Nailfold computed videomicroscopy in morpho-functional assessment of diabetic microangiopathy

Summary Although careful measurement of the size of capillary loops is mandatory in the evaluation of diabetic microangiopathy, no current technique allows rapid and careful morphometric analysis of capillaroscopic findings. In an attempt to solve this problem, assembling readily available instruments, the authors have set up an original apparatus for computed videomicroscopy. The apparatus ensures detailed morphological assessment of single loops at high magnification. Each single frame stored on videocassettes can be digitalized for morphometric analysis, saved on floppy disk or printed by means of a graphic printer.     

Mechanical valve prosthesis is a valid option for aortic valve replacement in the elderly

BACKGROUND AND AIM OF THE STUDY: Thromboembolism and hemorrhage related to anticoagulation remain a major concern in elderly patients with mechanical valves. Clinical results following isolated aortic valve replacement (AVR) with tilting disk and bileaflet prostheses in patients aged over 70 years were analyzed and compared with results in patients aged <45 years. METHODS: Between January 1980 and August 2002, 319 consecutive older patients (group A) and 497 young patients AVR. Preoperative clinical data, early and late mortality, valve-related complications and data related to anticoagulation status (including mean INR and mean interval between INR assays) were compared between groups. RESULTS: Hospital mortality was lower in group B (3.4%) than in group A (10.7%; p <0.0001). Twelve-year actuarial survival was lower in older patients (54% in group A versus 78% in group B; p <0.001). The two groups showed similar 12-year actuarial freedom from hemorrhage (99.6% versus 99.5%; p = 0.69), endocarditis (99.6% versus 98.43%; p = 0.25) and perivalvular leak (99.6% versus 97.9%; p = 0.21). However, actuarial freedom from thromboembolism was lower in older patients (98.8% versus 99.7%; p = 0.041). CONCLUSION: Despite lower rates of long-term mortality and thromboembolism (the latter because of advanced atherosclerosis) in group A, there were no differences in rates of other valve-related complications. Hence, older age cannot be considered a contraindication to implantation of mechanical valves in the aortic position.     

Neutropenia as a Complication of Tumefactive Demyelinating Disease: A Case Report

Tumefactive demyelination is an aggressive, localized, generally solitary area of demyelination that often mimics a neoplasm. We present a case of a 13-year-old female patient who presented with sudden-onset progressive hemiplegia and hemianopsia. Magnetic resonance imaging of the brain showed tumefactive demyelination with partial rim of enhancement. During inpatient rehabilitation, she developed myalgias, rash, and abdominal and mouth pain with evidence for severe neutropenia. The neutropenia was determined to be a secondary complication of the tumefactive disease process. This scenario may be concerning in an inpatient rehabilitation setting, as patients share common areas, increasing the risk of acquired infection while neutropenic.

Cross-cultural adaptation to Brazilian Portuguese of the Activity Measure for Post-Acute Care (AM-PAC) short forms for outpatients in rehabilitation

Background

The Activity Measure for Post-Acute Care was developed to evaluate the limitations of activities of adult individuals with different health conditions.

Advanced Practice Registered Nurse–directed Care Coordination Interventions and Outreach After Critical Illness

The purpose of this pilot study was to implement care collaboration measures into a critical care advanced practice. The intervention included an outreach algorithm and a standardized handoff tool during care transition. One hundred eight patients were enrolled; 5 (4%) experienced unplanned readmission. There was no significant association with transition time and the ability to complete the algorithm. Comorbidities of chronic obstructive pulmonary disease (P < .005), a PaO₂ ratio < 200 (P < .003), and pulmonary disease (P < .027) showed increased unplanned readmission within 48 hours of transition. Implementing critical care collaborating measures was not affected by transition time and unit care flow.     

Intraparental Inconsistency: The Influence of Parenting Behaviors on Aggression and Depression in Children

The authors examined several different predictive and mediation models of longitudinal parental inconsistency over a 3‐year time span. They hypothesized that parental behavior (communication/affection, kindness, and positive control) mediated the relationship between parental inconsistency (mother or father) and two emotional problems in children: (a) aggression and (b) depression. Data were obtained from a 3‐wave study (2007, 2008, and 2009) of 523 Spanish families with children ranging from 9–15 years of age at the beginning of Wave 1 (41.3% boys). Structural equation models revealed that multiple dimensions of parenting (mother or father) fully or partially mediated the relationship between longitudinal parental inconsistency and the child's adjustment. Communication/affection and kindness are the main processes through which parental inconsistency affects a child's aggression and depression. These results represent an important contribution to the improvement of parenting models of relationships between parental inconsistency and child adjustment.