Intestinal volvulus in the pump twin of a twin reversed arterial perfusion (TRAP) sequence after laser therapy at 18 weeks: a case report

Background: Twin reversed arterial perfusion sequence is a rare and potentially lethal condition affecting approximately 1% of monochorionic twin pregnancies and 1 in 35,000 pregnancies overall. An apparently normal (pump) twin perfuses its severely malformed cotwin with deoxygenated blood via retrograde flow in direct arterioarterial anastomoses between the umbilical arteries of each twin. Fetal intestinal volvulus is a rare condition usually manifesting after birth. We report a unique case of twin reversed arterial perfusion sequence in association with intestinal volvulus in the surviving pump twin. Case presentation: A 32-year-old Hispanic primigravida was referred to our clinic after a fetoscopy procedure of laser photocoagulation of anastomoses at 18 weeks of gestation. Follow up scans in the ex-pump twin revealed dilated bowel loops and a typical “whirlpool sign” at 26 weeks of gestation, and intrauterine intestinal volvulus was suspected. At 29 weeks of gestation, preterm premature rupture of membranes occurred, and an emergency cesarean section was performed. The newborn was diagnosed in the early neonatal period with intestinal perforation. The diagnosis was postnatally confirmed by surgery and histopathology. Conclusions: The type of fetal intervention and late gestational age of the procedure increase the risk of complications. This case alerts health providers to be vigilant in the follow-up of patients with complicated monochorionic pregnanciesBackground: Twin reversed arterial perfusion sequence is a rare and potentially lethal condition affecting approximately 1% of monochorionic twin pregnancies and 1 in 35,000 pregnancies overall. An apparently normal (pump) twin perfuses its severely malformed cotwin with deoxygenated blood via retrograde flow in direct arterioarterial anastomoses between the umbilical arteries of each twin. Fetal intestinal volvulus is a rare condition usually manifesting after birth. We report a unique case of twin reversed arterial perfusion sequence in association with intestinal volvulus in the surviving pump twin. Case presentation: A 32-year-old Hispanic primigravida was referred to our clinic after a fetoscopy procedure of laser photocoagulation of anastomoses at 18 weeks of gestation. Follow up scans in the ex-pump twin revealed dilated bowel loops and a typical “whirlpool sign” at 26 weeks of gestation, and intrauterine intestinal volvulus was suspected. At 29 weeks of gestation, preterm premature rupture of membranes occurred, and an emergency cesarean section was performed. The newborn was diagnosed in the early neonatal period with intestinal perforation. The diagnosis was postnatally confirmed by surgery and histopathology. Conclusions: The type of fetal intervention and late gestational age of the procedure increase the risk of complications. This case alerts health providers to be vigilant in the follow-up of patients with complicated monochorionic pregnancie

EFECTOS DE LA ESTIMULACION TRANSCRANEAL PULSADA, EN UN PACIENTE CON ENFERMEDAD DE PARKINSON MODERADO

In Panama, Parkinson's disease is estimated to be suffered by 3 to 5% of the population, giving a total of 30 to 40 thousand Panamanians affected by this disease. Parkinson's disease differs from Alzheimer's disease in that it occurs in the deeper areas of the brain and Alzheimer's disease occurs in the more superficial regions. This research aims to assess the effect of pulsed transcranial stimulation on the clinical characteristics of Parkinson's disease. En Panamá, la Enfermedad de Parkinson, se estima que la padece el 3 al 5% de la población, dando un total de 30 a 40 mil panameños afectados por esta enfermedad. La Enfermedad de Parkinson se diferencia de la enfermedad de Alzheimer en  que esta se da en las áreas mas profundas del cerebro y la afección de la enfermedad de Alzheimer ocurre en las regiones mas superficiales.  Esta investigación tiene el objetivo de valorar el efecto de la estimulación transcraneal pulsada en las características clínicas que presenta la enfermedad de Parkinson

