatos, intitulado análise semântica do corpus

Evaluation of the pleiotropic effects of statins:a reanalysis of the randomized trial evidence using Egger regression

Objective— To reanalyze data from recent randomized trials of statins to assess whether the benefits and risks of statins are mediated primarily via their LDL-C (low-density lipoprotein cholesterol) lowering effects or via other mechanisms. Approach and Results— We adapted Egger regression, a technique frequently used in Mendelian randomization studies to detect genetic pleiotropy, to reanalyze the available randomized control trial data of statin therapy. For cardiovascular end points, each 1 mmol/L change in LDL-C with statin therapy was associated with a hazard ratio of 0.77 (95% confidence interval, 0.71–0.84) with an intercept that was indistinguishable from zero (intercept, −0.0032; [95% confidence interval, −0.090 to 0.084]; P =0.94), indicating no pleiotropy. For incident diabetes mellitus, a 1 mmol/L change in LDL-C with statin therapy was associated with a hazard ratio of 1.07 (95% confidence interval, 0.99–1.16) and an intercept nondistinguishable from zero (intercept, −0.015; [95% confidence interval, −0.30 to 0.27]; P =0.91), again indicating no pleiotropy. Conclusions— Our reanalysis of the randomized control trial data using Egger regression adds to the existing evidence that the cardiovascular benefits of statins and their association with incident diabetes mellitus are mediated primarily, if not entirely, via their LDL-C lowering properties rather than by any pleiotropic effects. </jats:sec

Omnipolarity applied to equi-spaced electrode array for ventricular tachycardia substrate mapping

Aims : Bipolar electrogram (BiEGM)-based substrate maps are heavily influenced by direction of a wavefront to the mapping bipole. In this study, we evaluate high-resolution, orientation-independent peak-to-peak voltage (Vpp) maps obtained with an equi-spaced electrode array and omnipolar EGMs (OTEGMs), measure its beat-to-beat consistency, and assess its ability to delineate diseased areas within the myocardium compared against traditional BiEGMs on two orientations: along (AL) and across (AC) array splines. Methods and results: The endocardium of the left ventricle of 10 pigs (three healthy and seven infarcted) were each mapped using an Advisor™ HD grid with a research EnSite Precision™ system. Cardiac magnetic resonance images with late gadolinium enhancement were registered with electroanatomical maps and were used for gross scar delineation. Over healthy areas, OTEGM Vpp values are larger than AL bipoles by 27% and AC bipoles by 26%, and over infarcted areas OTEGM Vpp values are 23% larger than AL bipoles and 27% larger than AC bipoles (P < 0.05). Omnipolar EGM voltage maps were 37% denser than BiEGM maps. In addition, OTEGM Vpp values are more consistent than bipolar Vpps showing less beat-by-beat variation than BiEGM by 39% and 47% over both infarcted and healthy areas, respectively (P < 0.01). Omnipolar EGM better delineate infarcted areas than traditional BiEGMs from both orientations. Conclusion: An equi-spaced electrode grid when combined with omnipolar methodology yielded the largest detectable bipolar-like voltage and is void of directional influences, providing reliable voltage assessment within infarcted and non-infarcted regions of the heart.This work was funded by Abbott Laboratories, St. Paul, MN, USA.S

Relations between lipoprotein(a) concentrations, LPA genetic variants, and the risk of mortality in patients with established coronary heart disease: a molecular and genetic association study

Background: Lipoprotein(a) concentrations in plasma are associated with cardiovascular risk in the general population. Whether lipoprotein(a) concentrations or LPA genetic variants predict long-term mortality in patients with established coronary heart disease remains less clear. Methods: We obtained data from 3313 patients with established coronary heart disease in the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. We tested associations of tertiles of lipoprotein(a) concentration in plasma and two LPA single-nucleotide polymorphisms ([SNPs] rs10455872 and rs3798220) with all-cause mortality and cardiovascular mortality by Cox regression analysis and with severity of disease by generalised linear modelling, with and without adjustment for age, sex, diabetes diagnosis, systolic blood pressure, BMI, smoking status, estimated glomerular filtration rate, LDL-cholesterol concentration, and use of lipid-lowering therapy. Results for plasma lipoprotein(a) concentrations were validated in five independent studies involving 10 195 patients with established coronary heart disease. Results for genetic associations were replicated through large-scale collaborative analysis in the GENIUS-CHD consortium, comprising 106 353 patients with established coronary heart disease and 19 332 deaths in 22 studies or cohorts. Findings: The median follow-up was 9·9 years. Increased severity of coronary heart disease was associated with lipoprotein(a) concentrations in plasma in the highest tertile (adjusted hazard radio [HR] 1·44, 95% CI 1·14–1·83) and the presence of either LPA SNP (1·88, 1·40–2·53). No associations were found in LURIC with all-cause mortality (highest tertile of lipoprotein(a) concentration in plasma 0·95, 0·81–1·11 and either LPA SNP 1·10, 0·92–1·31) or cardiovascular mortality (0·99, 0·81–1·2 and 1·13, 0·90–1·40, respectively) or in the validation studies. Interpretation: In patients with prevalent coronary heart disease, lipoprotein(a) concentrations and genetic variants showed no associations with mortality. We conclude that these variables are not useful risk factors to measure to predict progression to death after coronary heart disease is established. Funding: Seventh Framework Programme for Research and Technical Development (AtheroRemo and RiskyCAD), INTERREG IV Oberrhein Programme, Deutsche Nierenstiftung, Else-Kroener Fresenius Foundation, Deutsche Stiftung für Herzforschung, Deutsche Forschungsgemeinschaft, Saarland University, German Federal Ministry of Education and Research, Willy Robert Pitzer Foundation, and Waldburg-Zeil Clinics Isny