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INTRODUCTION: Population ageing poses a challenge for countries in preventing and detecting neurodegenerative disorders. The Montreal Cognitive Assessment (MoCA), a short, simple, valid, and reliable screening test, assesses general cognitive status, and is useful in public health contexts. This study aims to normalise and standardise the MoCA test for the Chilean population. METHOD: We performed a descriptive, correlational validation study of the MoCA test, using a sample including 526 healthy individuals of both sexes, aged between 18 and 90 years, from the north, centre, and south of Chile. We analysed the effects of age, education level, and sex on MoCA performance. RESULTS: Age and education level had a significant impact on general cognitive performance, as determined by MoCA score. Age, education, and sex account for 1%-7% of variance. The mean (standard deviation) score for the total sample was 24.04 (3.22), whereas the normal range originally defined for the instrument is 26-30 points. Older adults with less formal education presented poorer results and lower cognitive performance. We propose a protocol for evaluating results by percentiles and scores for different age ranges, and an individual normalised scalar score. DISCUSSION: We present normative data for the MoCA test in the Chilean population, and propose cut-off points for different age ranges to discriminate normal cognitive performance from neurocognitive disorders; results are adjusted for education level. This proposal would assist in the use of the test and reduce the rate of false positives.
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Disfunção Cognitiva , Masculino , Feminino , Humanos , Idoso , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Chile , Testes de Estado Mental e Demência , Disfunção Cognitiva/diagnóstico , Cognição , EnvelhecimentoRESUMO
INTRODUCTION: Population ageing poses a challenge for countries in preventing and detecting neurodegenerative disorders. The Montreal Cognitive Assessment (MoCA), a short, simple, valid, and reliable screening test, assesses general cognitive status, and is useful in public health contexts. This study aims to normalise and standardise the MoCA test for the Chilean population. METHOD: We performed a descriptive, correlational validation study of the MoCA test, using a sample including 526 healthy individuals of both sexes, aged between 18 and 90 years, from the north, centre, and south of Chile. We analysed the effects of age, education level, and sex on MoCA performance. RESULTS: Age and education level had a significant impact on general cognitive performance, as determined by MoCA score. Age, education, and sex account for 1-7% of variance. The mean (standard deviation) score for the total sample was 24.04 (3.22), whereas the normal range originally defined for the instrument is 26-30 points. Older adults with less formal education presented poorer results and lower cognitive performance. We propose a protocol for evaluating results by percentiles and scores for different age ranges, and an individual normalised scalar score. DISCUSSION: We present normative data for the MoCA test in the Chilean population, and propose cut-off points for different age ranges to discriminate normal cognitive performance from neurocognitive disorders; results are adjusted for education level. This proposal would assist in the use of the test and reduce the rate of false positives.
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BACKGROUND AND OBJECTIVES: The standard treatment for endometrial cancer is simple hysterectomy with bilateral salpingo-oophorectomy. Patients with high risk also benefit from lumbo-aortic lymphadenectomy. High risk patients include those with grades and histologic subtypes associated with poor prognosis and depth of myometrial invasion greater than 50% (M2). To determine which patients would benefit from lumbo-aortic lymphadenectomy, the depth of myometrial invasion can be assessed by intraoperative frozen section or by magnetic resonance imaging (MRI). We aimed to determine the diagnostic yield of intraoperative frozen section and MRI for detecting the presence of M2 in patients with endometrial cancer. MATERIALS AND METHODS: This cross-sectional study included women with a histologically confirmed diagnosis of endometrial cancer who underwent baseline MRI and surgical intervention in our institution between 1 January 2010 and 31 December 2017. We reviewed the MRI studies and the intraoperative frozen section reports and compared them with the information in the histopathology report. We compared the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the two tests. We also calculated the diagnostic accuracy of each method and the percentages of underestimation and overestimation. Finally, we calculated the predictive value of MRI for the presence of M2, adjusting it for the histologic variables known to be associated with poor prognosis. RESULTS: To detect M2, MRI had 63% sensitivity, 87% specificity, 73% PPV, and 81% NPV; the diagnostic accuracy was 78.8%, with 13.12% underestimation and 8.13% overestimation of M2. Intraoperative frozen section had 69% sensitivity, 86.7% specificity, 69% PPV, and 86% NPV; the diagnostic accuracy was 81.5%, with 9.24% underestimation and 9.24% overestimation of M2. The degree of concordance between the two methods was moderate (k=0.54, p < 0.00001). CONCLUSIONS: In our experience, MRI and intraoperative frozen section have adequate diagnostic yields for determining M2, though intraoperative frozen section is slightly better. The contribution of MRI in determining the presence and the site of deep myometrial invasion, as well as the factors that can confound the diagnosis, when added to the contribution of intraoperative frozen section, means that both methods help reduce the number of unnecessary lymph node dissections and the morbidity, mortality, and health costs associated with this practice.
