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BACKGROUND: Patient-reported outcomes (PROs) are outcomes evaluated by patients based on their perception of their disease and treatment. OBJECTIVES: Determine antipsoriatic treatment-related adherence, quality of life (QoL) and satisfaction. MATERIALS AND METHODS: We conducted an observational cross-sectional, prospective, and single-center study in which PROs surveys were conducted on adherence (Morisky-Green [MG] test), treatment satisfaction (Spanish Questionnaire of Treatment Satisfaction in Psoriasis [CESTEP]) and QoL (Skindex-29 and DLQI). Additional variables include: PASI, BSA. STATISTICAL ANALYSIS: Jamovi®2.3.26. RESULTS: A total of 100 surveys were conducted. Based on the MG questionnaire, we found that 75% (75/100) of patients were adherent vs 94% (94/100) from the dispensation records. Regarding CESTEP, a mean score of 7.4±7.7 (close to maximum satisfaction 0) was obtained, while DLQI yielded a score of 2.6±4.6 (indicating a small effect on QoL), and SKINDEX-29 a score of 14.6±15.4 (68% indicating mild (< 5) or very mild (6-17) impact according to Nijsten et al.). Based on CESTEP a p.Rho Spearman value of 0.338 (p=0.004) was obtained in relation to PASI when the study was conducted with a BSA of 0.255 (p=0.050), DLQI results of 0.508 (p <0.001) and Skindex-29 results of 0.397(p <0.001). At the time of the study, the correlation matrix between DLQI result and PASI was 0.365 (p=0.002) with a BSA of 0.347 (p=0.007). Skindex-29 results with PASI were 0.380 (p=0.001) and with BSA, 0.295 (p=0.022). CONCLUSIONS: Patients on therapy exhibit a good QoL, high adherence and satisfaction with their treatment. A significant correlation was seen among satisfaction, QoL, and PASI-BSA at the time of the study.
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Plant-pollinator interactions are constrained by floral traits and available pollinators, both of which can vary across environmental gradients, with consequences for the stability of the interaction. Here, we quantified how the pollination ecology of a high-mountain hummingbird-pollinated plant changes across a progressively more stressful environmental gradient of the Venezuelan Andes. We compared pollination ecology between two populations of this plant: Piedras Blancas (PB) and Gavidia (GV), 4450 and 3600 m asl, respectively. We hypothesised that self-compatibility might be higher at the higher altitude site, however we found that flowers showed similar capacities for self-compatibility in both localities. Seed production by flowers exposed to natural pollinators was significantly higher in the lower locality, where we also found higher nectar quality, larger flowers and increased frequencies of pollinator visitations. Interestingly, the population energy offered in the nectar was the same for both localities due to the higher density and floral aggregation found in the higher altitude population. Our study demonstrates how two plant populations in different environmental conditions have different pollination ecology strategies. Pollinator visitations or their absence result in trait associations in one population that are independent in the other. These population differences are not explained by differences in pollinator assembly, but by environmental heterogeneity.
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PURPOSE OF REVIEW: Renal cell carcinoma presents a unique proclivity for vascular involvement giving rise to a peculiar form of locally advanced disease so-called tumor thrombus. To date, the only curative strategy for these cases remains surgery, which should aim to remove every vestige of macroscopic disease. Most of the preexisting literature advocates opening the vena cava to allow tumor thrombus removal and subsequent venous suture closure. However, inferior vena cava circumferential resection (cavectomy) without caval replacement is possible in the majority of cases since progressive occlusion facilitates the development of a collateral venous network aimed at maintaining cardiac preload. RECENT FINDINGS: Radical nephrectomy with tumor thrombectomy remains a surgical challenge not exempt of operative complications even in experienced hands. In opposition to what traditional cavotomy and thrombus withdrawal can offer, circumferential cavectomy without caval replacement would provide comparable or even better oncologic control, decrease the likelihood of operative bleeding, and prevent the development of perioperative pulmonary embolism. This review focuses on the rationale of circumferential IVC resection without caval replacement and the important technical aspects of this approach in cases of renal cell carcinoma with vascular involvement. We also include an initial report on the surgical outcomes of a contemporary series of patients managed under this approach at our center.
