Verbal fluency tests: Normative data for the Latin American Spanish speaking adult population

OBJECTIVE

To generate normative data for the Verbal Fluency Tests across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate.

METHOD

The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the Verbal Fluency Test as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms.

RESULTS

The final multiple linear regression models for the letter F explained 8-30% of the variance, 7-32% for letter A, 8-32% for the letter S, and 16-43% for the animal category in Verbal Fluency Test scores. Although t-tests showed significant differences between men and women on the Verbal Fluency Test, they did not have an effect size larger than 0.3. As a result, gender-adjusted norms were not generated.

CONCLUSIONS

This is the first normative multicenter study conducted in Latin America aiming to create norms for the Verbal Fluency Test; this study will have important outcomes for the future of neuropsychology in the region.

Stroop Color-Word Interference Test: Normative data for the Latin American Spanish speaking adult population

OBJECTIVE

To generate normative data on the Stroop Test across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate.

METHOD

The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the Stroop Test, as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms.

RESULTS

The final multiple linear regression models explained 14-36% of the variance in Stroop Word scores, 12-41% of the variance in the Stoop Color, 14-36% of the variance in the Stroop Word-Color scores, and 4-15% of variance in Stroop Interference scores. Although t-tests showed significant differences between men and women on the Stroop test, none of the countries had an effect size larger than 0.3. As a result, gender-adjusted norms were not generated.

CONCLUSIONS

This is the first normative multicenter study conducted in Latin America to create norms for the Stoop Test in a Spanish-Speaking sample. This study will therefore have important implications for the future of neuropsychology research and practice throughout the region.

Symbol Digit Modalities Test: Normative data for the Latin American Spanish speaking adult population

OBJECTIVE

To generate normative data on the Symbol Digit Modalities Test (SDMT) across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate.

METHOD

The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the SDMT as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms.

RESULTS

The final multiple linear regression models explained 29-56% of the variance in SDMT scores. Although there were gender differences on the SDMT in Mexico, Honduras, Paraguay, and Guatemala, none of the four countries had an effect size greater than 0.3. As a result, gender-adjusted norms were not generated.

CONCLUSIONS

This is the first normative multicenter study conducted in Latin America to create norms for the SDMT; this study will have an impact on the future practice of neuropsychology throughout the global region.

Hopkins Verbal Learning Test- Revised: Normative data for the Latin American Spanish speaking adult population

OBJECTIVE

To generate normative data on the Hopkins Verbal Learning Test- Revised (HVLT-R) across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate.

METHOD

The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the HVLT-R as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms.

RESULTS

The final multiple linear regression models explained 17- 45% of the variance in HVLT-R scores. Although t-tests showed significant differences between men and women in Guatemala on the HVLT-R, it was a small effect size. As a result, gender-adjusted norms were not generated.

CONCLUSIONS

The results from this study will have a substantial impact on the practice of neuropsychology in Latin America, as this is the first normative multicenter study to develop norms for the HVLT-R in this region.

Rey-Osterrieth Complex Figure - copy and immediate recall: Normative data for the Latin American Spanish speaking adult population

OBJECTIVE

To generate normative data on the Rey-Osterrieth Complex Figure Test (ROCF) across 11 countries in Latin America, with country-specific adjustments for gender, age, and education, where appropriate.

METHOD

The sample consisted of 3,977 healthy adults who were recruited from Argentina, Bolivia, Chile, Cuba, El Salvador, Guatemala, Honduras, Mexico, Paraguay, Peru, and, Puerto Rico. Each subject was administered the ROCF as part of a larger neuropsychological battery. A standardized five-step statistical procedure was used to generate the norms.

RESULTS

The final multiple linear regression models explained 7-34% of the variance in ROCF copy scores and 21-41% of the variance in immediate recall scores. Although t-tests showed significant differences between men and women on ROCF copy and immediate recall scores, none of the countries had an effect size larger than 0.3. As a result, gender-adjusted norms were not generated.

CONCLUSIONS

The present study is the first to create norms for the ROCF in Latin America. As a result, this study will have important implications for the formation and practice of neuropsychology in this region.

