Prevalence of subjective memory complaints (SMC) in elderly community dwellers (ECD) ranges from 25 to 50%. Some controversy exists over the association between SMC and cognitive status.ObjectiveWe investigated whether a correlation in cognitive performance existed between two different groups according to SMC.MethodsThe Mini Mental State Examination (MMSE) and Dementia Rating Scale-Mattis (DRS-Mattis) were applied to two groups: ECD (n=14) with SMC and residents (n=14) of a long-term care facility (LTCF) without SMC.ResultsThe median age in the ECD group was 81.0 years, and in the LTCF group was 75.0 years. There was a statistically significant difference (p=0.048) between these groups regarding age. Concerning schooling (1-8 or ≥9 years), there was no statistically significant difference between the groups (p=0.638). No statistically significant difference between the two groups was found for scores on the cognitive tests.ConclusionSMC might be related to extrinsic factors other than insipient cognitive decline.

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Objective: To describe a norovirus outbreak in a Brazilian longterm care facility from July 8 to 29, 2005. Methods: In the first 48 to 72 hours after onset of symptoms in inpatients and employees, the main infection control strategies were staff education, emphasis on hand washing, implementing contact precautions up to 48-72 hours after resolution of symptoms, complete cleaning of the rooms and exclusion of symptomatic employees from work until 48-72 hours after resolution of their symptoms. Epidemiological and clinical characteristics of the norovirus infections were described based on chart review. results: The incidence among inpatients and employees was 41.3% and 16.25%, respectively. The main symptom was diarrhea, affecting 100% of inpatients and employees. Forty-four percent of specimens were positive by RIDASCREEN ® Norovirus analyses, and identified as norovirus genogroup GII. Seventy percent of inpatients were women and their age range was 51-98 years. Inpatients had in average two comorbid conditions -87.3% with cardiovascular or chronic pulmonary condition and 47.6% with dementia. There was not relapse or death. conclusions: The early infection-control measures associated to surveillance are required to keep long-term care facilities free of noroviruses and to protect those who are most vulnerable. Keywords

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OBJETIVO: Avaliar a sensibilidade e a especificidade diagnósticas, e a concordância da Escala de Avaliação de Demência, com diagnóstico clínico de comprometimento cognitivo, e compará-las com as do Miniexame do Estado Mental. MÉTODOS: Oitenta e seis idosos de uma instituição de longa permanência foram convidados a participar do estudo e, destes, 58 concordaram em fazê-lo. A avaliação continha Miniexame do Estado Mental e Escala de Avaliação de Demência. O diagnóstico clínico de comprometimento cognitivo foi realizado por especialistas que utilizaram os critérios do DSM-IV. Escores da Escala de Avaliação de Demência e do Miniexame do Estado Mental foram correlacionados e suas sensibilidade e especificidade, obtidas. RESULTADOS: Vinte e dois (37,9%) idosos tinham comprometimento cognitivo (8,6% apresentaram comprometimento cognitivo leve e 29,3% demência). O Miniexame do Estado Mental e a Escala de Avaliação de Demência classificaram 31% e 55,2% como apresentando comprometimento cognitivo. Os escores da Escala de Avaliação de Demência e do Miniexame do Estado Mental tiveram uma forte correlação. A Escala de Avaliação de Demência teve uma sensibilidade maior do que o Miniexame do Estado Mental (86,4% versus 61,9%) e a especificidade foi menor (63,9% versus 86,5%). A concordância diagnóstica da Escala de Avaliação de Demência e do Miniexame do Estado Mental com a o diagnóstico clínico foi similar. CONCLUSÃO: A Escala de Avaliação de Demência mostrou uma sensibilidade maior na detecção de comprometimento cognitivo na população estudada e poderia ser um instrumento útil para aplicação em instituições de longa permanência.