Deterioro cognitivo leve y enfermedad de Alzheimer: Revisión de conceptos

La enfermedad de Alzheimer (EA) es una enfermedad neurológica degenerativa que afecta a más de 46 millones de personas alrededor del mundo. Representa el tipo de demencia más común en los adultos mayores y cursa con una alteración grave en la memoria y en la funcionalidad de la persona. La EA impacta al individuo, a su familia y/o cuidador y a la sociedad, generando grandes cargas para los sistemas sanitarios, sociales y económicos. La detección temprana de la EA se ha vuelto el foco de estudio en el área del envejecimiento en los últimos años. Diagnosticar la EA en etapas prodrómicas, cuando hay cambios cerebrales subyacentes a EA pero aún no se ha desarrollado la demencia pudiera incidir en mejorías en la intervención y en retrasar la aparición de los síntomas demenciales. Por ende es crucial estudiar el deterioro cognitivo leve (DCL), fase que precede a EA. Delimitar sus manifesta-ciones, criterios diagnósticos y su relación con EA es fundamental para identificar a aquellos sujetos que tienen mayor riesgo de progresar a EA. El estudio de las alteraciones cognitivas y biomarcadores de DCL y EA es la base para realizar diagnósticos diferenciales oportunos. La evaluación neuropsico-lógica es fundamental para determinar perfiles cognitivos y evaluar la progresión de la enfermedad. Una memoria episódica deficiente es la primera manifestación en DCL amnésico. Si la persona pro-gresa a EA, este déficit se vuelve más severo inhabilitando la recuperación de la información. Otras funciones como la atención, el lenguaje, las capacidades visuoespaciales, razonamiento, y la flexibilidad mental pueden también estar afectadas en DCL, deteriorándose progresivamente en EA hasta dete-riorar severamente la autonomía de la persona. El estudio de los biomarcadores en líquido cefalorra-quídeo (LCR), estudios con neuroimagen y biomarcadores en sangre ha permitido establecer los pro-cesos patológicos subyacentes en DCL y EA y junto con la evaluación neuropsicológica constituyen el enfoque más eficaz para el diagnóstico precoz.La enfermedad de Alzheimer (EA) es una enfermedad neurológica degenerativa que afecta a más de 46 millones de personas alrededor del mundo. Representa el tipo de demencia más común en los adultos mayores y cursa con una alteración grave en la memoria y en la funcionalidad de la persona. La EA impacta al individuo, a su familia y/o cuidador y a la sociedad, generando grandes cargas para los sistemas sanitarios, sociales y económicos. La detección temprana de la EA se ha vuelto el foco de estudio en el área del envejecimiento en los últimos años. Diagnosticar la EA en etapas prodrómicas, cuando hay cambios cerebrales subyacentes a EA pero aún no se ha desarrollado la demencia pudiera incidir en mejorías en la intervención y en retrasar la aparición de los síntomas demenciales. Por ende es crucial estudiar el deterioro cognitivo leve (DCL), fase que precede a EA. Delimitar sus manifesta-ciones, criterios diagnósticos y su relación con EA es fundamental para identificar a aquellos sujetos que tienen mayor riesgo de progresar a EA. El estudio de las alteraciones cognitivas y biomarcadores de DCL y EA es la base para realizar diagnósticos diferenciales oportunos. La evaluación neuropsico-lógica es fundamental para determinar perfiles cognitivos y evaluar la progresión de la enfermedad. Una memoria episódica deficiente es la primera manifestación en DCL amnésico. Si la persona pro-gresa a EA, este déficit se vuelve más severo inhabilitando la recuperación de la información. Otras funciones como la atención, el lenguaje, las capacidades visuoespaciales, razonamiento, y la flexibilidad mental pueden también estar afectadas en DCL, deteriorándose progresivamente en EA hasta dete-riorar severamente la autonomía de la persona. El estudio de los biomarcadores en líquido cefalorra-quídeo (LCR), estudios con neuroimagen y biomarcadores en sangre ha permitido establecer los pro-cesos patológicos subyacentes en DCL y EA y junto con la evaluación neuropsicológica constituyen el enfoque más eficaz para el diagnóstico precoz

Asociación entre cognición y depresión en adultos mayores panameños con cognición normal y deterioro cognitivo leve

