Lithium usage and renal function testing in a large UK community population; a case–control study

Objective

This study investigates the prevalence of lithium use, monitoring practice and associated effects on renal function in a large UK community sample.

Method

A large population-based renal function database was cross-referenced with a general practitioner database of 404,673 patients. The renal function of patients prescribed lithium during the 2-year period was compared with that of matched controls. The renal monitoring patterns of these cases were investigated in a naturalistic observational study. Data underwent parametric testing — continuous variables by analysis of variance, with appropriate adjustment, and categorical outcomes by χ² testing. Block analysis of variance was undertaken on case–control data.

Results

A total of 422 patients in the database were prescribed lithium. Renal function monitoring in accordance with published guidelines occurred in 69% of patients. Patients taking lithium had a significantly higher serum creatinine (5.8 μmol/L, P< .001) and lower glomerular filtration rate (5.9 ml/min, P< .001) when compared to matched controls.

Conclusions

This is the first study carried out in a large community sample. Lithium remains widely prescribed in the community setting. The study confirms that lithium has a statistically and clinically significant negative effect on renal function. Despite published guidelines and recognition of the importance of serial measurements, monitoring of renal function is inconsistent.     

La myasthénie associée aux thymomes : particularités cliniques et résultats chirurgicaux

Objective

The aim of this study was to compare the characteristics of myasthenic patients with and without thymoma, and the results of thymectomy in both types of patients.

Material and methods

A retrospective study was conducted among 66 patients who underwent thymectomy for myasthenia gravis in our department over a 10-year period (2000–2010). The surgical approach was sternotomy or anterolateral thoracotomy. Patients were divided into two groups according to the presence of thymoma: with (T-MG) and without (NT-MG) thymoma. Complete stable remission (CSR) was the primary endpoint.

Results

Median age was 35.09 ± 9.89 years. The NT-MG group had 38 patients (57.57%) and the T-MG group 28 patients (42.43%). There was no difference between the two groups regarding the surgical approach (P = 0.52). T-MG patients were older (40.54 ± 15.16 vs. 31.37 ± 9.46) (P = 0.008) and predominantly male. There were more generalized forms (P = 0.01) and more bulbar involvement (P = 0.02) in the T-MG group. The rate of CSR at 5 years was 7% and 17% in the T-MG and NT-MG patients respectively (P = 0.70). At 10 years, it was 36% and 94.73% respectively (P = 0.03).

Conclusion

Thymomatous myasthenia gravis is characterized by the severity of its clinical features. Remission rate at 10 years was significantly lower in the myasthenia with thymoma group.     

Efficacité à moyen terme de l’autogreffe de cellules souches hématopoïétiques périphériques sur la polyneuropathie du syndrome POEMS : expérience chez 5 cas

Introduction

POEMS syndrome (polyneuropathy, organomegaly, endocrynopathy, M-protein, and skin changes) is a rare multisystem disease associated with plasma cell dyscrasia. The efficacy of autologous peripheral blood stem cell transplantation (auto-PBSCT) reported in case series has been mainly based on hematologic criteria and clinical recovery of peripheral neuropathy dysfunctions but has not been specifically evaluated. This retrospective study aimed to analyze the efficacy of auto-PBSCT on disability and electrophysiological patterns in patients with POEMS syndrome.

Methods

Five patients presenting with POEMS syndrome received auto-PBSCT. Disability was evaluated before treatment and at 6 and 12 months using the Overall Neuropathy Limitation Scale (ONLS) and MRC sumscore of 28 muscles. Nerve conduction studies were performed before and one year after treatment, on median, ulnar, fibular and tibial nerves.

Results

Mean age was 60.6 years (49–70). Disease duration between first symptoms and auto-PBSCT was 15.4 months (2–33). Before auto-PBSCT, mean ONLS score was 4.2 (1–10) and mean MRC sumscore 115.8/140 (74–140). At M6, mean ONLS score decreased and mean MRC sumscore increased; both were improved in all patients at M12: mean ONLS score 3 (range 0–8) at M6 and 2.2 (range 0–7) at M12; mean MRC sumscore 118/140 (77–140) at M6 and 122.4/140 (80–140) at M12. Significant recovery in electrophysiological patterns was observed in all patients on ulnar and median nerves: before-after treatment differences were observed for motor conduction velocities (34.41 vs. 45.47 m/s; P < 0.001), distal CMAP amplitudes (5.04 vs. 5.96 mV; P = 0.004), and sensory conduction velocities (43.20 vs. 49.20 m/s; P = 0.001). Distal CMAP amplitude remained low in fibular and tibial nerves (0.41 vs. 0.17 mV).