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Neoplasias do Endométrio/diagnóstico por imagem , Neoplasias do Endométrio/patologia , Secções Congeladas , Imageamento por Ressonância Magnética , Miométrio/diagnóstico por imagem , Miométrio/patologia , Idoso , Estudos Transversais , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Período Intraoperatório , Pessoa de Meia-Idade , Invasividade NeoplásicaRESUMO
This paper builds on a previous paper in which new ciprofloxacin extended-release tablets were developed based on a ciprofloxacin-based swellable drug polyelectrolyte matrix (SDPM-CIP). The matrix contains a molecular dispersion of ciprofloxacin ionically bonded to the acidic groups of carbomer, forming the polyelectrolyte-drug complex CB-CIP. This formulation showed that the release profile of the ciprofloxacin bilayer tablets currently commercialised can be achieved with a simpler strategy. Thus, since ciprofloxacin urine concentrations are associated with the clinical cure of urinary tract infections, the goal of this work was to compare the urinary excretion of SDPM-CIP tablets with those of the CIPRO XR® bilayer tablets. A batch of SDPM-CIP tablets was manufactured by the wet granulation method and the CB-CIP ionic complex was obtained in situ. Fasted healthy volunteers received a single oral dose of 500 mg ciprofloxacin of either formulation in a randomised crossover study. Urinary concentrations were assessed by HPLC at intervals up to 36 h. Pharmacokinetic parameters (rate of urinary excretion, maximum urine excretion rate, tmax, area under the curve, amount and percentage of the ciprofloxacin dose excreted in urine) showed no statistical differences between both formulations at any of the time intervals of collection. The processing conditions to obtain SDPM-CIP tablets are easy to scale up since they involve technology currently employed in the pharmaceutical industry and the process is less challenging to implement. In addition, SDPM-CIP tablets met pharmacopoeial quality specifications.