Depression and mild cognitive impairment (MCI) in the elderly are related to the development of different types of dementia and decreased functionality. A descriptive cross-sectional study was carried out with a sample of 73 Panamanian older adults aged 65 years or older, from the cohort of the PanamaAgingResearch Initiative (PARI). Health status and functionality were measured in activities of daily living. Cognitive functioning was measured with neuropsychological tests whose scores were combined to form six domains: global cognition, memory, language, visuospatial skills, attention, and executive functions. To measure depressive symptoms, the Geriatric Depression Scale (GDS-30) was used. An analysis of covariance (ANCOVA) was performed comparing subjects with and without possible depression for each cognitive domain, in subjects with MCI and normal cognition (NC) and controlling for the variables of age and education. Significant differences were found between the groups, the group with possible depression and MCI had lower scores compared to the other groups in global cognition. Two linear regression analyzes were performed to determine the factors associated with cognitive performance in each diagnostic group individually. In the NC group, education was a significant predictor of performance in the cognitive domains, while in the MCI it was found that age, education, depression and body mass index (BMI) were related to lower cognitive performance. , depression predicted poor performance in the cognitive domains of executive functions and attention. These results could contribute to the development of health policies aimed at older adults, and to specialized prevention and intervention efforts focused on minimizing disability and its mediators.La depresión y el deterioro cognitivo leve (DCL)en el adulto mayorestánrelacionadoscon el desarrollo de distintos tipos de demencia y disminución en la funcionalidad. Se realizó un estudio descriptivo de corte transversal con una muestra de 73adultos mayores panameños de 65 años o más, de la cohorte del PanamaAgingResearchInitiative (PARI). Se midió estado de salud y funcionalidad en las actividades de la vida diaria. El funcionamiento cognitivo fue medido con pruebas neuropsicológicas cuyos puntajes se combinaron para formar seis dominios: cognición global, memoria, lenguaje, habilidades visuoespaciales, atención y funciones ejecutivas. Para medir síntomas depresivos se utilizó la Escala de Depresión Geriátrica (GDS-30). Se realizó un análisis de covarianza (ANCOVA) comparando sujetos con y sin posible depresión para cada dominio cognitivo, en sujetos con DCL y cognición normal (CN)y controlando por las variables de edad y escolaridad. Se encontraron diferencias significativas entre los grupos, el grupo con posible depresión y DCL tenía menores puntuaciones en comparación con los otros grupos en cognición global. Se realizaron dos análisis de regresión lineal para determinar los factores asociados con el desempeño cognitivo en cada grupo diagnóstico individualmente. En el grupo CN la escolaridad fue un predictor significativo del desempeño en los dominios cognitivos, mientras queen el DCL se encontróque la edad,la educación,la depresión y elíndice de masa corporal (IMC) estaban relacionados con menor desempeñocognitivo.En el grupo de DCL, depresión predijo bajo desempeño en los dominios cognitivos de funciones ejecutivas y atención. Estos resultados podrían aportar al desarrollo depolíticas de salud dirigidas a adultos mayores, y a esfuerzos especializados de prevención e intervención enfocados enminimizar la discapacidad y sus mediadores

Relación entre las funciones ejecutivas y el rendimiento académico en una muestra de escolares

In the last decade, the integration between neuroscience and education has contributed to the understanding and improvement of the educational system, in addition, there has been an interest in the study of executive functions and the academic performance of students. Executive functions are a multimodal system that coordinate higher mental processes. Research with a child population has emphasized the relationship between executive functions and cognitive abilities, literacy skills, and mathematical skills. It has been reported that alterations in executive functions could lead to poor academic performance. The objective of this study was to evaluate the relationship between executive functions and academic performance in a sample of schoolchildren.Materials and method: A correlational descriptive study was carried out with 34 students, to whom the ENFEN test was applied and the average of the first and second quarter grades of the school year as a value to measure academic achievement. Data were analyzed with Spearman's correlation coefficient. Results: It was found that the performance of most of the students in the ENFEN test was low and medium, while the academic performance of the participants was medium and high. No significant correlations were found between performance on the ENFEN and academic performance. Conclusions: The results found were opposite to what was proposed by the literature, which would lead to propose a review by the educational system to the evaluation of the cognitive and academic capacities of the students. Increasing the sample size and the use of other research designs are recommended in future studies.En la última década, la integración entre las neurociencias y la educación hacontribuido a la comprensión y mejoramiento del sistema educativo, además, se ha mostrado un interés en el estudio de las funciones ejecutivas y el rendimiento académico de los estudiantes. Las funciones ejecutivas son un sistema multimodal que coordinan procesos mentales superiores. Las investigaciones con población infantil han enfatizado la relación entre las funciones ejecutivas y las capacidades cognitivas, habilidades en lectoescritura y competencias matemáticas. Se ha reportado que alteracionesen las funciones ejecutivas podría llevar a un bajo rendimiento académico. El objetivo de este estudio fue evaluar la relación entre las funciones ejecutivas y el rendimiento académico en una muestra de escolares.Materiales y método:Se realizó un estudio descriptivo correlacional con 34 estudiantes, a los cuales se les aplicó la prueba ENFEN y se tomó el promedio de las notas del primer y segundo trimestre del año escolarcomo valor para medir rendimiento académico.Los datos se analizaron con el coeficiente de correlación de Spearman. Resultados:Se encontró que el desempeño de la mayoría de los estudiantes en la prueba ENFEN fue bajo y medio, mientras el rendimiento académicode los participantesfue medio y alto. No se encontraron correlaciones significativasentre la ejecución en el ENFEN y el rendimiento académico. Conclusiones:Los resultados encontrados fueron opuestos a lo planteado por la literatura, lo que conllevaría a plantear una revisión por parte del sistema educativo a la evaluación de las capacidades cognitivasy académicasde los estudiantes. Se recomienda aumentar el tamaño de la muestra y el uso de otros diseños de investigaciónen estudios futuros