Conclusions

Clinical and electrophysiological improvement is obvious in POEMS syndrome peripheral neuropathy within one year after treatment with auto-PBSCT, undoubtedly resulting from extensive remyelinisation and axonal regeneration. Further studies are required to examine long-term outcome in patients with POEMS syndrome given auto-PBSCT.     

The impact of childhood trauma on depression: Does resilience matter? Population-based results from the Study of Health in Pomerania

Objective

Data suggests that traumatic experiences at early age contribute to the onset of major depressive disorder (MDD) in later life. This study aims at investigating the influence of dispositional resilience on this relationship.

Methods

Two thousand and forty-six subjects aged 29–89 (SD = 13.9) from a community based sample who were free of MDD during the last 12 months prior to data collection were diagnosed for Lifetime diagnosis of MDD by the Munich-Composite International Diagnostic Interview (M-CIDI) according to DSM-IV criteria. Childhood maltreatment (CM) and resilience were assessed with the Childhood Trauma Questionnaire (CTQ) and the Resilience-Scale (RS-25).

Results

Both CM (OR = 1.03, 95% CI [1.02, 1.04], P < .000) and resilience (OR = 0.98, 95% CI [0.98, 0.99], P < .000) were associated with MDD later in life. The detrimental effects of low resilience on MDD were not only especially prominent in subjects with a history of CM (OR = 3.18, 95% CI [1.84, 5.50], P < .000), but also effective in subjects without CM (OR = 2.62, 95% CI [1.41, 4.88], P = .002).

Conclusions

The findings support the clinical assumption that resilient subjects may be partly protected against the detrimental long-term effects of child abuse and neglect.     

Évolution clinique de la dépression post-accident vasculaire cérébral à Kinshasa

Objectives

To describe the evolution of the clinical profile of post-stroke depression over a period of one year and to determine factors associated with changes in post-stroke depression.

Methods

Prospective cohort study with a follow-up of 1 year including 30 consecutive eligible patients. The severity of depression was assessed with the patient health questionnaire (PHQ9).

Results

The mean age was 55.87 ± 12.67 years. Seventy percent of patients were men. The two assessments for neurological status, perceived health status and test results of attention were not statistically different. The rate of depressive symptoms was 26.67% in 2011 and 20% in 2012. Disability and apathy were significantly improved. The average for disability increased from 2.77 ± 1.19 to 2.46 ± 2.19 (P = 0.002). From 66.7% in 2011, the proportion of patients able to walk without assistance rose to 93.3% in 2012 (P = 0.03). In addition, the proportion of patients apathetic decreased from 43.3% to 13.3% (P = 0.01). Greater age, female sex, sleep disorders and post-stroke apathy remained associated with DPAVC between the two assessments, with an increase in the strength of the association for apathy.

Conclusions

The frequency of post-stroke depression is high and remains stable over time. Disability is the clinical feature that evolved more favorably. The association with apathy, present at the beginning, of the study was strengthened one year later.     

Le traitement par apomorphine en perfusion continue sous-cutanée dans la maladie de Parkinson : analyse rétrospective d’une série de 81 patients

Background

Continuous subcutaneous infusion of apomorphine (CAI) has shown efficacy in the treatment of motor fluctuations but its place in the therapeutic arsenal remains poorly defined in terms of indication, acceptability and long-term tolerance. Indeed, few studies have been carried out with a follow-up greater than 12 months. The main objective was to assess the quality of life of Parkinson's disease (PD) patients treated with CAI. We also evaluate the effectiveness on the motor fluctuations, the long-term tolerance of this treatment with its causes of discontinuation and the treatment regimens used.

Methods

We conducted a retrospective study of 81 PD patients treated with CAI between April 2003 and June 2012. Data were collected from medical records. A repeated measures analysis of variance by the linear mixed model was used (significance level: 5%).