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Carcinoma de Células Renales , Neoplasias Renales , Células Neoplásicas Circulantes , Nefrectomía , Vena Cava Inferior , Humanos , Carcinoma de Células Renales/cirugía , Neoplasias Renales/cirugía , Vena Cava Inferior/cirugía , Nefrectomía/métodos , Trombectomía/métodosRESUMEN
BACKGROUND AND OBJECTIVE: Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS: We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and Embase databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS: We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION: The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.
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Administración Tópica , Hidradenitis Supurativa , Inyecciones Intralesiones , Hidradenitis Supurativa/tratamiento farmacológico , Humanos , Fotoquimioterapia/métodos , Resultado del Tratamiento , Femenino , Ensayos Clínicos Controlados Aleatorios como Asunto , MasculinoRESUMEN
BACKGROUND AND OBJECTIVE: Topical and intralesional (IL) treatments may be considered the first-line therapy in patients with hidradenitis suppurativa (HS); however, the evidence supporting their use is limited. The aim of our review is to evaluate the efficacy and safety profile of topical and IL treatments in patients with HS. MATERIALS AND METHODS: We designed a systematic review of the current medical literature available following the PICO(T) method. And including all types of studies (Study type [T]) of individuals with HS of any sex, age, and ethnicity (Population [P]) who received any topical or IL treatment for HS (Intervention [I]) compared to placebo, other treatments, or no treatment at all (Comparator [C]), and reported efficacy and/or safety outcomes (Outcomes [O]). Two outcomes were defined: quality of life and the no. of patients with, at least, one adverse event. The search was conducted in the Cochrane Library, MEDLINE, and EMBASE databases; study selection was performed based on pre-defined criteria. The risk of bias was determined in each study. RESULTS: We obtained a total of 11,363 references, 31 of which met the inclusion criteria. These studies included 1143 patients with HS, 62% of whom were women. A total of 10, 8, 6, 2, and 5 studies, respectively, evaluated the use of photodynamic therapy (PDT), glucocorticoids, resorcinol, topical antibiotics, and other interventions. Most articles were case series (n=25), with only five randomized clinical trials (RCTs) and one cohort study. RCTs showed improvement in disease activity with topical clindamycin and botulinum toxin (BTX) vs placebo, and PDT with methylene blue (MB) niosomal vs free MB; however, intralesional triamcinolone acetonide was not superior to placebo. The risk of bias was low in three RCTs and high in two RCTs. CONCLUSION: The quality of evidence supporting the use of topical, or IL treatments is low. However, it supports the use of topical clindamycin, PDT, and BTX. Well-designed RCTs with standardized outcomes and homogeneous populations of patients and lesions are needed to support decision-making in the routine clinical practice.
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Administración Tópica , Hidradenitis Supurativa , Inyecciones Intralesiones , Humanos , Hidradenitis Supurativa/tratamiento farmacológico , Fotoquimioterapia/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Resultado del TratamientoRESUMEN
INTRODUCTION: The worldwide pandemic of SARS-Cov2 has had a great impact on the lives of adolescents, affecting their health and well-being. There is little evidence of the emotional impact of the pandemic on adolescents. OBJECTIVE: To explore the knowledge, perceptions, and attitudes of young people regarding COVID-19 and its impact on emotional well-being. METHOD: A cross-sectional observational and descriptive study based on a survey of students aged 16-20 from five high schools in Barcelona metropolitan area. RESULTS: The study was carried out on 291 surveys. Females made up 56.7% of the population. The average age was 16.9 years. A greater lack of knowledge about the transmission of the disease was detected. The most frequently used sources of information were social networks. In terms of emotional distress, the most important aspects were worry about getting sick (64%), family financial problems (46%), anxiety and irritability (27%), and apathy (26.5%). Gender differences were detected in terms of worries (women: 28.8%; men: 11.1%), sadness (women: 29.3%, men: 15.5%), and feelings of fear (women: 24.5%; men: 11%). 16.7% of the participants consulted a mental health professional, with this being more common in women (women: 23.8%; men: 7.4%). CONCLUSIONS: COVID-19 has affected the emotional well-being of adolescents, especially the female population. It is necessary to implement emotional well-being strategies in early childhood to cope with possible stressful situations in daily life and avoid future mental health problems. There is a growing use of social media to combat social isolation. The results of the study hold the potential to strategies aimed at preempting forthcoming biopsychosocial distress.