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Antibacterianos , Ciprofloxacina , Polieletrólitos , Adulto , Antibacterianos/administração & dosagem , Antibacterianos/química , Antibacterianos/farmacocinética , Antibacterianos/urina , Ciprofloxacina/administração & dosagem , Ciprofloxacina/química , Ciprofloxacina/farmacocinética , Ciprofloxacina/urina , Estudos Cross-Over , Preparações de Ação Retardada/administração & dosagem , Preparações de Ação Retardada/química , Preparações de Ação Retardada/farmacocinética , Método Duplo-Cego , Liberação Controlada de Fármacos , Feminino , Voluntários Saudáveis , Humanos , Masculino , Polieletrólitos/administração & dosagem , Polieletrólitos/química , Polieletrólitos/farmacocinética , Comprimidos , Adulto JovemRESUMO
Introducción: La circulación de membrana extracorpórea consiste en el uso de una bomba de circulación extracorpórea con intercambio gaseoso, de forma prolongada, para proveer soporte vital temporario. Brinda soporte circulatorio, oxigena y remueve dióxido de carbono sin las complicaciones que puede generar la ventilación mecánica convencional. Diseño: Descriptivo, retrospectivo, observacional. Población: Se revisaron los registros clínicos de pacientes pediátricos y neonatos con diagnóstico de patología respiratoria y cardiovascular (0-192 meses) ingresados en ECMO entre el 1 de octubre de 2008 y el 30 de septiembre de 2013. Criterios de inclusión: edad gestacional >34 semanas y >2 kg), sin coagulopatía grave ni hemorragia cerebral grados III o IV, con enfermedad cardíaca reversible, enfermedad respiratoria con hipoxemia o hipercapnia , resistentes al mayor soporte mecánico ventilatorio disponible. Resultados: Ingresaron en ECMO 16 pacientes (mediana de la edad 24 meses, 0-192), 10 niñas y 6 niños. Cuatro ingresados por causas respiratorias y 12, por causas cardiovasculares. La mortalidad por ECMO respiratorio fue del 25% (1/4), cardiovascular 75% (10/12). El PIM de ingreso en la UCIP tuvo una mediana de 3 (1-10). La mediana de estadía en ECMO fue de 7 días (rango 3-16), la de estadía en UCIP-UCIN fue de 22 días (3-120) y en el hospital, de 40 (3-300).Cuatro pacientes recibieron canulación venovenosa y los restantes 12, arteriovenosa. El índice de oxigenación medio de ingreso fue de 26 (DE ± 4); mediana de presión media de la vía aérea, 22 (rango 19-35); media de PartO2 43 (DE ± 8) y la media de PCO2 53 (DE ± 5). El índice Pa/Fi al ingreso tuvo una mediana de 42 (rango 32-74). Conclusión: El ECMO es una herramienta útil para el rescate de pacientes con falla cardíaca e insuficiencia respiratoria, pues permite sostener al paciente, evitando los efectos nocivos de la ventilación mecánica convencional (cuando no se puede mantener la estrategia de protección pulmonar) y de altas dosis de drogas vasoactivas. No obstante, el desarrollo de programas costo- efectivos de ECMO en nuestro país plantea un escenario difícil.(AU)
Introduction: Extracorporeal membrane circulation (ECMO) is the use of cardiopulmonary bypass with prolonged gas exchange to provide temporary life support. The ECMO offers circulatory support, oxygenates and removes carbon dioxide without the complications that can generate conventional mechanical ventilation. Design: Descriptive, retrospective, observational. Population: Clinical records of pediatric and neonatal patients diagnosed with respiratory and cardiovascular disease (0-192 months) admitted to ECMO from October 10, 2008 to September 30, 2013 were reviewed. Inclusion criteria: gestational age >34 weeks and >2 kg, absence of severe coagulopathy and cerebral hemorrhage grade III or IV, with reversible heart disease, respiratory disease with hypoxemia and/or hypercapnia refractory to the most ventilatory mechanical support available. Results: Sixteen children with a median age of 24 months (0-192) (10 girls and 6 boys) were admitted to ECMO. Four children were admitted due to respiratory illness and 12 for cardiovascular disease. Mortality from respiratory ECMO was 25% (1/4), cardiovascular 75% (10/12). PIM at the PICU admissions had a median of 3 (1-10). Median ECMO stay was 7 days (range 3-16), median PICU-NICU stay 22 days (3-120) and hospital stay 40 (3-300). The kind of cannulation was veno-venous (4), and arteriovenous (12). Mean oxygenation index at admission, 26 (SD ± SD 4); median average pressure of air, 22 (range 19-35); average PartO2, 43 (SD ± 8) and mean PCO2 53 (SD ± 5). Median Pa/Fi index at admission, 42 (range 32-74 ). Conclusions: The ECMO is a useful tool for the rescue of patients with heart failure and respiratory failure, avoiding the deleterious effects of conventional mechanical ventilation (when it is not possible to maintain lung protective strategy) and high doses vasoactive drug. However the development of cost-effective ECMO programs in our country poses a difficult scenario.(AU)
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Humanos , Insuficiência Respiratória , Oxigenação por Membrana Extracorpórea , PediatriaRESUMO
Polymorphous silicon thin films (pm-Si) have been deposited from mixtures of dichlorosilane and hydrogen, using argon as the diluting gas by plasma-enhanced chemical vapor deposition. The deposition conditions were chosen to simultaneously obtain both Si nanocrystallites and an amorphous silicon matrix in the as-grown samples. High resolution transmission electron microscopy studies show the crystallinity of Si domains whose dimensions are in the interval of 2-14 nm. The surface passivation state of the silicon nanocrystals was inferred from Fourier transform infrared spectroscopy analysis. Two optical absorption edges, corresponding to the amorphous matrix and the Si nanocrystals, were observed for all the pm-Si thin films. Intense visible photoluminescence was observed for the as-grown samples. The possibility of using these thin films for the down-conversion effect in silicon solar cells is discussed.