Results

In August 2012, 27/81 patients were still treated with CAI with a mean duration of 28 months, 46/81 discontinued CAI (9 precociously), and 8 were lost to view. We didn’t show improvement in the quality of life nor efficacy of CAI on the UPDRS IV score (P = 0.54) and dyskinesia score (P = 0.95). The CGI score patient also reflects this result with a majority response suggesting no significant change with CAI. We observed relative good cognitive and psychiatric tolerance. Adverse events were frequent but often benign. The average (± SD) rate of apomorphine was 3.15 ± 1.71 mg/h and the oral dopaminergic treatment was decreased by 37.8%.

Discussion

The results are consistent with the literature except for the lack of efficiency on motor fluctuations which may be due to the use of too small doses of apomorphine. This seems to be a leading cause of discontinuation of CAI, especially when it is associated with side effects or important constraints. For better efficiency on motor fluctuations, we recommend the use of apomorphine at higher doses to obtain an optimal continuous dopaminergic stimulation.     

Indications curative et préventive dans le trouble bipolaire

Objectives

The efficacy of lithium in bipolar disorder is widely accepted for many years. It is still considered as the gold standard in most international guidelines. Lithium is indicated in the treatment of mania, of depressive episodes and in the prevention of mania and depression. The objective of this paper is to focus on scientific data supporting the interest of lithium in the management of bipolar disorder.

Methods

A Medline search of papers published between 1950 and 2013 and focusing on the efficacy of lithium in bipolar disorder was performed. The content of this paper was mainly based on the most recent studies comparing lithium to placebo and to new drugs potentially effective in the treatment of bipolar disorder.

Results

This review shows that the evidence is strong in the treatment of mania and in the prevention of recurrences. The results in the treatment of depression are more conflicting. Some studies suggested both positive and negative predictors of response to lithium in the treatment of mania. The serum-lithium level associated with an optimal preventive effect against manic and depressive recurrence is probably between 0,6 and 0,8 mEq/L.

Conclusion

Today, there is no doubt about the efficacy of lithium in the treatment of mania and in the prevention of mania and depression.     

Safety behaviors and sleep effort predict sleep disturbance and fatigue in an outpatient sample with anxiety and depressive disorders

Objective

Theoretical and empirical support for the role of dysfunctional beliefs, safety behaviors, and increased sleep effort in the maintenance of insomnia has begun to accumulate. It is not yet known how these factors predict sleep disturbance and fatigue occurring in the context of anxiety and mood disorders. It was hypothesized that these three insomnia-specific cognitive–behavioral factors would be uniquely associated with insomnia and fatigue among patients with emotional disorders after adjusting for current symptoms of anxiety and depression and trait levels of neuroticism and extraversion.

Methods

Outpatients with a current anxiety or mood disorder (N = 63) completed self-report measures including the Dysfunctional Beliefs About Sleep Scale (DBAS), Sleep-Related Safety Behaviors Questionnaire (SRBQ), Glasgow Sleep Effort Scale (GSES), Pittsburgh Sleep Quality Index (PSQI), NEO Five-Factor Inventory (FFI), and the 21-item Depression Anxiety and Stress Scale (DASS). Multivariate path analysis was used to evaluate study hypotheses.

Results

SRBQ (B = .60, p < .001, 95% CI [.34, .86]) and GSES (B = .31, p < .01, 95% CI [.07, .55]) were both significantly associated with PSQI. There was a significant interaction between SRBQ and DBAS (B = .25, p < .05, 95% CI [.04, .47]) such that the relationship between safety behaviors and fatigue was strongest among individuals with greater levels of dysfunctional beliefs.

Conclusion

Findings are consistent with cognitive behavioral models of insomnia and suggest that sleep-specific factors might be important treatment targets among patients with anxiety and depressive disorders with disturbed sleep.     

Increased serum concentrations of pentosidine are related to presence and severity of coronary artery disease

Background

There are limited data regarding the contribution of advanced glycation end products (AGEs) in the presence of coronary artery disease (CAD). We investigated whether serum pentosidine and Nε-carboxymethyllysine (CML) were related to the presence and the severity of CAD.

