Rey-Osterrieth Complex Figure - copy and immediate recall (3 minutes): Normative data for Spanish-speaking pediatric populations

OBJECTIVE

To generate normative data for the Rey-Osterrieth Complex Figure (ROCF) in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the ROCF as part of a larger neuropsychological battery. The ROCF copy and immediate recall (3 minutes) scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models showed main effect for age on copy and immediate recall scores, such that scores increased linearly as a function of age. Age2 affected ROCF copy score for all countries, except Puerto Rico; and ROCF immediate recall scores for all countries, except Chile, Guatemala, Honduras, Paraguay, and Puerto Rico. Models indicated that children whose parent(s) had a MLPE >12 years obtained higher scores compared to children whose parent(s) had a MLPE≤12 years for Chile, Puerto Rico, and Spain in the ROCF copy, and Paraguay and Spain for the ROCF immediate recall. Sex affected ROCF copy and immediate recall score for Chile and Puerto Rico with girls scoring higher than boys.

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate approach to interpret the ROCF Test in pediatric populations.

Symbol Digit Modalities Test: Normative data for Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the Symbol Digit Modalities Test (SDMT) in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the SDMT as part of a larger neuropsychological battery. SDMT scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models showed main effects for age in all countries, such that score increased linearly as a function of age. In addition, age2 had a significant effect in all countries, except in Honduras and Puerto Rico. Models indicated that children whose parent(s) had a MLPE >12 years of education obtained higher score compared to children whose parent(s) had a MLPE ≤12 years for Chile, Guatemala, Mexico, and Spain. Sex affected SDMT score for Paraguay and Spain.

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate interpretation of the SDMT with pediatric populations.

Shortened Version of the Token Test: Normative data for Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the Shortened Version of the Token Test in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the Shortened Version of the Token Test as part of a larger neuropsychological battery. Shortened Version of the Token Test total scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models showed main effects for age in all countries, such that score increased linearly as a function of age. In addition, age2 had a significant effect in all countries, except Guatemala and Puerto Rico. Models showed that children whose parent(s) had a MLPE >12 years obtained higher score compared to children whose parents had a MLPE ≤12 years in Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, Puerto Rico, and Spain. The child's sex did not have an effect in the Shortened Version of the Token Test total score for any of the countries.

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate interpretation of the Shortened Version of the Token Test when used in pediatric populations.

Newly developed Learning and Verbal Memory Test (TAMV-I): Normative data for Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the Learning and Verbal Memory Test (TAMV-I) in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the TAMV-I as part of a larger neuropsychological battery. Free recall, memory delay and recognition scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models indicated main effects for age on all scores, such that scores increased linearly as a function of age. Age2 had a significant effect in all countries except Cuba, and Puerto Rico for free recall score; a significant effect for memory delay score in all countries except Cuba and Puerto Rico; and a significant effect for recognition score in in all countries except Guatemala, Honduras, and Puerto Rico. Models showed an effect for MLPE in Chile (free recall), Honduras (free recall), Mexico (free recall), Puerto Rico (free recall, memory delay, and recognition), and Spain (free recall and memory delay). Sex affected free recall score for Cuba, Ecuador, Guatemala, Mexico, Paraguay, Peru, and Spain, memory delay score for all countries except Chile, Paraguay, and Puerto Rico, and recognition score for Ecuador, Mexico, Peru, and Spain, with girls scoring higher than boys.

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate way to interpret the TAMV-I with pediatric populations.

Stroop Color-Word Interference Test: Normative data for Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the Stroop Word-Color Interference test in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the Stroop Word-Color Interference test as part of a larger neuropsychological battery. The Stroop Word, Stroop Color, Stroop Word-Color, and Stroop Interference scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models showed main effects for age on all scores, except on Stroop Interference for Guatemala, such that scores increased linearly as a function of age. Age2 affected Stroop Word scores for all countries, Stroop Color scores for Ecuador, Mexico, Peru, and Spain; Stroop Word-Color scores for Ecuador, Mexico, and Paraguay; and Stroop Interference scores for Cuba, Guatemala, and Spain. MLPE affected Stroop Word scores for Chile, Mexico, and Puerto Rico; Stroop Color scores for Mexico, Puerto Rico, and Spain; Stroop Word-Color scores for Ecuador, Guatemala, Mexico, Puerto Rico and Spain; and Stroop-Interference scores for Ecuador, Mexico, and Spain. Sex affected Stroop Word scores for Spain, Stroop Color scores for Mexico, and Stroop Interference for Honduras.

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate approach to interpret the Stroop Word-Color Interference test in pediatric populations.

