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BACKGROUND: Few studies have prospectively evaluated predictors of mortality or decline in functional capacity in nonagenarians. The aim of this study is to determine predictors of death or functional decline in basic activities of daily living in nonagenarians after 2 years of follow-up. METHODS: One hundred and seventy-six nonagenarians were prospectively evaluated. Functional status was determined by the Lawton-Brody index (LI) and the Barthel Index (BI), and cognition by the Spanish version of the Mental State Examination. The Charlson score was used to measure co-morbidity. Nutritional status was evaluated by the short version of the Mini Nutritional Assessment questionnaire. RESULTS: The sample comprised 135 women (76.3%) and 41 men. Mean age was 93 +/- 3.2 years. Mortality after 2 years was 36.3%. Forty-six (41%) of the 112 survivors presented BI losses >19%. One hundred and ten subjects (63%) presented the combined negative outcome item (death or functional decline). A multiple stepwise logistic regression analysis identified two variables associated with a fall of >19% on the BI or death: a low LI (odds ratio 0.785, 95% CI 0.656-0.940) and a low score at baseline on the Spanish version of the Mental State Examination (odds ratio 0.950, 95% CI 0.914-0.987). CONCLUSION: Better cognitive status and higher capacity to perform instrumental activities of daily living (ADL) at baseline are the best predictors to identify which nonagenarians survived without major functional decline after a 2-year follow-up period. [ABSTRACT FROM AUTHOR]

Abstract Background Accurate, high-resolution mapping of aboveground carbon density (ACD, Mg C ha-1) could provide insight into human and environmental controls over ecosystem state and functioning, and could support conservation and climate policy development. However, mapping ACD has proven challenging, particularly in spatially complex regions harboring a mosaic of land use activities, or in remote montane areas that are difficult to access and poorly understood ecologically. Using a combination of field measurements, airborne Light Detection and Ranging (LiDAR) and satellite data, we present the first large-scale, high-resolution estimates of aboveground carbon stocks in Madagascar. Results We found that elevation and the fraction of photosynthetic vegetation (PV) cover, analyzed throughout forests of widely varying structure and condition, account for 27-67% of the spatial variation in ACD. This finding facilitated spatial extrapolation of LiDAR-based carbon estimates to a total of 2,372,680 ha using satellite data. Remote, humid sub-montane forests harbored the highest carbon densities, while ACD was suppressed in dry spiny forests and in montane humid ecosystems, as well as in most lowland areas with heightened human activity. Independent of human activity, aboveground carbon stocks were subject to strong physiographic controls expressed through variation in tropical forest canopy structure measured using airborne LiDAR. Conclusions High-resolution mapping of carbon stocks is possible in remote regions, with or without human activity, and thus carbon monitoring can be brought to highly endangered Malagasy forests as a climate-change mitigation and biological conservation strategy.

Listeriosis in HIV infected patients is uncommon and usually presents as meningitis or bacteraemia. Pleural fluid infections caused by this organism are extremely rare. A case is described of empyema caused by Listeria monocytogenes in an HIV infected patient that was successfully treated with medical treatment only. [ABSTRACT FROM AUTHOR]

Background: Hip fractures are almost always the result of a fall. Causes and circumstances of falls may differ between frail and vigorous patients., Aim: To describe the circumstances of falls causing hip fractures, number of falls during the previous year, and their association with long-term mortality., Patients and Methods: The study is a retrospective review conducted in a tertiary university hospital serving a population of 425,000 inhabitants in Barcelona. All patients admitted with hip fractures with medical records describing the circumstances and number of previous falls were included. The number of falls in the previous 12 months was recorded, including the one causing the fracture. The circumstances of the index fall were dichotomized according to whether it was from the patient's own height or above; day or night; indoors or outdoors, due to intrinsic or extrinsic causes. Cumulative mortality was recorded for almost 5 years after hip fracture., Results: Indoor falls were strongly associated with shorter survival. Falling more than once in the previous year was also a risk factor for long-term mortality (hazard ratio 1.461, p < 0.001 and hazard ratio 1.035, p = 0.008 respectively)., Conclusion: Indoor falls and falling more than once in the previous year are long-term risk factors for mortality after hip fractures. It is always essential to take a careful patient history on admission to determine the number of falls and their circumstances, and special care should be taken to reduce mortality in patients at high risk., (© 2023. The Author(s).)