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COVID-19 , Adolescente , Femenino , Humanos , Masculino , Ansiedad/epidemiología , Estudios Transversales , ARN Viral , SARS-CoV-2 , Adulto JovenRESUMEN
OBJECTIVE: We aimed to investigate the relationship between systemic strengths and complexity in home care of end-of-life patients. METHODS: Quantitative descriptive longitudinal study of patients cared for at home by a palliative care team. Place of death was analyzed in relation to complexity, as determined by the HexCom complexity model after the initial home assessment. We used Pearson's chi-square test to analyze the comparison of proportions. RESULTS: Forty-six hundred patients (74.4% oncologic) with a mean age of 76.2 years (SD 13.2) participated. Fifty-three percent had complete or severe functional dependence, 30.8% were already bedridden in the first assessment, and 59.7% died at home. Strengths influenced place of death, specifically exosystem (team) strength (OR: 4.07 [1.92-8.63]), microsystem (both patient 0.51 [0.28-0.94]) and caregiver (OR: 3.90 [1.48-10.25]), and chronosystem, related to prediction of progressive course (OR: 2.22 [1.37-3.60]). CONCLUSIONS: To improve care for end-of-life patients and their families, a systemic view of dying and death that includes both needs and strengths is necessary. In this sense, the systemic framework proposed by Bonfrenbrenner can be useful for clinical practice.
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Servicios de Atención de Salud a Domicilio , Cuidados Paliativos , Humanos , Anciano , Estudios Longitudinales , Cuidadores , MuerteRESUMEN
INTRODUCTION: The COVID-19 pandemic has caused an unexpected boost to telemedicine. We analyse the impact of the pandemic on telemedicine applied in Spanish headache consultations, review the literature, and issue recommendations for the implementation of telemedicine in consultations. METHOD: The study comprised 3 phases: 1) review of the MEDLINE database since 1958 (first reported experience with telemedicine); 2) Google Forms survey sent to all members of the Spanish Society of Neurology's Headache Study Group (GECSEN); and 3) online consensus of GECSEN experts to issue recommendations for the implementation of telemedicine in Spain. RESULTS: COVID-19 has increased waiting times for face-to-face consultations, increasing the use of all telemedicine modalities: landline telephone (from 75% before April 2020 to 97% after), mobile telephone (from 9% to 27%), e-mail (from 30% to 36%), and video consultation (from 3% to 21%). Neurologists are aware of the need to expand the availability of video consultations, which are clearly growing, and other e-health and m-health tools. CONCLUSIONS: The GECSEN recommends and encourages all neurologists who assist patients with headaches to implement telemedicine resources, with the optimal objective of offering video consultation to patients under 60-65 years of age and telephone calls to older patients, although each case must be considered on an individual basis. Prior approval and advice must be sought from legal and IT services and the centre's management. Most patients with stable headache and/or neuralgia are eligible for telemedicine follow-up, after a first consultation that must always be held in person.
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COVID-19 , Neurología , Telemedicina , Humanos , Pandemias , Cefalea/terapiaRESUMEN
INTRODUCTION: the current literature relates the return to driving with multiple variables. For various reasons, the current data on the time to return to driving after a total hip arthroplasty (THA) are diverse and even contradictory. We have proposed the objective of determining the time required to drive a manual gear vehicle again in a group of patients who underwent primary THA through a posterolateral approach with focus on manual gear cars. MATERIAL AND METHODS: we have studied the functional results of 112 patients who underwent primary THA between January 2019 and January 2020 in a high level in Cadiz, Andalusia, Spain. RESULTS: the median return to driving was three weeks (IQR 2-4). We have identified that 89.3% of the patients were able to drive again before the sixth week after surgery and in 92% of the cases they did so feeling even safer than before the THA. CONCLUSION: we consider that after the sixth week of an THA it is safe to resume driving a vehicle.