Methods

69 Tunisian patients with CAD (≥ 50% obstruction in ≥ 1 coronary artery), 32 Tunisian patients without CAD but with potential cardiovascular risk factors and 60 Tunisian control subjects were included in a cross-sectional study. Patients were classified as CAD and non CAD patients according to angiographic results. The severity of CAD was assessed using the Gensini score. Serum pentosidine and CML were measured by LC-MS/MS.

Results

Serum pentosidine and CML concentrations were significantly higher in non-CAD patients vs control subjects (P < 0.001). Serum pentosidine concentrations were significantly higher in CAD patients vs non-CAD patients (P < 0.001). A multiple logistic regression analysis demonstrated that pentosidine was independently associated with the presence of CAD (OR = 1.52, 95% CI: 1.12-2.07, P = 0.007). The area under curve (AUC) determined by ROC analysis was 0.74 (95% CI: 0.64-0.84, P < 0.001) and the optimal cut-off value of pentosidine to predict the presence of CAD was 3.2 μmol/mol Lys, with 64% sensitivity and 78% specificity. Furthermore, in a multivariate stepwise regression analysis, pentosidine was independently correlated with Gensini score (standardized β = 0.46, 95% CI: 0.70-1.99, P < 0.001).

Conclusions

High concentrations of pentosidine show the presence and the severity of CAD with high sensitivity.     

Association between PAI-1 4G/5G Polymorphisms and osteonecrosis of femoral head: A Meta-analysis

Background

The polymorphism of the plasminogen activator inhibitor-1 (PAI-1) 4G/5G gene has been correlated with susceptibility to osteonecrosis of the femoral head (ONFH), but study results are controversial. The aim of this study was to derive a more precise estimation of the relationship between the PAI-1 4G/5G Gene polymorphism and ONFH by performing a meta-analysis.

Methods

The meta-analysis was based on five eligible case-control studies involving 419 cases and 969 controls and summarized data indicating the association between PAI-1 polymorphism and risk of osteonecrosis of the femoral head. Odds ratios (OR) with 95% confidence intervals (95% CI) were used to assess the strength of this association in the random-effects model or fixed-effects model.

Results

A significant association between PAI-1 4G/5G polymorphism and ONFH susceptibility was observed for 4G4G + 4G5G vs. 5G5G (OR = 1.766, 95% CI 1.279–2.437, P = 0.001), 4G/4G vs. 4G/5G + 5G/5G (OR = 2.050, 95% CI 1.581–2.657, P = 0.000), 4G/4G vs. 5G/5G (OR = 2.553, 95% CI 1.345–4.846, P = 0.004), and 4G vs. 5G (OR = 1.758, 95% CI 1.236–2.500, P = 0.002). No significant association between PAI-1 4G/5G polymorphism and ONFH susceptibility was observed for 4G/5G vs. 5G/5G (OR = 1.327, 95% CI 0.939–1.877, P = 0.109).

Conclusions

This meta-analysis suggested that 4G/5G polymorphism of the PAI-1 gene was a risk factor for ONFH. This study also suggests that the PAI-1 4G4G genotype may indicate a risk for ONFH.     

Association of depression symptoms with quality of life and chronic artery vasculopathy: A cross-sectional study in heart transplant patients

Objective

Depression represents a relevant co-morbidity in patients with chronic heart disease and may diminish the overall success for long-term survival after heart transplantation (HTx). This study aimed to assess the prevalence of depression symptoms in long-term HTx survivors, and to compare depressive patients to those without depression with respect to chronic artery vasculopathy (CAV).

Methods

A sample of 203 HTx patients, median 11.5 (IQR 7–17) years after transplant, provided detailed data of depression symptoms, and other psychosocial symptoms including anxiety, family support, professional re-integration, and health-related quality of life (HRQoL). Data were analyzed for an association with CAV.