The effects of impaired cerebral circulation on Alzheimer's disease pathology: evidence from animal studies.

Persistent systemic hypoxia, a direct consequence of alterations in vascular function, can compromise the brain by increasing the risk of developing dementias such as Alzheimer’s disease (AD). Vascular contributions to cognitive impairment and AD in aged individuals are common, and several vascular risk factors for AD are linked to hypoxia. Clinical evidence confirms that structural and functional changes characteristic of AD pathology also occur following hypoxic-ischemic events such as stroke and traumatic brain injury. Studies with transgenic and non-transgenic mouse models reliably show that hypoxia increases the levels of amyloid- peptides that form the characteristic plaques in AD brains. Moreover, some studies suggest that vascular lesions also promote tau phosphorylation, modulate apolipoprotein E expression, and have more profound in effects in aged animals, but additional evidence is needed to establish these findings. Although the mechanisms underlying hypoxia-related effects remain unclear, controlled animal studies continue to reveal mechanistic aspects of the relationship between hypoxia and AD pathology that are necessary for therapeutic developments. The present review summarizes evidence from rodent studies regarding the effects of hypoxia on AD-related pathology and evaluates its impact on understanding human disease.Persistent systemic hypoxia, a direct consequence of alterations in vascular function, can compromise the brain by increasing the risk of developing dementias such as Alzheimer’s disease (AD). Vascular contributions to cognitive impairment and AD in aged individuals are common, and several vascular risk factors for AD are linked to hypoxia. Clinical evidence confirms that structural and functional changes characteristic of AD pathology also occur following hypoxic-ischemic events such as stroke and traumatic brain injury. Studies with transgenic and non-transgenic mouse models reliably show that hypoxia increases the levels of amyloid- peptides that form the characteristic plaques in AD brains. Moreover, some studies suggest that vascular lesions also promote tau phosphorylation, modulate apolipoprotein E expression, and have more profound in effects in aged animals, but additional evidence is needed to establish these findings. Although the mechanisms underlying hypoxia-related effects remain unclear, controlled animal studies continue to reveal mechanistic aspects of the relationship between hypoxia and AD pathology that are necessary for therapeutic developments. The present review summarizes evidence from rodent studies regarding the effects of hypoxia on AD-related pathology and evaluates its impact on understanding human disease

Inflammatory Biomarkers, Depressive Symptoms and Falls Among the elderly in Panama

Background: Falls are common among elderly adults, and are predictors of hospitalization, institutionalization and mortality. Objective: The objective of the present study was to examine the relationship between blood-based markers of inflammation and fall events in a sample of elderly Hispanic adults. Method: Data were collected from 190 participants enrolled in the Panama Aging Research Initiative study who completed baseline clinical and cognitive assessments. A non-fasting blood sample was obtained. Self-reported falls were classified as no falls, single falls or recurrent (two or more) falls reported in the 12 months prior to baseline evaluations. Serum levels of C Reactive Protein (CRP), T-lymphocyte secreting protein (I-309), interleukin 10 (IL-10), interleukin 6 (IL-6) and interleukin 7 (IL-7) were measured. Global cognition was assessed with the Mini Mental State Examination and depressive symptoms were assessed with the Geriatric Depression Scale (GDS-30). Multinomial logistic regression was used to assess the link between inflammation and fall events. Results: Depressive symptoms, limitations in Instrumental Activities of Daily Living (IADL), IL-7 and I-309 were significantly related to fall events. Elevated levels of IL-7 increased the likelihood of single and recurrent falls, while increased levels of I-309 were associated only with recurrent falls. Greater IADL limitations and depressive symptoms were associated with an increased likelihood of recurrent falls. Conclusion: There is a lack of research investigating the relationship between inflammatory biomarkers and fall events. These results provide evidence of risk factors for falls in Hispanic older adults, and could serve to guide public health professionals to establish clinical guidelines to reduce fall risks.Background: Falls are common among elderly adults, and are predictors of hospitalization, institutionalization and mortality. Objective: The objective of the present study was to examine the relationship between blood-based markers of inflammation and fall events in a sample of elderly Hispanic adults. Method: Data were collected from 190 participants enrolled in the Panama Aging Research Initiative study who completed baseline clinical and cognitive assessments. A non-fasting blood sample was obtained. Self-reported falls were classified as no falls, single falls or recurrent (two or more) falls reported in the 12 months prior to baseline evaluations. Serum levels of C Reactive Protein (CRP), T-lymphocyte secreting protein (I-309), interleukin 10 (IL-10), interleukin 6 (IL-6) and interleukin 7 (IL-7) were measured. Global cognition was assessed with the Mini Mental State Examination and depressive symptoms were assessed with the Geriatric Depression Scale (GDS-30). Multinomial logistic regression was used to assess the link between inflammation and fall events. Results: Depressive symptoms, limitations in Instrumental Activities of Daily Living (IADL), IL-7 and I-309 were significantly related to fall events. Elevated levels of IL-7 increased the likelihood of single and recurrent falls, while increased levels of I-309 were associated only with recurrent falls. Greater IADL limitations and depressive symptoms were associated with an increased likelihood of recurrent falls. Conclusion: There is a lack of research investigating the relationship between inflammatory biomarkers and fall events. These results provide evidence of risk factors for falls in Hispanic older adults, and could serve to guide public health professionals to establish clinical guidelines to reduce fall risks