INTRODUCCIÓN: la literatura actual relaciona el regreso a la conducción vehicular con múltiples variables. Sin embargo, los datos actuales sobre el tiempo de regreso a la conducción luego de una artroplastía total de cadera (ATC) son diversos e incluso contradictorios. Por lo tanto, nos hemos planteado el objetivo de determinar el tiempo requerido para volver a conducir en un grupo de pacientes sometidos a una ATC primaria mediante un abordaje posterolateral, centrándonos específicamente en vehículos de marcha manual. MATERIAL Y MÉTODOS: hemos estudiado los resultados clínico-funcionales de 112 pacientes sometidos a una ATC primaria entre Enero de 2019 y Enero de 2020 en un hospital de alta complejidad en Cádiz, Andalucía, España. RESULTADOS: la mediana del tiempo de regreso a la conducción fue de tres semanas (RIC 2-4). Hemos identificado que 89.3% de los pacientes pudo volver a conducir antes de la sexta semana posterior a la cirugía. Además, en 92% de los casos, los pacientes se sintieron aún más seguros al conducir después de la ATC que antes de la intervención. CONCLUSIÓN: consideramos que a la sexta semana de una ATC es seguro reanudar la conducción de un vehículo.
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Artroplastia de Reemplazo de Cadera , Conducción de Automóvil , Humanos , Artroplastia de Reemplazo de Cadera/métodosRESUMEN
Distyly has been interpreted as a mechanism that promotes cross-pollination between floral morphs. According to this hypothesis, pollen from anthers positioned at different heights could adhere to different body parts of the pollinator that would correspond to those points where stigmas of compatible morph contact the animal. In this regard, hummingbird species with different bill sizes may play different roles as pollinators of each morph. If pollinators mobilize more legitimate pollen towards one of the two morphs, gender specialization may occur. This work aimed to assess experimentally the role of long- and short-billed hummingbirds as pollinators of short-style (SS) and long-style (LS) flowers of Palicourea demissa, a distylous, hummingbird-pollinated treelet in Venezuelan cloud forests. Flowers were emasculated and exposed to a single visit of the hummingbird Coeligena torquata (long-billed), Heliangelus spencei (short-billed) or Adelomyia melanogenys (short-billed). Later, stigmas were removed, and pollen load counted under a microscope to calculate the probability of legitimate- and illegitimate-pollen transfer by hummingbirds. The probability analyses of pollen transference showed that short-billed hummingbirds have higher pollination probabilities from SS-anthers to LS- and SS-stigmas, and from LS-anther to LS-stigmas than from LS-anther to SS-stigmas. In contrast, long-billed hummingbirds have higher probabilities of pollen transference from LS-anthers to SS-stigmas than in other directions. A deeper view of the sexual expression of each morph in P. demissa will depend on future studies that determine possible morpho-differences in the biological function of male and female floral structures, and the role played by less frequent floral visitors as mediators of legitimate pollination between floral morphs.
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Reproducción , Rubiaceae , Animales , Polinización , Flores , Bosques , AvesRESUMEN
A total of 197 nulliparous rabbits (from three paternal lines) were used to test potential strategies to overcome the consequences on reproduction associated with the selection for high growth rate. The R line was selected for growth rate during the growing period for 37 generations, the RF line was founded through a high selection intensity of elite animals of the R line, and the RFLP line, which was obtained by backcrossing RF animals with the LP line (a long-lived productive maternal line, characterised by high resilience). BW, perirenal fat thickness, fertility, daily feed intake, milk yield and blood metabolites of females were controlled from 1st artificial insemination to 3rd parturition. Litter size, litter weight, individual weight and feed ingestion of kits were controlled from birth to weaning. Our results show that RF females were significantly lighter than R and RFLP females throughout the trial (-5.0%; P < 0.05). Furthermore, RF animals had a higher fertility rate than RFLP females, at first cycle (+10.5 percentage points; P < 0.05). However, RFLP had a higher fertility rate than RF females at second cycle (+21.5 percentage points; P < 0.01). On average, RFLP females had higher perirenal fat thickness than R females at parturition (+3.0%; P < 0.05) and higher daily feed intake than of R and RF females during gestation and late lactation (+9.7 and +8.7%, respectively; P < 0.05). RFLP females produced more milk than R and RF females in the two first lactations (+18.5%; P < 0.001). In the first three parturitions, R females delivered fewer kits born alive (-1.7 kits than RF and RFLP; P < 0.05). In addition, R females' blood had a higher concentration of glutamine and glutamate than RFLP (+24 and +22.7%, respectively; P < 0.05). RFLP litters were heavier than both R and RF litters throughout lactation. However, R kits were heavier at birth than RF and RFLP (+7.9%). Results suggest that the foundation of a paternal line using elite animals could generate females with better early reproductive performance. In addition, backcrossing the RF line with a maternal LP line resulted in a genetic line whose females had a different resource allocation strategy to foster reproduction during the studied period.
