Cognitive screening test in primary care: cut points for low education

OBJECTIVE

To establish the diagnostic accuracy of the Brazilian version of the General Practitioner Assessment of Cognition (GPCOG-Br) compared to the Mini-Mental State Examination (MMSE) in individuals with low educational level.

METHODS

Ninety-three patients (≥ 60 years old) from Brazilian primary care units provided sociodemographic, cognitive, and functional data. Receiver operating characteristics, areas under the curve (AUC) and logistic regressions were conducted.

RESULTS

Sixty-eight patients with 0-4 years of education. Cases (n = 44) were older (p = 0.006) and performed worse than controls (n = 49) on all cognitive or functional measures (p < 0.001). The GPCOG-Br demonstrated similar diagnostic accuracy to the MMSE (AUC = 0.90 and 0.91, respectively) and similar positive and negative predictive values (PPV/NPV, respectively: 0.79/0.86 for GPCOG-Br and 0.79/0.81 for MMSE). Adjusted cut-points displayed high sensitivity (all 86%) and satisfactory specificity (65%-80%). Lower educational level predicted lower cognitive performance.

CONCLUSIONS

The GPCOG-Br is clinically well-suited for use in primary care.

New aspects of the reaction of silver(I) cations with the ethylenediaminetetraacetate ion

The highly neutralized ethylenediaminetetraacetate (EDTA) titrant (95-99% as Y(4-) anion) precipitates with Ag(+) cations to form the Ag(4)Y species, in aqueous medium, which is well characterized from conductometric titration, thermal analysis and potentiometric titration of the silver content of the solid. The precipitate dissolves in excess Y(4-) to form a complex, AgY(3-). Equilibrium studies at 25 degrees C and ionic strength 0.50 M (NaNO(3)) have shown from solubility and potentiometric measurements that the formation constant (95% confidence level) beta(1) = (1.93 +/- 0.07) x 10(5) M(-1) and the solubility products are K(S0) = [Ag +](4)[Y(4-)] = (9.0 +/- 0.4) x 10(-18) M(5) and K(S1) = [Ag +](3)[AgY(3-)] = (1.74 +/- 0.08) x 10(-12)M(4). The presence of Na(+), rather than ionic strength, markedly affects the equilibrium; the data at ionic strength 0.10 M are: beta(1) = (1.19 +/- 0.03) x 10(6) M(-1), K(S0) = (1.6 +/- 0.4) x 10(-19) M(5) and K(S1) = (1.9 +/- 0.5) x 10(-13) M(4); at ionic strength tending to zero; beta(1) = (1.82 +/- 0.05) x 10(7) M(-1), K(S0) = (2.6 +/- 0.8) x 10(-22) M(5) and K(S1) = (5 +/- 1) x 10(-15) M(4). The intrinsic solubility is 2.03 mM silver (I) in 0.50 M NaNO(3). Well-defined potentiometric titration curves can be taken in the range 1-2 mM with the Ag indicator electrode. Thermal analysis revealed from differential scanning calorimetry a sharp exothermic peak at 142 degrees C; thermal gravimetry/differential thermal gravimetry has shown mass loss due to silver formation and a brown residue, a water-soluble polymeric acid (decomposition range 135-157 degrees C), tending to pure silver at 600 degrees C, consistent with the original Ag(4)Y salt.

Genital-type human papillomavirus infection is not associated with surface epithelial ovarian carcinoma

Tumor tissues from 29 women with borderline or malignant epithelial ovarian tumors were examined for the presence of human papillomavirus (HPV) DNA by the polymerase chain reaction (PCR). The PCR analysis used a set of consensus primers that are complementary to highly conserved sequences in the genital HPVs (M. M. Manos, Y. Ting, D. K. Wright, A. J. Lewis, T. R. Broker, and S. M. Wolinsky, Cancer Cells 7, 209-214, 1989). Amplification products were detected by Southern hybridization with consensus oligonucleotide probes. A total of 70 paraffin-embedded tissue sections from ovarian carcinomas were tested and we did not detect genital-type HPV DNA sequences in any of these specimens. However, all of the tissue specimens were considered adequate for PCR analysis because a human cellular gene (beta-globin) was successfully amplified in each tissue specimen. In addition, HPV 16 DNA was found in a concurrent invasive squamous-cell carcinoma of the cervix from one ovarian cancer patient, indicating that the PCR was able to detect HPV in the lower genital tract of this individual. We conclude that there is no association between infection with the most common genital HPVs and borderline and malignant epithelial ovarian tumors.