Results

Overall, 14.8% patients (95% CI: 10.2–20.4) showed relevant depression symptoms. No significant differences were seen between non-depressed vs. depressed patients with respect to demographics, clinical variables, and cardiovascular risk factors. Anxiety was prevalent in 9.0% (95% CI: 5.4–13.9) of the sample. Depression symptoms showed impaired HRQoL in the SF-36 physical (P = .012) and psychosocial (P = .0001) components. CAV was prevalent in 34.0% (95% CI: 27.5–41.0), and depression symptoms and CAV were not significantly associated. CAV-patients did not report their physical HRQoL being lower relative to those without CAV (P = .40). Multivariate analysis revealed overweight BMI (OR = 2.20; P = .04), longer time since transplant (OR = 1.10; P = .001), and older age (OR = 1.04; P = .01) being associated with CAV.

Conclusion

Depression symptoms are prevalent in long-term survivors after HTx, and psychological impairments decrease patients' perceptions of HRQoL. More research seems necessary to identify the inter-relationship between depression symptoms and CAV, in order to develop targeted interventions to overcome this problem.     

Le centrage des hanches au moyen de sièges moulés – études et résultats

Background

Musculo-skeletal disorders and hip deformity play a key role on future development of motor and adaptive functions in children with cerebral palsy (CP). Lateral migration of the femoral head increases on average of 7.7% per year and may progress to hip dislocation. Conservative preservation of muscle length and balance may prevent or reduce femoral head migration and acetabular dysplasia. A prospective comparative non randomized study was conducted to determine the effect of a siège moulé postural management, in association with a physiotherapy program, on the progression of hip displacement in children with CP. Thirty-five patients with bilateral CP and so-called hip at risk (migration percentage [MP] of over 10% but less than 40%) were included into the study and evaluated by neurofunctional assessment, Gross Motor Function Classification System (GMFCS), Tardieu scale and radiological measurements (MP by Reimers). Eighteen children were treated with therapeutic education and postural management 4 hours a day, and 17 children (control group) were treated with NDT alone.

Results

A significant difference was found between MP values of case group and control group after 1 year (T1) and 2 years of treatment (T2) (p = 0,001). The rate of hip displacement was reduced by 5 % in the treatment group after the first year and by 7 % at second follow-up.

Conclusion

Our data show a progressive reduction of MP values measured in the treated group confirming the significant benefit from combined non-surgical approach. The study supports the evidence that conservative management of hip deformity can be successful if implemented before the development of hip dysplasia.     

Evaluación ecológica en el deterioro cognitivo leve y enfermedad de Alzheimer mediante el Rivermead Behavioural Memory Test

Introduction

The Rivermead Behavioural Memory Test (RBMT) is a short, ecologically-valid memory test battery that can provide data about a subject's memory function in daily life. We used RBMT to examine daily memory function in patients with mild cognitive impairment (MCI), Alzheimer disease (AD), and in healthy controls. We also evaluated differences between the memory profiles of subjects whose MCI remained stable after 1 year and those with conversion to AD.

Patients and methods

Sample of 91 subjects older than 60 years: 30 controls, 27 MCI subjects and 34 AD patients. Subjects were assessed using MMSE and RBMT.

Results

The 40 men and 51 women in the sample had a mean age of 74.29 ± 6.71 and 5.87 ± 2.93 years of education. For the total profile and screening RBMT scores (P<.001) and total MMSE scores (P<.05), control subjects scored significantly higher than those with MCI, who in turn scored higher than AD patients. In all subtests, the control group (P<.001) and MCI group (P<.05) were distinguishable from the AD group. Prospective, retrospective, and orientation subtests found differences between the MCI and control groups (P<.05). MCI subjects who progressed to AD scored lower at baseline on the total RBMT and MMSE, and on name recall, belongings, story − immediate recall, route − delayed recall, orientation (P<.05), face recognition, story − delayed recall, and messages − delayed recall sections (P<.01).

Conclusions

RBMT is an ecologically-valid episodic memory test that can be used to differentiate between controls, MCI subjects, and AD subjects. It can also be used to detect patients with MCI who will experience progression to AD.     

Emotion suppression and mortality risk over a 12-year follow-up

Objective

Suppression of emotion has long been suspected to have a role in health, but empirical work has yielded mixed findings. We examined the association between emotion suppression and all-cause, cardiovascular, and cancer mortality over 12 years of follow-up in a nationally representative US sample.