Predictors of cognitive change in cognitively healthy older women in Panama: the PARI-HD study

BackgroundEvidence suggests that a combination of biological and social factors influence risk of dementia differently for women and men. In healthy older women, several factors may contribute to changes in cognition.ObjectiveDescribe the characteristics associated with variation in cognition in a sample of cognitively healthy older Panamanian women.MethodsThe study includes cross-sectional analyses of cognitive domains at baseline (n = 357) and 17-month (SD = 2.0) follow-up (n = 200) for women aged 60 years and older enrolled in the Panama Aging Research Initiative-Health Disparities (PARI-HD) study. Instruments included clinical questionnaires, physiological measures, and a neuropsychological test battery assessing global cognition and seven cognitive domains. Multiple regression analyses examined the associations between demographic and clinical characteristics and cognition at baseline. Repeated measures analyses were used to investigate changes in cognition from baseline to follow-up.ResultsOn average, participants were 68.6 years of age (SD = 5.9) with 16.1 years of education (SD = 4.7). Age, income, and education showed robust associations with baseline cognition. Subjective cognitive impairment was associated with lower performance in global cognition, verbal learning, and memory domains. Only performance in the attention domain decreased at follow-up, and subjective health state and depressive symptoms significantly predicted the change in attention.DiscussionOur study findings contribute to the investigation of cognitive health in older Hispanic women and to the understanding of sociodemographic and health-related factors associated with cognitive decline and the progression to cognitive impairment and dementia

Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016

Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita.Background A key component of achieving universal health coverage is ensuring that all populations have access to quality health care. Examining where gains have occurred or progress has faltered across and within countries is crucial to guiding decisions and strategies for future improvement. We used the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) to assess personal health-care access and quality with the Healthcare Access and Quality (HAQ) Index for 195 countries and territories, as well as subnational locations in seven countries, from 1990 to 2016.Methods Drawing from established methods and updated estimates from GBD 2016, we used 32 causes from which death should not occur in the presence of effective care to approximate personal health-care access and quality by location and over time. To better isolate potential effects of personal health-care access and quality from underlying risk factor patterns, we risk-standardised cause-specific deaths due to non-cancers by location-year, replacing the local joint exposure of environmental and behavioural risks with the global level of exposure. Supported by the expansion of cancer registry data in GBD 2016, we used mortality-to-incidence ratios for cancers instead of risk-standardised death rates to provide a stronger signal of the effects of personal health care and access on cancer survival. We transformed each cause to a scale of 0–100, with 0 as the first percentile (worst) observed between 1990 and 2016, and 100 as the 99th percentile (best); we set these thresholds at the country level, and then applied them to subnational locations. We applied a principal components analysis to construct the HAQ Index using all scaled cause values, providing an overall score of 0–100 of personal health-care access and quality by location over time. We then compared HAQ Index levels and trends by quintiles on the Socio-demographic Index (SDI), a summary measure of overall development. As derived from the broader GBD study and other data sources, we examined relationships between national HAQ Index scores and potential correlates of performance, such as total health spending per capita