Prevalence and risk factors for gallstone disease

Gallstone disease is a main public health problem. The overall prevalence data range from 3.9% in the pre-echographic era to 13.7% when ultrasonography was used as a diagnostic tool. This study is aimed to determine the prevalence of gallstone disease in a medium income level population in Lima, as well as the relationship with some risk factors: age, sex, familiar history and obesity. A total of 534 adult men and women from a medium economic level underwent ultrasonographic examination of abdomen for detection of gallstone disease (July 2003). The echographic evaluation was performed by 10 general surgeons trained in ultrasonography. Likewise, 4 risk factors--age, gender, familial history, and obesity--were analyzed. Pearson chi2 test (2-sided) was used with a probability of <0.05 for statistical significance and logistic regression analyses for assessment of confounding factors. The prevalence founded was 15%. Eighty-one of 534 participants had lithiasis. Compared to the age group under 30, the odds ratio for the 31 to 50 years and >50 years of age group was 0.9 and 1.1, respectively. The female-male ratio was 1.07 and the odds ratio 0.8. The prevalence of gallstone disease in people reporting a first-degree relative with lithiasis was 21%, whereas in participants without such a condition, it was 13%. On the other hand, a familial history was present in 38% of the lithiasis group and in 25% of the nonlithiasis group. The odds ratio for familial history was 1.8 (P = 0.01, 95% confidence interval 1.1-2.9). The prevalence of the disease for body mass index <24, 25 to 29, and higher than 30 was 17%, 14% and 13%, respectively. Compared to the reference group (body mass index <24), the other 2 groups (body mass index 25-29 and >30) both had a similar odds ratio, 0.8. Logistic regression analyses showed an odds ratio of 1.9 for familiar history (95% confidence interval 1.1-3.2), whereas the odds ratio of the overweight (body mass index 25-29) and obese group (body mass index >30) when compared to the normal group, BMI <24, was 0.7 and 0.9, respectively. The prevalence data for gallstone disease remain slightly higher than those previously reported. Although the familiar history was the only characteristic with a statistically significant positive relationship with lithiasis, additional studies are needed because few biases could not be completely avoided and some confounding factors were not controlled.

Characterization of Neisseria gonorrhoeae strains isolated from patients with conjunctivitis

The conjunctivitis produced by Neisseria gonorrhoeae is the less frequently reported clinical form of gonococcal infection. We aim to phenotypically characterize N. gonorrhoeae isolated from conjunctivae sites. A total of six cases of this disease were notified in the Camagüey province, Cuba. All the strains isolated were penicillin-producing, showed the serogroup WI and exhibited the same antimicrobial susceptibility pattern and plasmid profile (2.6-3. 2-24.5). The results contribute to the characterization of N. gonorrhoeae strains circulating in our environment.

Tuberculosis prevention questionnaire: common practices among pulmonary medicine and infectious disease specialists in Puerto Rico

A survey about tuberculosis infection status, surveillance and protection practices among pulmonologists and infectologists was performed.A fourteen-item questionnaire was mailed. The survey was addressed to 108 pulmonologists and 61 infectologists. Responses were collected from 35 pulmonologists (32%) and 18 infectologists (29%). Sixteen out 35 pulmonologists had a positive tuberculin test (TST) (46%). Nine of fourteen took at least 6 months of preventive therapy with isoniazid when converted. Three out of eighteen infectologists had a positive TST. 63% of the pulmonologists and 38% of the infectologists evaluate their TST every 12 months. 40% of the pulmonologists and 66% of the infectologists answered that they treat more than ten patients with tuberculosis annually. Interestingly, 50% of the responder bronchoscopists use surgical masks instead of recommended HEPA filter masks. 73% of the responders reported not having negative pressure rooms when performing procedures. Despite stamped-addressed envelopes and the relation of these professionals with the related issue, low participation was observed.Among the responders a low frequency of TST was observed, especially in those exposed to higher-risk procedures. Non-adequate facilities and lack of use of protective equipment was reported. Even though not representative of the entire medical community the results of this survey are concerning regarding educational and safety policies of our professionals and institutions.