This article analyses the social perception of human exposure to chemical compounds and discourses and practices regarding bodily boundaries when faced with internal contamination. Based on qualitative and interdisciplinary research carried out in Catalonia, the social meanings attributed to the environmental and food dangers and risks related to chemical compounds that affect human health, and the place that the body takes in the production of these discourses, were explored. In order to do so, between June and November 2011, 43 semi-structured interviews with workers with some awareness of chemical contaminants were carried out, emphasizing how these people (re)interpret the different existing discourses about internal contamination as well as their perceptions regarding the introduction of chemical compounds into the body and the dangers that these substances pose to health.

Background: Skin problems are among the most frequent reasons for seeking medical attention in primary care. In recent years, as a result of the process of adapting medical curricula to the requirements of the European Higher Education Area, the amount of time students spend learning the concepts of dermatology has been reduced in many universities., Material and Methods: In order to reach a consensus on core content for undergraduate education in dermatology, we sent a survey to the 57 members of the instructors' group of the Spanish Academy of Dermatology and Venereology (AEDV), asking their opinions on what objectives should be set for a dermatology course in Spain. A total of 131 previously selected objectives were listed. We then applied the Delphi method to achieve consensus on which ones the respondents considered important or very important (score≥4 on a Likert scale)., Results: Nineteen responses (33%) were received. On the second round of the Delphi process, 68 objectives achieved average scores of at least 4. The respondents emphasized that graduates should understand the structure and functions of the skin and know about bacterial, viral, and fungal skin infections, the most common sexually transmitted diseases (STDs), and the 4 main inflammatory dermatoses. Students should also learn about common complaints, such as itching and bald patches; the management of dermatologic emergencies; purpura and erythema nodosum as signs of internal disease; and the prevention of STDs and skin cancer. During clinical clerkships students should acquire the communication skills they will need to interview patients, write up a patient's medical history, and refer the patient to a specialist., Conclusions: The AEDV's group of instructors have defined their recommendations on the core content that medical faculties should adopt for the undergraduate subject of dermatology in Spain., (Copyright © 2014. Published by Elsevier España, S.L.U.)

Background: Obesity is a growing public health issue. One of the main strategies to prevent it is physical activity., Objectives: To determine if a correlation exists between awareness of the consequences of obesity and physical activity level., Methods: A cross-sectional study performed on a group of 215 students was conducted in 2013 and 2014. Non-health related program students were selected by convenience sampling at a university in Lima, Peru. Their physical activity level was measured using the International Physical Activity Questionnaire (IPAQ), and knowledge about the consequences of obesity was assessed using the Obesity Risk Knowledge-10 scale (ORK-10). Each student was also asked to record the source where they obtained whatever information they knew about the topic., Results: The median age of the participants was 20 (interquartile range of 4; 22-18), and 63% of the participants were female. According to the IPAQ, 53.9% of the participants recorded high levels of physical activity, 35.4% recorded moderate levels, and 10.7%, recorded low levels. While a low correlation between the ORK-10 score and the amount of METs/minute/week spent was found (rs=0.06), it was not significant (p=0.38). We found that people who were informed by the media or by healthcare personnel achieved higher scores on the ORK-10 scale than those who used other sources of information (p<0,05)., Conclusions: There is a very low correlation between the knowledge about the consequences of obesity and a person’s physical activity level. A multidisciplinary approach that includes all determinants of physical activity is necessary in order to attain changes in people’s behavior.

Background: Dystrophic epidermolysis bullosa (DEB) is a rare disease that represents a heavy burden for both the patient and the health care system. There are currently no data on the prevalence of DEB in Spain., Objective: To determine the prevalence of DEB in Spain., Methods: We used data from 3 incomplete population-based sources (hospital dermatology departments, diagnostic laboratories performing antigenic mapping, genetic testing or both, and the Spanish Association of Epidermolysis Bullosa Patients [DEBRA]) and combined them using the 3-source capture-recapture methodology., Results: We identified 152 living DEB patients. The estimated prevalence of DEB was 6.0 cases per million (95% CI, 4.2-11.8) in adults and 15.3 (95% CI, 10.4-40.8) in children under 18 years of age. The data indicated that 77% of the patients were not being followed up in specialized centers of reference; 65% had not had a genetic diagnosis, and 76% were not members of DEBRA., Conclusions: The prevalence of DEB in Spain is 6.0 patients per million (95% CI, 4.2-11.8), a figure higher than previous estimates in many areas, but similar to those found in other southern Europe countries. The north-south difference may represent real geographic differences in prevalence, but it might be due to the fact that most of the data come from registries with a lower than expected catchment. Many patients are not being followed up in centers of reference, do not have genetic diagnosis, and are not members of patients' associations, suggesting that there is room for considerable improvement in their care., (Copyright © 2012 Elsevier España, S.L. and AEDV. All rights reserved.)