Methods

We used the 2008 General Social Survey–National Death Index (GSS–NDI) cohort, which included an emotion suppression scale administered to 729 people in 1996. Prospective mortality follow up between 1996 and 2008 of 111 deaths (37 by cardiovascular disease, 34 by cancer) was evaluated using Cox proportional hazards models adjusted for age, gender, education, and minority race/ethnicity.

Results

The 75th vs. 25th percentile on the emotional suppression score was associated with hazard ratio (HR) of 1.35 (95% Confidence Interval [95% CI] = 1.00, 1.82; P = .049) for all-cause mortality. For cancer and cardiovascular disease mortality, the HRs were 1.70 (95% CI = 1.01, 2.88, P = .049) and 1.47 (95% CI = .87, 2.47, P = .148) respectively.

Conclusions

Emotion suppression may convey risk for earlier death, including death from cancer. Further work is needed to better understand the biopsychosocial mechanisms for this risk, as well as the nature of associations between suppression and different forms of mortality.     

Restoring professionalism: the physician fitness-for-duty evaluation

Objectives

We compare findings from 10 years of experience evaluating physicians referred for fitness-to-practice assessment to determine whether those referred for disruptive behavior are more or less likely to be declared fit for duty than those referred for mental health, substance abuse or sexual misconduct.

Method

Deidentified data from 381 physicians evaluated by the Vanderbilt Comprehensive Assessment Program (2001–2012) were analyzed and compared to general physician population data and also to previous reports of physician psychiatric diagnosis found by MEDLINE search.

Results

Compared to the physicians referred for disruptive behavior (37.5% of evaluations), each of the other groups was statistically significantly less likely to be assessed as fit for practice [substance use, %: odds ratio (OR)=0.22, 95% confidence interval (CI)=0.10–0.47, P< .001; mental health, %: OR=0.14, 95% CI=0.06–0.31, P< .001; sexual boundaries, %: OR=0.27, 95% CI=0.13–0.58, P= .001].

Conclusions

The number of referrals to evaluate physicians presenting with behavior alleged to be disruptive to clinical care increased following the 2008 Joint Commission guidelines that extended responsibility for professional conduct outside the profession itself to the institutions wherein physicians work. Better strategies to identify and manage disruptive physician behavior may allow those physicians to return to practice safely in the workplace.     

Análisis morfológico de la región del hipocampo asociado a una tarea conductual innata en el modelo de ratón transgénico (3xTg-AD) para la enfermedad de Alzheimer

Introduction

Different animal models for Alzheimer disease (AD) have been designed to support the hypothesis that the neurodegeneration (loss of neurons and synapses with reactive gliosis) associated with Aβ and tau deposition in these models is similar to that in the human brain. These alterations produce functional changes beginning with decreased ability to carry out daily and social life activities, memory loss, and neuropsychiatric disorders in general. Neuronal alteration plays an important role in early stages of the disease, especially in the CA1 area of hippocampus in both human and animal models.

Methods

Two groups (WT and 3xTg-AD) of 11-month-old female mice were used in a behavioural analysis (nest building) and a morphometric analysis of the CA1 region of the dorsal hippocampus.

Results

The 3xTg-AD mice showed a 50% reduction in nest quality associated with a significant increase in damaged neurons in the CA1 hippocampal area (26% ± 6%, P < .05) compared to the WT group.

Conclusions

The decreased ability to carry out activities of daily living (humans) or nest building (3xTg-AD mice) is related to the neuronal alterations observed in AD. These alterations are controlled by the hippocampus. Post-mortem analyses of the human hippocampus, and the CA1 region in 3xTg-AD mice, show that these areas are associated with alterations in the deposition of Aβ and tau proteins, which start accumulating in the early stages of AD.     

Infarto cerebeloso: pronóstico y complicaciones de sus territorios vasculares

Introduction

Cerebellar infarction (CI) is uncommon, but may result in severe complications. The aim of our study was to determine the characteristics of patients with CI, as well as their outcomes as regards the territories affected.

Patients and methods

Data were collected from 124 patients admitted to our department during a five-year period, with a radiological diagnosis of CI, and with or without involvement of other brain territories.