Objectives: In the treatment of acute myocardial infarction (MI), the time delay to achieve reperfusion of the infarction-related artery has been linked to survival rates. Primary or direct angioplasty has been found to be an excellent means of achieving reperfusion in acute ST-elevation MI compared to thrombolytic therapy in randomized trials. However, no mortality benefit of primary angioplasty over thrombolysis was observed in several registries, in which delays in performing primary angioplasty were longer. Our objectives were to evaluate the door-to-balloon time (DBT) in our institution and investigate its relationship with clinical and prognostic variables. Methods:We studied, retrospectively, 67 patients submitted to primary angioplasty, from January 1999 to November 2000. We divided our patient population into two groups. Group A (GA) included patients with DBT less than 120 min and group B (GB) patients with DBT greater or equal to 120 min. We evaluated several clinical variables, such as left ventricular ejection fraction (LVEF) on their first echocardiogram during hospitalization, admission Killip classification, in-hospital length of stay (LOS) and major cardiovascular events (MACE) during hospitalization and up to 6-month follow-up (in 23 patients). Results:The median DBT was 132 min and the mean was 165 min, with a standard deviation of 137 min for all the cases. We had 32 patients in the GA and 35 patients (52%) in the GB. We observed four in-hospital deaths, all in GB. The mean LVEF was 53.1 ± 9% in GA and 46.1 ± 13% in GB (P = 0.059). Admission Killip class greater than 1 was noted in three patients of each group. The in-hospital LOS was similar for both groups (GA = 8.35 ± 4 and GB = 8.33 ± 4 days; NS). In-hospital events occurred in eight patients of GA (25%) and seven patients of GB (20%; NS). Only five follow-up events occurred during the first 6 months, three events in GA patients and two in GB patients (NS). Conclusion:DBT greater than or equal to 2 h are common and in our population it occurred in more than half of the primary angioplasties. Greater than 2 h DBTs were associated with a trend to larger left ventricular dysfunction early after MI. Monitoring and measures to reduce DBT are crucial for the potential prognosis improvement offered by primary angioplasty and for the broadening of its use in the management of acute MI. P2Primary angioplasty versus streptokinase in elderly patients with acute myocardial infarction PF Leite, M Park, VS Kawabata, MS Barduco, S Timerman, LF Cardoso, JAF Ramires Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil Because only a few studies about acute myocardial infarction (AMI) include elderly patients, we compared outcomes of patients aged 70 years or older with AMI who underwent thrombolysis or primary angioplasty treatment. Methods:From April 1995 to June 1999, 64 patients within 12 h of symptom onset and no contraindications for thrombolytic therapy were randomized in two groups. Group I (32 patients, 20 men) sub...

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Background At 28th February 2020, local public health authorities were notified that an occupational activity center headed to adult individuals with disabilities, in Guimarães (Portugal), had several cases of users vomiting or with diarrhea during that week, requesting control measures. Methods An outbreak investigation was carried out, with case definition being someone with nausea, vomiting and/or diarrhea. An epidemic curve was made with the number of cases per date of symptoms onset. Attack rate was calculated as the number of cases in the occupational activity center divided by the number of people in the same center. Results Mild, self-limited acute symptoms of nausea, vomiting and/or diarrhea were identified in 18 individuals that attended the occupational activity center. The first case developed symptoms on 24th February (day 0); the second case appeared about 24 hours after; the peak occurred at day 4 with seven cases. Attack rate was 27% among users and 15% among monitors. The mean age was 40 years. Two cases went to the emergency department and were clinically diagnosed with acute viral gastroenteritis, no further care needed. Meals were served at a neighbor building, shared with another rehabilitation institution. The rehabilitation institution reported zero cases. Additionally, Hazard Analysis and Critical Control Point process was fully accomplished. Conclusions Clinical and epidemiological findings suggest a probable viral outbreak with person-to-person transmission. The incubation period is consistent with norovirus, the most common agent of viral gastroenteritis. No biological samples were collected, because symptoms were mild and there was no chance to do it. Environmental samples were not collected. Preventive hygiene measures were immediatly enhanced, namely hand washing, appropriate disinfection of contaminated surfaces and isolation if symptomatic. These measures are highly efficient breaking the chain of infection and that was obtained. Key messages Epidemiological findings are at the core of an outbreak investigation and support immediate implemention of effective control measures. Although laboratory results are important, they are not always available for outbreak investigation.