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Lactancia , Reproducción , Embarazo , Conejos , Femenino , Animales , Ingestión de Alimentos/genética , Destete , Parto , Tamaño de la Camada/genéticaRESUMEN
BACKGROUND: Patients should get actively involved in the management of their illness. The aim of this study was to assess the influence of lifestyle factors, including sleep, diet, and physical activity, on lithium levels in patients with bipolar disorder. METHODS: A multicenter study was performed. In total, 157 lithium measurements were done biweekly in a sample of 65 patients (35 women) over 6 weeks. Lifestyle, based on total sleep hours and physical activity, was assessed by actigraphy. Diet was evaluated using the Mediterranean Lifestyle Index (Medlife). RESULTS: 35.4% of patients had a normal weight. The mean Medlife score was 14.5 (± 2.5) (moderate-good adherence to Mediterranean diet). BMI, daily dose of lithium and intensity of physical activity had a combined effect on lithium levels, after adjustment for other variables. Patients who practiced intense physical exercise, who took lower doses and had a higher BMI exhibited lower levels of lithium. CONCLUSIONS: Higher physical activity and BMI contribute to lower lithium levels. Patients should be made aware of these relationships to improve their perception of control and self-management. Lifestyle-based interventions contribute to establishing a more personalized medicine.
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PURPOSE: This works comprehensively analyses a modern cohort of patients with ipsilateral hemiparesis (IH) and discusses the pathophysiological theories elaborated to explain this paradoxical neurological sign according to the findings from contemporary neuroimaging and neurophysiological techniques. METHODS: A descriptive analysis of the epidemiological, clinical, neuroradiological, neurophysiological, and outcome data in a series of 102 case reports of IH published on since the introduction of CT/MRI diagnostic methods (years 1977-2021) was performed. RESULTS: IH mostly developed acutely (75.8%) after traumatic brain injury (50%), as a consequence of the encephalic distortions exerted by an intracranial haemorrhage eventually causing contralateral peduncle compression. Sixty-one patients developed a structural lesion involving the contralateral cerebral peduncle (SLCP) demonstrated by modern imaging tools. This SLCP showed certain variability in its morphology and topography, but it seems pathologically consistent with the lesion originally described in 1929 by Kernohan & Woltman. The study of motor evoked potentials was seldom employed for the diagnosis of IH. Most patients underwent surgical decompression, and a 69.1% experienced some improvement of the motor deficit. CONCLUSIONS: Modern diagnostic methods support that most cases in the present series developed IH following the KWNP model. The SLCP is presumably the consequence of either compression or contusion of the cerebral peduncle against the tentorial border, although focal arterial ischemia may also play a contributing role. Some improvement of the motor deficit should be expected even in the presence of a SLCP, provided the axons of the CST were not completely severed.
