Relation Between Chronic Obstructive Pulmonary Disease and Antibiotics

Chronic obstructive pulmonary disease (COPD) constitutes a major health problem. Recurrent acute exacerbations are characteristic of the course of COPD (AECOPD) associated with significant healthcare costs and contribute to the progress of the disease. Given that almost half of AECOPD is caused by bacteria, administration of antibacterial agents is recommended for patients with severe exacerbations or severe underlying COPD. Optimal antibiotic selection for exacerbations has therefore incorporated quantifying the risk for a poor outcome of the exacerbation and choosing antibiotics differently for low risk and high risk patients. It is unclear whether antibiotics should be provided as prophylactic agents in COPD patients although ongoing trials are reexamining the question of whether the antiinflammatory action of antibiotics such as macrolides can be useful in preventing exacerbations. In addition, nowadays, the occurrence of pneumonia in COPD has received considerable recent attention as it appears to be increased by the use of inhaled corticosteroids.     

Memoria,fluidez y orientación: prueba de cribado de deterioro cognitivo en 5 minutos

Background

The prevalence of cognitive impairment (CI) will double in the next 20 years, making early detection a key priority.

Objectives

Validation of a 5-minute CI screening test.

Methods

Adults aged 60 and older were recruited from memory clinics and the community at large in the Santiago, Chile metropolitan area. Based on clinical examination they were categorised as No CI (NCI), Mild CI (MCI) and dementia sufferers (DS). We measured the validity of a new test, MEFO, evaluating memory (5 points), phonetic verbal fluency (2 points) and orientation (6 points) by comparing its results with those from the MMSE.

Results

We evaluated 214 subjects, comprising 49 with dementia, 47 with MCI, and 118 with no CI. The MEFO differentiated between all 3 groups whereas the MMSE did not discriminate between the MCI and NCI groups. The area under the ROC curve (AUC) for the MEFO distinguishing NCI subjects from dementia sufferers was 0.97; for NCI vs CI (dementia + MCI), 0.89; and for NCI vs MCI, 0.80. On the MMSE these values were 0.95, 0.84, and 0.73, respectively. A cut-off score of 6/7 on the MEFO identified dementia sufferers with a sensitivity of 86% and a specificity of 96%. A cut-off score of 8/9 distinguished CI from NCI subjects with a sensitivity of 83% and a specificity of 75%.

Conclusions

The MEFO is a valid and reliable test for discriminating between dementia and CI sufferers and subjects with no CI. Its validity is similar to that the MMSE under these conditions, but it is more effective for identifying subjects with MCI and its administration time is shorter.     

Vessel wall enhancement in herpes simplex virus central nervous system vasculitis

Infection is a well-known cause of cerebral vasculopathy and vasculitis. We report a 36-year-old woman with cerebral vasculitis and ischemic stroke secondary to herpes simplex virus (HSV). MRI studies revealed a pontine stroke with basilar artery stenosis and vessel wall gadolinium enhancement. This case demonstrates the ability of HSV to cause a focal brainstem vasculitis and the utility of enhanced MRI in the diagnosis of stroke related to HSV central nervous system vasculitis.     

Frontotemporoparietal asymmetry and lack of illness awareness in schizophrenia

Introduction: Lack of illness awareness or anosognosia occurs in both schizophrenia and right hemisphere lesions due to stroke, dementia, and traumatic brain injury. In the latter conditions, anosognosia is thought to arise from unilateral hemispheric dysfunction or interhemispheric disequilibrium, which provides an anatomical model for exploring illness unawareness in other neuropsychiatric disorders, such as schizophrenia. Methods: Both voxel‐based morphometry using Diffeomorphic Anatomical Registration through Exponentiated Lie Algebra (DARTEL) and a deformation‐based morphology analysis of hemispheric asymmetry were performed on 52 treated schizophrenia subjects, exploring the relationship between illness awareness and gray matter volume. Analyses included age, gender, and total intracranial volume as covariates. Results: Hemispheric asymmetry analyses revealed illness unawareness was significantly associated with right < left hemisphere volumes in the anteroinferior temporal lobe (t = 4.83, P = 0.051) using DARTEL, and the dorsolateral prefrontal cortex (t = 5.80, P = 0.003) and parietal lobe (t = 4.3, P = 0.050) using the deformation‐based approach. Trend level associations were identified in the right medial prefrontal cortex (t = 4.49, P = 0.127) using DARTEL. Lack of illness awareness was also strongly associated with reduced total white matter volume (r = 0.401, P < 0.01) and illness severity (r = 0.559, P < 0.01). Conclusion: These results suggest a relationship between anosognosia and hemispheric asymmetry in schizophrenia, supporting previous volume‐based MRI studies in schizophrenia that found a relationship between illness unawareness and reduced right hemisphere gray matter volume. Functional imaging studies are required to examine the neural mechanisms contributing to these structural observations. Hum Brain Mapp, 2013. © 2012 Wiley Periodicals, Inc.     

Fibronectin. Structure and functions associated to hemostasis. Review

Fibronectin is an adhesive glycoprotein present in a soluble form in plasma and in an insoluble form in the extracellular matrix of many tissues. The human plasma level of this protein is about 300 +/- 100 microg/mL. It is synthesized and secreted by a wide variety of cells, consequently is one of the components of greater distribution in the body that participates in the biochemical reactions of diverse physiological and pathological processes. Due to the presence of multifunctional domains in its structure, fibronectin interacts with diverse components of the coagulation and fibrinolysis. It may bind to collagen, fibrinogen, fibrin, heparin, factor XIII and platelets, among others, regulating processes of importance in hemostasis such as: platelet adhesion and aggregation, tissue remodelling during wound healing, and activation of fibrinolysis by the plasminogen activators.     

A comparison of jaw dimensional and quality assessments of bone characteristics with cone-beam CT, spiral tomography, and multi-slice spiral CT

PURPOSE: For proper preoperative planning of oral implants, the need has increased for tomographic imaging for precise determination of anatomic dimensions. However, concern for radiation exposure, which is substantial with computerized tomography (CT), has also grown. In the present study, the validity of jawbone width assessment and delineation by means of cone-beam CT (CBCT) and spiral tomography on dry mandibles was compared. Secondly, the subjective image quality of CBCT images with those obtained by multi-slice spiral CT (MSCT) of a fixed ex vivo cadaver with its soft tissues was compared. MATERIALS AND METHODS: The study included 25 dry human mandibles for the dimensional study and 1 formalized maxilla for image quality assessment. Measurements of the mandibles by means of a digital sliding caliper acted as the gold standard. Radiographic examination of the premolar and canine regions was performed with both CBCT and spiral tomography. Observational measurements were carried out by postgraduates in oral imaging. Subjective image quality was assessed on the fixed maxilla, including soft tissues, by comparing CBCT and MSCT. Inter- and intraobserver variability were determined. RESULTS: Direct mandibular measurements were on average 0.23 mm (SD 0.49) and 0.34 mm (SD 0.90) larger than the CBCT and spiral tomography measurements, respectively. Subjective image quality of the CBCT was significantly better than for the MSCT with regard to visualization and delineation of the lamina dura and periodontal ligament space. Subjective image quality of the MSCT was significantly better for the MSCT than the CBCT for the gingiva and cortical bone. CONCLUSIONS: These results indicate that on dry mandibles, jawbone width measurements by means of CBCT and spiral tomography are reliable, even if on average they slightly underestimate the bone width. For the subjective image quality, the CBCT offered better visualization of details of the small bony structures. Spiral tomography offered better visualization of the cortical bone and the gingiva.