Absence of tobramycin pharmacokinetic and creatinine clearance variation during the menstrual cycle: implied absence of variation in glomerular filtration rate

During the menstrual cycle, a 20% increase in creatinine clearance (CL(CR] has previously been reported between the menstrual (phase 1) and late luteal (phase 4) phases. Tobramycin pharmacokinetics and CL(CR) were studied in eight healthy women with documented, regular, ovulatory menses. During the first and fourth phases of the menstrual cycle (as determined by urinary luteinizing hormone peak and basal body temperature shift), subjects received tobramycin by intravenous bolus. Tobramycin half-life, total body clearance, and volume of distribution were not significantly different between the two study phases. No significant change in total urinary creatinine excretion or CL(CR) was seen between phases. Total 24 hour urinary recovery of tobramycin was 98-99.7%. We conclude that no significant changes in renal function, as evaluated by tobramycin pharmacokinetics and CL(CR), occur between these hormonally different phases of the menstrual cycle, and that urinary recovery of a single dose of tobramycin is nearly complete within 24 hours in premenopausal women with normal renal function.

Amikacin pharmacokinetics during continuous ambulatory peritoneal dialysis

The pharmacokinetics of amikacin were investigated in five stable patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Each patient was studied after the administration of 7.5 mg of amikacin per kg by both the intravenous (i.v.) and intraperitoneal (i.p.) route, allowing a 1-month washout period between doses. No differences in amikacin half-life, volume of distribution, total body clearance, or time-averaged peritoneal clearance were noted between the two routes of administration. After a 5-h dwell period, bioavailability as calculated by the area under the curve for i.p. amikacin was 53 +/- 14.0%. Amikacin pharmacokinetics parallel those of other aminoglycosides in CAPD patients when the drug is administered either i.v. or i.p. Single loading doses of amikacin administered i.v. to uninfected CAPD patients provided therapeutic serum and dialysate levels for many aerobic gram-negative organisms for up to 72 h. Because of the variability of absorption of i.p. administered amikacin, single i.p. doses are not recommended.

Glomerular annular-tubular immune deposits in adult hemolytic uremic syndrome

An 82-year-old female developed hemolytic uremic syndrome (HUS) after a prodromal illness of bloody diarrhea. No specific enteric pathogen was isolated. A renal biopsy performed 5 days after the onset of azotemia revealed typical thrombotic microangiopathy. By electron microscopy, massive annular-tubular deposits admixed with fibrillar fibrin were demonstrated in glomerular capillaries. Immunofluorescent staining of the intracapillary material was positive for IgG, IgM, C3, C1q and fibrin-related antigens. No evidence of plasma cell dyscrasia, cryoglobulinemia or systemic lupus erythematosus was found, and the patient recovered renal function uneventfully in 2 months. Organized immune deposits appear to have played a role in the pathogenesis of HUS in this patient.

Vitamin D toxicity complicating the treatment of senile, postmenopausal, and glucocorticoid-induced osteoporosis. Four case reports and a critical commentary on the use of vitamin D in these disorders

Hypervitaminosis D developed in four patients with osteoporosis or osteomalacia. All patients were given pharmacologic doses of vitamin D, had reduced baseline levels of renal function, and became hypercalcemic with acute renal failure. Measured 25-hydroxyvitamin D (25-OH D) levels were elevated in three patients; levels were not determined in a fourth patient who became normocalcemic when vitamin D therapy was discontinued. Published data on the use of vitamin D for prophylaxis or treatment of any form of osteoporosis fail to document benefits superior to those of calcium alone or calcium with estrogens and fluoride. Data on the use of 25-OH D show no greater benefit than for vitamin D. The use of 1,25-dihydroxyvitamin D (1,25-OH2 D) plus calcium may be superior to the use of calcium alone in some forms of osteoporosis. Vitamin D toxicity is associated with enhanced resorption of bone in some patients. Morbidity included extended hospitalization, dialysis, and chronic renal failure. Pharmacologic doses of vitamin D cannot be recommended for any form of osteoporosis.

Factors affecting aminoglycoside disposition: effects of circadian rhythm and dietary protein intake on gentamicin pharmacokinetics

The effects of dietary protein loading and circadian cycle on the pharmacokinetics of gentamicin were studied in healthy adult men. Ten subjects fasted overnight, and at 8 AM the next morning they received gentamicin, 1.5 mg/kg. Serum and urine samples were obtained over a 6-hour period. In two additional clearance studies with 2-week washout periods in between, 10 subjects were given the same dose of gentamicin at 8 PM in the fasted state and six subjects were also studied in a protein-supplemented (90 gm) state. Pharmacokinetic analysis revealed no significant effect of circadian cycle on gentamicin pharmacokinetic parameters at each of the two fasted periods. In contrast, dietary protein loading resulted in a significant decrease in the elimination t1/2 (P less than 0.05) and an increase in total body clearance compared with the fasted 8 PM study. Urinary excretion of gentamicin was also found to increase significantly (P = 0.03) as a result of protein intake compared with the fasted evening study period. Our study demonstrates the importance of dietary controls in chronopharmacokinetic studies of drugs eliminated predominantly by renal mechanisms.