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Encefalopatías , Pedúnculo Cerebral , Humanos , Encefalopatías/complicaciones , Encéfalo , Imagen por Resonancia Magnética , Paresia/diagnóstico , Paresia/etiologíaRESUMEN
INTRODUCTION: The role of the central and peripheral nervous system in the generation of migraine is not well understood. Our aim was to determine whether peripheral trigeminal nerve stimuli, such as nasopharyngeal swabs, could trigger migraine attacks. SUBJECTS AND METHODS: A survey was sent to 658 doctors, nurses and medical students, asking about the presence of headache suggestive of migraine after carrying out a SARS-CoV-2 swab test, their previous history of migraine, and demographic and headache-related characteristics. Those who tested positive or had associated clinical signs and symptoms of COVID were excluded. RESULTS: A total of 377 people were recruited, 309 of whom were included in the sample. Forty-seven (15.2%) reported headache suggestive of migraine after the swab test and 42 (89.4%) of them had a previous history of migraine. The risk of developing migraine was higher in the subgroup of patients with a history of headache suggestive of migraine - odds ratio: 22.6 (95% confidence interval: 8.597-59.397); p < 0.001. No differences were found between the main characteristics of attacks suggestive of migraine before and after the swab test, except for a lower percentage of associated aura afterwards (42.8% vs. 26.1%; p = 0.016). Individuals with previous attacks suggestive of migraine with a frequency of more than two episodes per month had a higher risk of developing a headache suggestive of migraine after the test - odds ratio = 2.353 (95% confidence interval: 1.077-5.145); p = 0.03. CONCLUSIONS: Nasopharyngeal swabbing may trigger migraine attacks, with a greater likelihood in individuals with a higher frequency of previous migraines. This would confirm the idea that peripheral stimuli on the trigeminal nerve can trigger migraine attacks in individuals with migraine, according to their degree of trigeminovascular sensitisation.
TITLE: Estimulación periférica del nervio trigémino mediante frotis nasofaríngeo como posible desencadenante de migraña.Introducción. La implicación del sistema nervioso central y periférico en la generación de la migraña no se conoce bien. Nuestro objetivo fue determinar si estímulos periféricos sobre el nervio trigémino, como el frotis nasofaríngeo, podrían desencadenar ataques de migraña. Sujetos y métodos. Se envió una encuesta a 658 médicos, enfermeras y estudiantes de medicina, preguntando por la presencia de cefalea sugestiva de migraña tras la realización de un frotis para la determinación del SARS-CoV-2, su historia previa de migraña, y sobre características demográficas y relacionadas con la cefalea. Los que tenían resultado positivo o que asociaban sintomatología de COVID fueron excluidos. Resultados. Se reclutó a 377 personas y se incluyó a 309. Cuarenta y siete (15,2%) refirieron cefalea sugestiva de migraña tras la realización del frotis, de las cuales 42 (89,4%) tenían historia previa de migraña. El riesgo de desarrollarla fue mayor en el subgrupo de pacientes con cefalea sugestiva de migraña previa razón de probabilidad: 22,6 (intervalo de confianza al 95%: 8,597-59,397); p < 0,001. No hubo diferencias entre las características principales de los ataques sugestivos de migraña previos y los desencadenados tras la prueba, excepto un porcentaje menor de aura asociada tras el frotis (42,8% frente a 26,1%; p = 0,016). Los individuos con ataques sugestivos de migraña previos con frecuencia superior a dos episodios mensuales presentaron mayor riesgo de desarrollar una cefalea sugestiva de migraña tras el test razón de probabilidad = 2,353 (intervalo de confianza al 95%: 1,077-5,145); p = 0,03. Conclusiones. El frotis nasofaríngeo podría desencadenar ataques de migraña, más probablemente en individuos con mayor frecuencia de migrañas previas. Esto confirmaría que estímulos periféricos sobre el nervio trigémino pueden desencadenar ataques de migraña en individuos con migraña, de acuerdo con su grado de sensibilización trigeminovascular.