Background: Weight is one of the most important parameters in assessing nutritional status. However, weight can be difficult to measure in elderly people who are unable to stand. Chumlea et al. created two equations to estimate weight in non-ambulatory patients using readily available body measurements., Objective: The aim of the study is to analyze the usefulness of Chumlea equations in assessing nutritional status of elderly hospitalized patients., Methods: We measured weight, height, arm and calf circumference, subscapular skinfold and knee height of 82 hospitalized elderly patients, all of whom were able to stand. Estimated weight (EW) was obtained by Chumlea equations. Body mass index (BMI) and Mini Nutritional Assessment test (MNA) were calculated using actual weight and EW. Bland-Altmann analysis and intraclass correlation coefficient (ICC) between real and estimated parameters were assessed., Results: We found a statistically significant ICC between actual weight and EW (r = 0.926), real BMI and estimated BMI (r = 0.910) and real MNA and estimated MNA (r = 0.982) (p < 0.001). Chumlea equations, however, underestimated weight: 54.05 (DS 11.88) vs 61.46 (DS 13.08); BMI: 22.30 (DS 4.61) vs 25.36 (DS 5.17) and MNA: 22.73 (DS 4.43) vs 23.30 (DS 4.33) (P<0.001). In spite of this underestimation, estimated MNA detected 100% of patients malnourished and 96% of those at risk of malnutrition., Conclusions: Results obtained by Chumlea equations showed a good ICC with actual body weight and real BMI and MNA, but values were underestimated. These equations can be useful to detect undernourished hospitalized elderly patients., (Copyright © AULA MEDICA EDICIONES 2013. Published by AULA MEDICA. All rights reserved.)

Background and Objectives: Dermatitis herpetiformis is a chronic bullous disease that is currently considered a cutaneous expression of gluten hypersensitivity. The aim of this study was to analyze and describe the clinical, histological, and immunopathological characteristics of patients with dermatitis herpetiformis assessed at Hospital Clinic de Barcelona, Spain between 1995 and 2010., Material and Methods: Demographic, clinical, serologic, and histopathological data were reviewed for 33 patients with dermatitis herpetiformis., Results: The median age of the patients at the time of disease onset was 30 years and the majority were men. Associated autoimmune disease was present in 49% of patients. In 6 patients, celiac disease was diagnosed before dermatitis herpetiformis. Although excoriations were the most predominant lesions, 9 patients had blisters. Histological findings in skin lesions were compatible with dermatitis herpetiformis in 46% of cases. The most frequently observed staining pattern by indirect immunofluorescence was the presence of granular immunoglobulin A deposits in the basement membrane (62%). More than 80% of intestinal biopsies were compatible with celiac disease. Antibodies linked to gluten sensitivity were observed in 79% of patients. Only 1 malignant tumor was detected., Conclusions: Notable findings were the frequent presence of bullous lesions, the high prevalence of celiac disease, and the positive findings on intestinal biopsy, all of which are suggestive of late diagnosis. Our findings confirm the lack of specificity of conventional histology in dermatitis herpetiformis and the association of the disease with other immunological disorders., (Copyright © 2010 Elsevier España, S.L. y AEDV. All rights reserved.)