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Cristalização/métodos , Membranas Artificiais , Nanoestruturas/química , Nanoestruturas/ultraestrutura , Nanotecnologia/métodos , Silanos/química , Silício/química , Gases , Temperatura Alta , Substâncias Macromoleculares/química , Teste de Materiais , Conformação Molecular , Tamanho da Partícula , Propriedades de SuperfícieRESUMO
The preeclampsia-eclampsia syndrome is a vasospastic disorder and probably has a placental origin. Once the hypertensive syndrome is established the uteroplacental blood flow is reduced as well as the intervillous blood flow. Since 18-24 weeks of gestation and before the symptoms of preeclampsia become overt, changes in placental flow velocity can be detected with Doppler technics. The placental theories for the etiology of preeclampsia are focused on the hypoxic effect in the trophoblastic tissue of second trimester. The placental ischemic changes are evident and seen in the uteroplacental bed. They are interrelated with the stages of trophoblastic invasion of the spiral arteries during the 14 and 20 weeks. When the trophoblastic invasion is over, the spiral arteries become a high resistance system. The defect observed in preeclampsia is the lack of invasion of the trophoblast to the maternal arteries. The diminished placental perfusion probably creates endothelial damage. This damage has several effects: decreased prostaglandin production, activated coagulation cascade, stimulated fibrin aggregation, and increased vascular permeability. The ideal laboratory test for preeclampsia shall predict the onset of this entity. Recent findings seem promising. The fibronectin concentration increases 2-3 wks. prior to the clinical manifestation of preeclampsia. Severe hypertension shows an abnormal decrease in fibronectin levels. Hypocalciuria has been described as an early predictor in the development of preeclampsia. Other agents undergoing extensive evaluation as predictors are: uric acid, b-thromboglobin, prolactin and atrial natriuretic peptide. Recently high levels of b-HCG (human corionic gonadotrophin) have been linked to a lack of trophoblastic invasion during the second trimester, therefore this is a potential marker for those patients that will eventually develop preeclampsia.
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Eclampsia/etiologia , Pré-Eclâmpsia/etiologia , Adulto , Cálcio/urina , Permeabilidade Capilar , Gonadotropina Coriônica/análise , Eclampsia/diagnóstico , Feminino , Humanos , Hipertensão/complicações , Pré-Eclâmpsia/diagnóstico , Valor Preditivo dos Testes , Gravidez , Segundo Trimestre da Gravidez , Prognóstico , Síndrome , Trofoblastos/metabolismo , Ácido Úrico/análiseRESUMO
Uterine arteriovenous malformation (AVMs) are fairly rare. Seventy four cases have been reported in the medical literature. The clinical presentation of this entity is quite diverse. The approach to uterine AVM requires clinical alertness and to make the diagnosis a high index of suspicion is required. Prompt treatment is often essential. This article reviews the entire literature on uterine AVM emphasizing the various clinica presentations and treatment modalities available for the gynecologist.