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COVID-19 , Trastornos Migrañosos , Humanos , SARS-CoV-2 , Trastornos Migrañosos/diagnóstico , Trastornos Migrañosos/etiología , Cefalea/etiología , Nervio TrigéminoAsunto(s)
Tuberculosis Extensivamente Resistente a Drogas , Mycobacterium tuberculosis , Tuberculosis Resistente a Múltiples Medicamentos , Humanos , Tuberculosis Extensivamente Resistente a Drogas/tratamiento farmacológico , Diarilquinolinas , Antituberculosos/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológicoRESUMEN
AIMS: Childhood adversities (CAs) predict heightened risks of posttraumatic stress disorder (PTSD) and major depressive episode (MDE) among people exposed to adult traumatic events. Identifying which CAs put individuals at greatest risk for these adverse posttraumatic neuropsychiatric sequelae (APNS) is important for targeting prevention interventions. METHODS: Data came from n = 999 patients ages 18-75 presenting to 29 U.S. emergency departments after a motor vehicle collision (MVC) and followed for 3 months, the amount of time traditionally used to define chronic PTSD, in the Advancing Understanding of Recovery After Trauma (AURORA) study. Six CA types were self-reported at baseline: physical abuse, sexual abuse, emotional abuse, physical neglect, emotional neglect and bullying. Both dichotomous measures of ever experiencing each CA type and numeric measures of exposure frequency were included in the analysis. Risk ratios (RRs) of these CA measures as well as complex interactions among these measures were examined as predictors of APNS 3 months post-MVC. APNS was defined as meeting self-reported criteria for either PTSD based on the PTSD Checklist for DSM-5 and/or MDE based on the PROMIS Depression Short-Form 8b. We controlled for pre-MVC lifetime histories of PTSD and MDE. We also examined mediating effects through peritraumatic symptoms assessed in the emergency department and PTSD and MDE assessed in 2-week and 8-week follow-up surveys. Analyses were carried out with robust Poisson regression models. RESULTS: Most participants (90.9%) reported at least rarely having experienced some CA. Ever experiencing each CA other than emotional neglect was univariably associated with 3-month APNS (RRs = 1.31-1.60). Each CA frequency was also univariably associated with 3-month APNS (RRs = 1.65-2.45). In multivariable models, joint associations of CAs with 3-month APNS were additive, with frequency of emotional abuse (RR = 2.03; 95% CI = 1.43-2.87) and bullying (RR = 1.44; 95% CI = 0.99-2.10) being the strongest predictors. Control variable analyses found that these associations were largely explained by pre-MVC histories of PTSD and MDE. CONCLUSIONS: Although individuals who experience frequent emotional abuse and bullying in childhood have a heightened risk of experiencing APNS after an adult MVC, these associations are largely mediated by prior histories of PTSD and MDE.
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Trastorno Depresivo Mayor , Trastornos por Estrés Postraumático , Adulto , Humanos , Adolescente , Adulto Joven , Persona de Mediana Edad , Anciano , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/diagnóstico , Trastorno Depresivo Mayor/psicología , Depresión/psicología , Encuestas y Cuestionarios , Vehículos a MotorRESUMEN
BACKGROUND: Racial and ethnic groups in the USA differ in the prevalence of posttraumatic stress disorder (PTSD). Recent research however has not observed consistent racial/ethnic differences in posttraumatic stress in the early aftermath of trauma, suggesting that such differences in chronic PTSD rates may be related to differences in recovery over time. METHODS: As part of the multisite, longitudinal AURORA study, we investigated racial/ethnic differences in PTSD and related outcomes within 3 months after trauma. Participants (n = 930) were recruited from emergency departments across the USA and provided periodic (2 weeks, 8 weeks, and 3 months after trauma) self-report assessments of PTSD, depression, dissociation, anxiety, and resilience. Linear models were completed to investigate racial/ethnic differences in posttraumatic dysfunction with subsequent follow-up models assessing potential effects of prior life stressors. RESULTS: Racial/ethnic groups did not differ in symptoms over time; however, Black participants showed reduced posttraumatic depression and anxiety symptoms overall compared to Hispanic participants and White participants. Racial/ethnic differences were not attenuated after accounting for differences in sociodemographic factors. However, racial/ethnic differences in depression and anxiety were no longer significant after accounting for greater prior trauma exposure and childhood emotional abuse in White participants. CONCLUSIONS: The present findings suggest prior differences in previous trauma exposure partially mediate the observed racial/ethnic differences in posttraumatic depression and anxiety symptoms following a recent trauma. Our findings further demonstrate that racial/ethnic groups show similar rates of symptom recovery over time. Future work utilizing longer time-scale data is needed to elucidate potential racial/ethnic differences in long-term symptom trajectories.