Introduction: Depressive symptoms in health sciences students are common, these might be potentially detrimental., Objectives: To determine the prevalence of depressive symptoms and its associated factors in students from the Health Sciences Faculty of the Universidad Peruana de Ciencias Aplicadas in Lima (Peru), June 2010., Materials and Methods: Cross-sectional analytic study; a pre-consented survey was applied to the population 590/869 students. Zung's abbreviated scale was used to measure depressive symptoms. To evaluate de associated factors, logistic regression was used, p<0.05 was considered statistically significant., Results: The mean age was 18.97 ± 2.45 years and 71.1% were women, 19.6% were migrants and 62.5% were medical students. The prevalence of depressive symptoms was 31.2% in the whole population and in medical students was 33.6%. Depressive symptoms were not associated in bivariate analysis with sex, career, having failed a course, living alone or being a migrant (p>0.05). In the multivariate analysis, significant statistical association was found between depressive symptoms and dissatisfaction with the own academic performance (OR=2.13 CI95%1.47-3.08), dissatisfaction with the current economic status (OR=1.93 CI95%1.24-2.99) and living with a relative external to the nuclear family (OR=1.62 CI95%1.07-2.45)., Conclusion: A high prevalence of depressive symptoms was found, especially in medical students; being dissatisfaction with academic performance, economic status and living with a relative external to the nuclear family associated factors that could be taken into account in order to build preventive programs.

Background and Aims: Few studies have prospectively evaluated predictors of mortality in nonagenarian cohorts. Our objective was to determine a set of predictors of all-cause mortality in a cohort of nonagenarians after one year of follow-up., Methods: 186 nonagenarians were evaluated prospectively, 137 of whom lived in their own homes (74%) and 49 (26%) were institutionalized. Functional status was determined by the Lawton-Brody (LI) and Barthel Index (BI), and cognition by the Spanish version of the Mini Mental State Examination (MEC). The Charlson score was used to measure global comorbidity. Nutritional status was evaluated by the short version of the Mini Nutritional Assessment questionnaire (short- MNA)., Results: The sample was composed of 143 women (76.5%) and 43 men, with a mean age of 93.06 (3.1) years. The rate of mortality was 19.3%. There were no differences in mortality between men and women. Although the BI and LI were both related to 1-year mortality in bivariate, unadjusted analysis, their contribution was minimal in multivariate analyses. Age, heart failure and short-MNA remained associated with mortality in the multivariate analyses., Conclusions: This study supported the importance of age, heart failure and nutritional status in predicting 1- year mortality in nonagenarians.

Background and Aims: Malnutrition in general and protein deficiency in particular, both upon admission and during the recovery period, may adversely influence the clinical outcome after hip fracture. This study investigates the relationship between nutritional status measured by the Mini-Nutritional Assessment short form (MNA-SF) and biological markers in elderly hip-fractured patients., Methods: A prospective study in a university hospital. The MNA-SF nutritional scale and laboratory values (serum albumin, cholesterol, total lymphocyte count) were assessed within three days after hip fracture surgery., Results: Seventy-three patients were included: 61 (84%) were women and 12 men. Mean age was 81.5+/-7.1 years. Inhospital mortality was 10%. The mean MNA-SF score was 11+/-0.5 (range 3-14); according to these values, 39 patients (53%) were at risk of malnutrition. MNA-SF scores were not significantly correlated to patients' laboratory values. Fourteen episodes of nosocomial infection were diagnosed in 11 patients, and 6 patients developed pressure ulcers during hospitalization., Conclusions: MNA-SF test scale values reflect a clinical process in post-operative hip-fractured patients which is different from serum albumin, cholesterol or lymphocyte count.

CT and MR findings in two patients with hepatoerythropoietic porphyria are presented. CT scans showed atrophy and cortical mineralization at the same level. MR examination performed in one of the two patients showed mainly frontal cortical atrophy and punctate bright signal on T1- and T2-weighted sequences.