Always remember chylothorax

Chylothorax is a rare cause of pleural effusion in association with cardiovascular surgery. A 68-year-old man had a coronary artery bypass graft; 10 days after surgery, he had progressive shortness of breath and a massive left pleural effusion. After chylothorax was diagnosed, it was successfully treated with a thoracostomy tube and total parenteral nutrition. The patient had an uneventful recovery. Nutrition is the most important issue in the treatment of chylothorax. Once chylothorax is identified, nutritional support is the priority, since it will have an important role in the recovery of the patient. Besides our case, we hereby present a short review of the literature regarding the diagnosis and management of this rare entity.

Asthma knowledge among internal medicine residents

OBJECTIVES

To assess the medical knowledge about asthma among residents from the Accreditation Council on Graduate Education (ACGME) accredited Internal Medicine programs.

BACKGROUND

Asthma prevalence and morbidity has increased significantly in the last 20 years. Recent morbidity data suggests that approximately 14 to 15 million Americans suffer from asthma and 5,000 of them die annually due to this illness. Previous studies have suggested that Puerto Ricans are disproportionally affected by asthma. In order to impact both morbidity and mortality relates to asthma, primary care givers should be knowledgeable about the disease.

METHODS

Based in the 1993 National Heart, Lung and Blood Institute (NHLBI) guidelines, a questionnaire was developed to evaluate the knowledge of asthma in physicians in the Internal Medicine Residency Programs. It consisted of 27 questions covering the areas of diagnosis and treatment of asthma.

RESULTS

The questionnaire was answered by 90% of the 138 residents active at the moment of the study. Fifty-one percent of the residents failed to obtain a score of 70% or greater. Score on asthma diagnosis was less than 70% and did not improve through year of training. Score obtained on asthma treatment improved through training year although no statistical difference was obtained.

CONCLUSIONS

In view of these results it is imperative to reinforce the state of the art asthma education of physicians. Research initiatives must evaluate educational strategies to improve asthma education.

Occult aspiration of a chicken wishbone as a cause of hemoptysis

Aspiration of foreign bodies is more common in children than adults. The clinical and radiological findings between these two age groups are different. It is a clinical diagnosis often overlooked in adults. We hereby present an elderly male patient who was referred to us due to a one year history of hemoptysis. He was heavy smoker, so the initial working diagnosis was malignancy. Upon bronchoscopic evaluation, a foreign object was found which is very uncommon in adults. The unusual location of the aspirated material is another interesting feature of our case. Clinicians should be aware that aspiration of foreign objects may occur also in adults.

Risk factors for treatment-related death in elderly patients with aggressive non-Hodgkin's lymphoma: results of a multivariate analysis

PURPOSE

It has been suggested that age is associated with chemotherapy-related death in patients with non-Hodgkin's lymphoma (NHL) treated with doxorubicin-containing chemotherapy. The purpose of this study was to evaluate the relative influence of increasing age and other clinical parameters on the occurrence of treatment-related death in elderly patients with intermediate- or high-grade NHL treated with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy.

METHODS

A retrospective study of patients 60 years of age or older with intermediate- or high-grade NHL treated with CHOP chemotherapy in a single cancer center. The following variables were recorded: age (60 to 69, 70 to 79, and 80 to 94 years), histology (Working Formulation [WF] D, E, F, G, and H), Ann Arbor stage, B symptoms, extranodal involvement, bulky disease (> 7 cm), performance status (Eastern Cooperative Oncology Group [ECOG] scale), International Prognostic Index (IPI score), serum lactate dehydrogenase (LDH) level and doxorubicin relative dose-intensity (RDI). The relationship between these features and treatment-related death was assessed in univariate and multivariate logistic regression analysis.

RESULTS

From 1982 to 1991, 267 consecutive patients were treated. Median age was 70 years (range, 60 to 94 years). There were 35 toxic deaths. Sixty-three percent of the deaths occurred after the first cycle. Infection accounted for 82% of the toxic deaths. In the univariate analysis, the features associated with an increased risk of toxic death were ECOG performance status 2 to 4 (relative risk [RR], 7.82), B symptoms (RR, 3.38), diffuse large-cell histology (RR, 3.06), bulky disease (RR, 2.58), serum levels of LDH (RR, 2.53), and IPI score (RR, 2.46). The age groups did not show significance. In the regression model, performance status 2 to 4 was the only independent predictor of treatment-related death (RR, 3.52; 95% confidence interval [CI], 2.98 to 4.06).