Results

The mean age in our series was 65.2 years, with most being male (68.5%). The posterior inferior cerebellar artery (PICA) was the most commonly affected territory at 49.2%, followed by superior cerebellar artery (SCA) at 17.7%, and anterior inferior cerebellar artery (AICA) at 10.5%. There was simultaneous supratentorial involvement in 13.7%, and two or three cerebellar arteries involved in 8.9%. The main aetiology in PICA was atherothrombosis (P = .02). On the other hand, cardio-embolism was the main origin in cases with more than one affected territory (P = .04). No particular aetiology could be found in SCA and AICA. There was haemorrhagic transformation in 29 patients (23.4%), particularly in the PICA and when other territories were involved. There was hydrocephalus in 15 patients (12.1%, 12 of them PICA; P = .02) in 2.9 ± 1.5 days from stroke onset. At discharge, the degree of disability was worse if more than one arterial territory was involved (Rankin ≥ 3, 64% versus 31-36%; P = .05). Four (3.2%) patients died.

Conclusions

CI is very heterogeneous. Nevertheless, it is noteworthy that PICA infarction is the most frequent type and its aetiology is usually atherothrombotic. Moreover, it is the territory most frequently associated with severe complications, which take place during the first week of the stroke.     

Comparación de la capacidad diagnóstica precoz de los biomarcadores de la enfermedad de Alzheimer en resonancia magnética cerebral y líquido cefalorraquídeo

Introduction

The goals of this study were to compare the early diagnostic utility of Alzheimer disease biomarkers in the CSF with those in brain MRI in conditions found in our clinical practice, and to ascertain the diagnostic accuracy of both techniques used together.

Methods

Between 2008 and 2009, we included 30 patients with mild cognitive impairment (MCI) who were examined using 1.5 Tesla brain MRI and AD biomarker analysis in CSF. MRI studies were evaluated by 2 radiologists according to the Korf?s visual scale. CSF biomarkers were analysed using INNOTEST reagents for Aβ_1-42, total-tau and phospho-tau_181p. We evaluated clinical changes 2 years after inclusion.

Results

By 2 years after inclusion, 15 of the original 30 patients (50%) had developed AD (NINCDS-ADRA criteria). The predictive utility of AD biomarkers in CSF (RR 2.7; 95% CI, 1.1-6.7; P<.01) was greater than that of MRI (RR 1.5; 95% CI 95%, 0.7-3.4; P<.2); using both techniques together yielded a sensitivity and a negative predictive value of 100%. Normal results on both complementary tests ruled out progression to AD (100%) within 2 years of inclusion.

Conclusions

Our results show that the diagnostic accuracy of biomarkers in CSF is higher than that of biomarkers in MRI. Combined use of both techniques is highly accurate for either early diagnosis or exclusion of AD in patients with MCI.     

24-h residual urine volume at hemodialysis initiation: A possible predictor for acute ischemic stroke incurrence in hemodialyis patients

Background

Residual renal function (RRF) recently has been confirmed to be a significant predictor of morbidity and mortality in hemodialysis (HD) patients. As RRF is not exactly the same with 24-h residual urine volume, the aim of our study is to evaluate the association of residual urine volume with acute ischemic stroke (AIS) among HD patients.

Methods

282 patients starting chronic HD in our center during January 2005 and December 2008 were enrolled. The clinical data at HD initiation and the occurrence of AIS since starting HD were recorded and obtained from our database. According to the prevalence of AIS, we divided 282 patients into the AIS group (n = 69) and non-AIS (n = 213) group.

Results

A total of 69 (24.5%) patients suffered from AIS since HD initiation. Patients with AIS were much older, with more diabetes, had higher levels of hemoglobin, while lower levels of residual urine volume and serum uric acid. In multivariate logistic regression analysis, old age (OR, 1.036; 95% CI, 1.009–1.063; P = 0.008), diabetes (OR, 2.385; 95% CI, 1.074–5.294; P = 0.033) and 24-h residual urine volume < 1290 ml at HD initiation (OR, 2.446; 95% CI, 1.219–4.907; P = 0.012) was significant predictors for future AIS occurrence during HD.

Conclusion

This study indicates that residual urine volume levels at HD initiation are inversely associated with AIS risk in future in chronic HD patients. Besides, aging and diabetes should also be noticed for prevention of AIS.