Influence of education on the neuropsychological assessment of the elderly: application and analysis of the results from the Mattis Dementia Rating Scale (MDRS)

OBJECTIVE: To assess the influence of low education and illiteracy on the evaluation of dementia by the Mattis Dementia Rating Scale (MDRS). METHOD: We applied the MDRS to 62 normal elderly subjects (64-77 years), divided into five groups according to schooling, i.e., 15-16 years, 11-12 years, 8-9 years, 4 years, and illiterate. The MDRS covers the study of five subscales and the sum of their scores may represent the degree of cognitive impairment. RESULTS: A significant difference (p < 0.05) in performance on this scale was observed among the subgroups in relation to education on 12 items, 5 subscales (illiterates < all other groups and 15-16 years > 4 and 8 years of schooling, p < or = 0.001) and the total MDRS score (illiterates < all others and 4 and 8 years < 15-16 years, p < 0.001). No significant correlations where found for age and, regarding gender, the differences were significant in only one item. CONCLUSION: Education interfered with individual performance on the MDRS. Illiteracy is a determinant factor of lower MDRS scores that could generate diagnostic errors.     

Southwick's head-shaft angles: normal standards and abnormal values observed in obesity and in patients with epiphysiolysis

Southwick's angles measured in the anteroposterior and Lauenstein frog-leg views have been used for planning surgical treatment of deformities caused by slipped capital femoral epiphysis (SCFE). Clinically established epiphysiolysis is associated with a decrease in anteroposterior angles and an increase in Lauenstein angles. Obesity is one of the factors involved in the development of SCFE, but its influence in Southwick's angles has not been previously described. Additionally, few reports describe normal values adjusted for sex and bone age. In this study, we determined Southwick's angles in normal control participants (n=70), in patients with obesity (n=31) and in patients with epiphysiolysis (n=33). The intra-observer variations were 1.7 and 23.3% for the anteroposterior and Lauenstein angles, respectively. No significant differences were detected in the control group when these individuals were compared according to sex or chronological age. Obese patients showed a significant increase in the anterposterior angle when compared with control individuals. The hip with epiphysiolysis presented a significant reduction in the anteroposterior angle and an increase in the Lauenstein angle, when the same was compared with the contralateral hip or with the control values. In patients with unilateral SCFE the Lauenstein angle of the normal hip was detected as increased, which was possibly related to the obesity associated with decreased insulin resistance presented by these patients. We conclude that the detection of risk for developing SCFE should include an expanded clinical and radiological profile characterized by pubertal males who present obesity associated with insulin resistance and an increase in Southwick's anteroposterior angle.     

Computed tomographic volumetric analysis as a predictor of local control in laryngeal cancers treated with conventional radiotherapy

BACKGROUND: There is still controversy regarding the appropriate management of large T2 and T3 laryngeal cancers, with some investigators finding little correlation between the current TNM staging system and tumour control following external beam radiotherapy. OBJECTIVE: To establish the utility of computed tomography (CT)-determined tumour volume as a predictor of local control of moderately advanced (T2 and T3) squamous cell carcinoma of the larynx. MATERIALS AND METHODS: A retrospective chart review and CT volumetric analysis were performed on 47 patients who were treated for T2 or T3 laryngeal squamous cell carcinoma with radiotherapy alone at the London Regional Cancer Centre between 1995 and 2000. Of these 47 patients, there were 30 with glottic tumours and 17 with supraglottic tumours. Forty-two males and five females were included in the analysis, with ages ranging from 40 to 84 years. Each patient's CT scan was redigitized, and the tumours were outlined by the chief investigator and by a head and neck radiologist using anatomy modelling software. Patient demographics, tumour characteristics, and tumour stage were analyzed, with local failure rates described and related to the variables through univariate and multivariate analyses. RESULTS: Tumour size ranged from 0.15 to 16.64 cm3, with a mean volume of 3.5 cm3. The local recurrence rate in this group of patients was 40% (19/47). Local control was correlated on multivariate analysis to tumour size for all patients combined (> 3 cm3 vs < 3 cm3; p = .003) and for glottic tumours alone (> 1 cm3 vs < 1 cm3; p = .001). A correlation was also demonstrated on multivariate analysis between local control and overall stage (p = .023), patient age (p = .029), and hypopharyngeal involvement (p = .032). CONCLUSIONS: There is a significant and independent relationship between CT-determined tumour volume and local recurrence in moderately advanced squamous cell carcinoma of the larynx treated with conventional radiotherapy. Based on these results and those of similar studies, CT should therefore become a routine part of the staging system for T2 tumours and above.     