Epidermal blister formation is the hallmark of three cutaneous autoimmune diseases: pemphigus foliaceous (PF), pemphigus vulgaris (PV) and bullous pemphigoid (BP). In PF and PV, blistering is due to acantholysis (cell-cell detachment) in the subcorneal and suprabasal epidermal layers, respectively, while BP is characterized by detachment of the basal epidermal cells from the underlying dermis. For several years, we have focused our research efforts on elucidating the pathogenic mechanisms operating in these bullous diseases. Early studies performed by our research group and others revealed that in all three diseases, the patients produce autoantibodies that bind to target antigens located on the surface of cells that are undergoing detachment. Thus it was hypothesized that these anti-epidermal autoantibodies played a role in initiating blister formation. We recognized that elucidating the normal mechanisms of epidermal cell-cell and cell-dermis adhesion would help us understand the abnormal epidermal cell detachment seen in these patients. We hypothesized that under normal conditions these adhesive mechanisms in the epidermis are complex and dynamic and mediated by the interaction of cell surface molecules unique to each layer of the epidermis. Also, we postulated that PV, PF and BP autoantibodies may cause cell detachment by impairing the function of their respective epidermal cell surfaces. Support for this hypothesis has come from recent studies which showed that PV and PF autoantibodies recognize distinct, yet related, desmosomal glycoproteins in the cadherin family of calcium-dependent adhesion molecules. The epidermal antigen in PV is desmoglein-3 (dsg3), while in PF it is desmoglein-1 (dsg1). These anti-epidermal autoantibodies have been shown to be pathogenic in passive transfer experiments. Neonatal mice injected with these antibodies develop intraepidermal blisters characteristic of the corresponding human disease. Autoantibodies in BP react with BP180 and BP230, two major components of the hemidesmosome, a cell structure involved in dermal-epidermal adhesion. Recent passive transfer mouse model studies performed in our laboratory have shown that anti-BP180 antibodies can induce subepidermal blistering in the experimental animals. Moreover, the pathogenic mechanism was shown to be dependent on complement activation and recruitment of neutrophils to the dermal-epidermal junction. In conclusion, desmosomal glycoproteins are the targets of autoimmune injury in PV and PF. The anti-epidermal autoantibodies may cause intraepidermal blisters by impairing the function of dsg1 and dsg3. In BP the hemidesmosome is the target. It appears that antiBP180 antibodies cause subepidermal blister formation by triggering a complement- and neutrophil-mediated inflammatory process.

Objective: To investigate the consensus among one group of experts regarding the substitution percentage which is possible to obtain with the surgical procedures that are capable of being made by day surgery., Method: A Delphi method was designed to know the opinions of some experts selected from different specialities (Anaesthesia, General surgery, Ophthalmology, Orthopaedic surgery and Gynecology) and according with the criteria of their speciality. A questionnaire was designed with 45 procedures which could be performed through day surgery, and 2 rounds of answers were required., Results: Opinion results got percentages for 45 different surgical procedures. Variability was high, except in Gynecology and other pathologies as adenopathies, correction of hammer toe, olecranon bursa excision, or carpal tunnel descompression. The common trend among experts was not very high, it was depending on specialities. In Gynecology (ANOVA F 4.2 p = 0.001), General surgery (ANOVA F 4.9 p = 0.001). In Ophthalmology any change of opinion was almost detected., Conclusion: The substitution percentages observed are high in the major part of procedures. A notable variability exists between experts when defining the substitution percentage. The consensus rate obtained with the Delphi method has not been high.

Chronic inflammation seems to play a major role in skin and muscle cell damage in dermatomyositis. Adhesion molecules and their ligands are fundamental in regulating inflammation. We have carried out an immunohistochemical analysis of different activation-inducible adhesion markers in 15 biopsy specimens from dermatomyositis skin lesions. Consistent findings were the increased expression of intercellular adhesion molecule-1 (ICAM-1) on endothelial cells, inflammatory cells and focally grouped keratinocytes in contact with subepidermal inflammatory infiltrates. Immunoreactivity for vascular cell adhesion molecule-1 (VCAM-1) was predominant on endothelial cells of the upper reticular dermis and dermal stellate-shaped cells. E-selectin (endothelial leukocyte adhesion molecule-1) immunoreactivity was less extensive, detected mostly on segments of vessels of the papillary dermis and upper reticular dermis, and sometimes independent of inflammation. This pattern of adhesion molecule expression is similar to that described in other immunemediated dermatoses. The up-regulation of the adhesion molecules appears to play a role in the development and perpetuation of dermatomyositis skin lesions.

A case of POEMS syndrome and Castleman's multicentric disease is reported. Multiple long-standing cutaneous lesions, histologically similar to histiocytomas, were the initial manifestation of POEMS syndrome. A high incidence of angiomatous lesions associated with POEMS syndrome has already been established. To our knowledge, this report is the first report to associate multiple angioproliferative lesions mimicking generalized histiocytomas with POEMS syndrome.

Two of three patients with erythropoietic protoporphyria showed pigment deposits with typical red porphyrin fluorescence on liver biopsy specimens. Birefringence of this pigment by polarized light is due to its crystalline nature, as demonstrated by electron microscopy. There was slight portal inflammation in these cases. A liver biopsy specimen from a third patient was normal.