Effect of melatonin administration on the PER1 and BMAL1 clock genes in patients with Parkinson's disease

Sleep disorders are a widespread condition in patients with Parkinson's disease (PD), which has been linked to a deregulation of the circadian cycle and therefore of the clock genes. The aim of this study was to evaluate the effect of melatonin (MEL) on the PER1 and BMAL1 clock genes in patients with PD. A double-blind, cross-over, placebo-controlled randomized clinical trial pilot study was conducted in 26 patients with stage 1-3 PD according to the Hoehn & Yahr scale, who received either 25 mg of MEL or a placebo at noon and 30 min before bedtime for three months. The relative expression of the PER1 and BMAL1 genes was measured, as well as the presence of daytime, nocturnal, and global sleepiness, and the progression of PD. The levels of the PER1 and BMAL1 genes at baseline were 0.9 (0.1-3) vs. 0.56 (0.1-2.5), respectively; while after the intervention with MEL or placebo the BMAL1 levels increased to 2.5 (0-3.70) vs. 2.2 (0.10-3.30), respectively (d = 0.387). Fifty percent (50 %) of patients had daytime sleepiness and sixty-five percent (65 %) had abnormal nighttime sleepiness, yet neither group showed changes after the intervention. Patients with PD exhibited an alteration in the levels of the clock genes: MEL increased the levels of BMAL1, but the PER1 levels remained unchanged.

[Surgical management and recurrence of congenital preauricular fistula]

In this paper we describe the surgical management and postoperative recurrence of preauricular fistula (PAF) since the surgical treatment is characterized by high recurrence rates. All clinical, operative and postoperative data were collected from a retrospective review of patients's charts who underwent primary surgical management between January 2001 and December 2006 at five Hospitals in Guadalajara, Jalisco. Thirty-eight patients (15 male, 23 female) with PAF underwent 44 surgical procedures. Recurrent acute infection and discharge were the most common symptoms. The surgical management included 25 standard techniques (sinectomy) and 19 supra-auricular approaches. The overall rate of recurrence was 59%, it differed widely between surgical techniques employed. The 52.2% recurrence rate of standard technique was significantly higher than the 6.8% recurrence rate of the supra-auricular approach (p = 0.01). Also, the patients in whom a portion of the cartilage of the helix was not excised from the base of the tract, 84.6% recurred vs. 15.3% when cartilage was excised (p = 0.01). Our experience has shown that independently of clinical presentation of PAF, the standard technique and not to remove a portion of the cartilage at the base of the helix contributed to recurrence. We advise the supra-auricular approach particularly when there are abscess prior to surgery.

[Predictors of use of ante-natal care]

OBJECTIVE

To establish the association and possible interactions between emotional and cognitive factors in pregnant women and their use of institutional antenatal care. It was assumed that the knowledge and attitude of a pregnant woman determines her approach to demanding antenatal care.

DESIGN

Analytic study.

SETTING

Hospitals in the Health Area of Jalisco, Mexico.

PARTICIPANTS

2955 women leaving hospital early who had had at least 2 antenatal consultations.

MAIN MEASUREMENTS

Personal and reproductive characteristics of the women, opportunity and continuity of antenatal care, knowledge of pregnancy and the antenatal care programme, attitudes towards institutional medical care of pregnancy.

RESULTS

In the logistical regression model, 6 associations or interactions between unsatisfactory antenatal care and the variables analysed were found. The strong association of positive attitudes and sufficient knowledge in achieving satisfactory antenatal care was notable, and was even placed above the question of receiving, or otherwise, free medical provision from the health service.

CONCLUSIONS

Undoubtedly, women's educational background plays a major role. This obliges the health services to strengthen their educational programmes by adjusting them to women's culture.

Correlates of cognitive impairment in elderly residents of long term care institutions in the metropolitan area of Guadalajara, Mexico

AIM

To determine the prevalence of cognitive impairment and to examine the correlation between demographic and social factors, the activities of daily living (ADL), and depression with cognitive function in elderly Mexicans living in nursing homes.

DESIGN

Cross-sectional.

SETTING

Fourteen nursing homes in Guadalajara.

PARTICIPANTS

Data were drawn from a random sample of 451 elderly, aged 60-104 years.

MEASUREMENTS

The Spanish versions of MMSE (Folstein), ADL index (Barthel), and the Geriatric Depression Screening (GDS) (Yesavage); demographic factors were obtained.

RESULTS

The prevalence of cognitive impairment was 52.3%, with a cut-off of 19/20 (Bohnstedt). Cognitive impairment was significantly related to gender, educational level, activity participation, pension, ADL, and depression.

CONCLUSION

The results indicate a higher prevalence of cognitive impairment than in other Mexican studies. The data are consistent with previous findings that cognitive impairment in the elderly is more common among females, those with a low level of education, the lack of participation in social/leisure activities, ADL dependencies, and depression.