CONCLUSION

Our results show that in elderly patients with NHL treated with doxorubicin-based chemotherapy the risk for treatment-related death is associated with poor performance status rather than with increasing chronologic age.

[Lipoprotein in children and adolescents: relationship with family history of coronary artery disease]

BACKGROUND

Lipoprotein (a) is considered an independent cardiovascular risk factor.

AIM

To study lipoprotein (a) levels in children of 18 years old or less with or without family history of coronary artery disease.

SUBJECTS AND METHODS

Forty four children aged between 3 and 18 years old with a family history of coronary artery disease and 44 age and sex matched controls were studied. A fasting blood sample was obtained to measure total, HDL and LDL cholesterol, triglycerides, A1 and B apoproteins and lipoprotein (a).

RESULTS

Compared to controls, children with a family history of coronary disease had higher total cholesterol (177 +/- 35 and 159 +/- 23 mg/dl respectively), LDL cholesterol (112 +/- 34 and 94 +/- 21 mg/dl respectively), triglycerides (89 +/- 38 and 71 +/- 25 mg/dl respectively), apoprotein B (85 +/- 17 and 65 +/- 13 mg/dl respectively) and lipoprotein (a) (40 +/- 50 and 22 +/- 31 mg/dl respectively). Thirty two percent of children with positive family history had lipoprotein (a) levels over 30 mg/dl, compared to 23% of controls.

CONCLUSIONS

Children with family history of coronary artery disease have higher levels of cholesterol, triglycerides and lipoprotein (a) than matched controls.

Mutation analysis of glucose-6-phosphate dehydrogenase (G6PD) variants in Costa Rica

Glucose-6-phosphate dehydrogenase (G6PD) deficiency has previously been reported among both the black and white populations of Costa Rica. All 28 G6PD A- samples were found to be of the common G6PD A-376G/202A type. A previously described mutation associated with nonspherocytic hemolytic anemia, G6PD Puerto Limón, was found to be due to a G----A transition at nucleotide (nt) 1192, causing a glu----lys substitution. Mutations in this region of the G6PD molecule seem invariably to be associated with chronic hemolytic anemia. G6PD Santamaria had been described previously in two unrelated white subjects. We found that both did, indeed, have the same mutations. In this variant the A----G substitution at nt 376 that is characteristic of G6PD A was present, but an A----T mutation at nt 542, apparently superimposed on the ancient G6PD A mutation, resulted in an asp----val substitution. Thus, the gain of a negative charge at amino acid 126 was counterbalanced by the loss of a charge at amino acid 181, giving rise to a variant with the G6PD A mutation but with normal electrophoretic mobility.

[Risk factors of cardiovascular disease in a Chilean school population: I: Blood lipids in 552 children and adolescents 6-15 years of age]

The distribution of serum cholesterol (TC), low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL)-cholesterol and triglycerides (TG), and the prevalence of risk-considered values were studied in school children from Concepción, Chile (6 to 15 years old; 326 boys, 226 girls). The mean TC levels were 146 mg/dl for boys and 154 mg/dl for girls but 9.1% of the sampled children had TC values between 175 and 190 mg/dl, and 10% were over 190 mg/dl. Mean LDL-C was 83 mg/dl in boys and 89 mg/dl in girls; 6% of samples showed values between 130 and 159 mg/dl, and 1.3% over 160 mg/dl. Mean HDL-C was 46 mg/dl for boys and 48 mg/dl for girls. The mean TG values were 80 mg/dl for boys and 93 mg/dl for girls.

[Hereditary persistence of fetal Hb and its association with Hb S. 1st case found in Costa Rica]

An electrophoretic pattern of Hb S + Hb F, the relative concentration of this last being 37%, was found in a phenotypically mestizo 3 year-old child of Costa Rica. The genotype of the child was G gamma/A gamma, with a ratio of 1:1. Both hereditary alterations were disperse, according to the family study performed, which showed Hb S plus hereditary persistence of foetal haemoglobin of the African type G gamma A gamma (delta beta o). This case is briefly discussed, along with the molecular heterogeneity of HPFH and the importance of the differential diagnosis of electrophoretic patterns found in Hb S + Hb F patients.