Waist-hip ratio and waist circumference associated with body mass index in a study with schoolchildren

The objectives of this study were to determine the percentile levels of the anthropometric indices body mass index (BMI), waist-hip ratio (WHR), and waist circumference (WC) and to verify possible correlations among theses indices in schoolchildren registered at the State Institute of Education, Florianópolis, Santa Catarina State, Brazil. A total of 419 children ages 7 to 9 years were investigated: 215 (51.3%) boys and 204 (48.7%) girls. BMI, WHR, and WC were higher for boys than for girls. However, the differences were only statistically significant for WHR and WC. Prevalence rates were 17.9% for overweight and 6.7% for obesity. The anthropometric indices with the highest correlation were BMI and WC (r = 0.87 and p < 0.01). For overweight, BMI and WC also presented the strongest correlation (r = 0.74). For obesity, WHR and WC showed the best correlation (r = 0.54).     

Karyotypic analysis in species of the genus Dasyprocta (Rodentia: Dasyproctidae) found in Brazilian Amazon

A total of 30 animals of the genus Dasyprocta were cytogenetically studied. They belong to the following species: D. prymnolopha (N=20), D. leporina (N=6), D. fuliginosa (N=1) and Dasyprocta sp. (N=3) (Dasyproctidae, Hystricognathi). Cell suspensions were obtained by peripheral blood culture, besides bone marrow and spleen cells, from D. prymnolopha and D. leporina. The diploid number was 64/65 for all samples. The karyotypes showed similarity, and chromosomal polymorphism was not detected by Giemsa conventional staining and G banding. The constitutive heterochromatin distribution at the pericentromeric region of all the chromosomes was similar in all species. D. prymnolopha, D. leporina and Dasyprocta sp. presented variation in the heterochromatical block size at one of the homologues of the A18 pair. D. fuliginosa presented the heterochromatin uniformly distributed in all chromosomes. There was not variation in the NORs pattern in the species studied.     

Recurrent syncope and Chiari malformation

Downward herniation of the cerebellar tonsils through the foramen magnum (Chiari I malformation) is usually revealed by head and neck pain, often associated with brain-stem or spinal cord disturbances. Syncopes are rarely reported and may be difficult to link to their cause when they occur alone. We report two cases with brief and repetitive syncopes revealing a Chiari I malformation. These manifestations may be attributed to transient compression of brain stem or vascular structures at the craniocervical junction, triggered by intracranial pressure increase, as they disappear after posterior fossa decompression.     

Influence of maternal schistosomiasis on the immunity of adult offspring mice

Schistosoma mansoni infection modulates the immunity to unrelated antigens in the host. In this study, we have investigated the effect of pregnancy and nursing from schistosomotic mother mice on the immune response to ovalbumin (OA), in adult offspring. Then, newborn mice were divided into four groups: animals born from infected mothers (BIM) suckled by non-infected mothers; animals from non-infected mothers suckled by infected mothers (SIM); and two other groups that were mice born and suckled in infected mothers (BSIM) or non-infected (control) mothers. The adult offspring were immunized with OA plus adjuvant. We compared the OA-specific hypersensitivity reactions (HR), antibodies levels (IgG, IgG2a) and the cytokine production in splenocyte cultures. Remarkable interleukin (IL)-10 synthesis was observed in mice BIM; while the anti-OA antibodies levels and immediate HR were impaired. IL-10 neutralization recovered this suppression. Differently, in mice SIM and BSIM there was an enhancement in the anti-OA humoral response and high IL-2 production, however low level of the IL-10 was detected in mice BSIM. In conclusion, schistosomotic pregnancy provides an immunosuppressive potential, IL-10 dependent, which was sustained throughout adult life. Regardless, suckling by infected mothers induces great responsiveness to an unrelated antigen and repairs the inhibitory potential acquired during prenatal stage.