From Immunity to Neurogenesis: Toll-like Receptors as Versatile Regulators in the Nervous System.

Toll-like receptors (TLRs) are among the main components of the innate immune system. They can detect conserved structures in microorganisms and molecules associated with stress and cellular damage. TLRs are expressed in resident immune cells and both neurons and glial cells of the nervous system. Increasing evidence is emerging on the participation of TLRs not only in the immune response but also in processes of the nervous system, such as neurogenesis and cognition. Below, we present a review of the literature that evaluates the expression and role of TLRs in processes such as neurodevelopment, behavior, cognition, infection, neuroinflammation, and neurodegeneration.

Analytical and functional profiles of paralytic shellfish toxins extracted from Semele proficua and Senilia senilis from Angola.

Paralytic shellfish poisoning is a foodborne illness that typically derive from the consumption of shellfish contaminated with saxitoxin-group of toxins produced by dinoflagellates of the genus Gymnodinium, Alexandrium and Pyrodinium. N-sulfocarbamoyl, carbamate and dicarbamoyl are the most abundant. In 2007 and 2008 some episodes of PSP occurred in Angola where there is not monitoring program for shellfish contamination with marine biotoxins. Therefore, ten samples extracted from Semele proficua from Luanda Bay and Senilia senilis from Mussulo Bay, were analyzed by HPLC finding saxitoxin, decarbamoylsaxitoxin and other three compounds that have an unusual profile different to the known hydrophilic PSP toxins were found in different amounts and combinations. These new compounds were not autofluorescent, and they presented much stronger response after peroxide oxidation than after periodate oxidation. The compounds appear as peaks eluted at 2.5 and 5.6 min after periodate oxidation and 8.2 min after peroxide oxidation. Electrophysiological studies revealed that none of the three unknown compounds had effect at cellular level by decreasing the maximum peak inward sodium currents by blocking voltage-gated sodium channels. Thus, not contributing to PSP intoxication. The presence in all samples of saxitoxin-group compounds poses a risk to human health and remarks the need to further explore the presence of new compounds that contaminate seafood, investigating their activity and developing monitoring programs.

Dye-Perfused Human Placenta for Simulation in a Microsurgery Laboratory for Plastic Surgeons.

In recent decades, a number of simulation models for microsurgical training have been published. The human placenta has received extensive validation in microneurosurgery and is a useful instrument to facilitate learning in microvascular repair techniques as an alternative to using live animals. This study uses a straightforward, step-by-step procedure for instructing the creation of simulators with dynamic flow to characterize the placental vascular tree and assess its relevance for plastic surgery departments. Measurements of the placental vasculature and morphological characterization of 18 placentas were made. After the model was used in a basic microsurgery training laboratory session, a survey was given to nine plastic surgery residents, two microsurgeons, and one hand surgeon. In all divisions, venous diameters were larger than arterial diameters, with minimum diameters of 0.8 and 0.6 mm, respectively. The majority of the participants considered that the model faithfully reproduces a real microsurgical scenario; the consistency of the vessels and their dissection are similar in in vivo tissue. Furthermore, all the participants considered that this model could improve their surgical technique and would propose it for microsurgical training. As some of the model's disadvantages, an abundantly thick adventitia, a thin tunica media, and higher adherence to the underlying tissue were identified. The color-perfused placenta is an excellent tool for microsurgical training in plastic surgery. It can faithfully reproduce a microsurgical scenario, offering an abundance of vasculature with varying sizes similar to tissue in vivo, enhancing technical proficiency, and lowering patient error.

The First Latin American Consensus on Superficial and Perforating Venous Mapping.

With the aim of obtaining a map which is useful as a diagnostic tool and therapeutical orientation, complementing the written report of duplex ultrasound venous study, Latin-American Scientific Societies of Phlebology, Vascular Surgery and Vascular Imaging were invited to participate, through their regional representatives, to the First Consensus of Superficial and Perforating Venous Mapping. A consensus process using a modified Delphi method was carried out. An International Working Group was formed, which developed a Prototype of the Venous Mapping that worked as a starting point for consensus, and was presented in a first virtual meeting of 54 experts (societies' representatives) when the methodology was explained. For the consensus process, two rounds of self-administrated questionnaires with feedback were used. In the first questionnaire a 100% consensus was obtained in the 15 statements (an agreement range of 85.2% to 100%) In the analysis of qualitative data, three categories according to the actions to implement were identified - actions which involved no action, minor changes and major changes. This analysis was used to build the second questionnaire, which reached a consensus in its six statements (agreement range of 87.1% to 98.1%). A final consensus on every field proposed was established with the approval of all the experts consulted and it was presented at a third online meeting. The document of the superficial and perforating venous mapping reached by consensus is presented hereafter.

Rinitis alérgica, apnea-hipopnea obstructiva del sueño y sensibilización a ácaros / Allergic rhinitis, obstructive sleep apnea-hypopnea and mite sensitization

La asociación de rinitis alérgica y el síndrome de apnea-hipopnea obstructiva del sueño se presenta en diferentes edades. En la rinitis alérgica y el síndrome de apnea-hipopnea obstructiva del sueño, puede estar involucrada la sensibilización a ácaros, principalmente: Dermatophagoides pteronyssinus, Dermatophagoides siboney y Blomia tropicalis. Con el objetivo de diagnosticar el síndrome de apnea-hipopnea obstructiva del sueño se seleccionaron 120 individuos del registro de alergia del Policlínico Previsora, Camagüey, Cuba, con diagnóstico presuntivo de rinitis alérgica y edad entre 5 y 15 años cumplidos. Todos tenían realizada la prueba de punción cutánea con Dermatophagoides pteronyssinus, Dermatophagoides siboney y Blomia tropicalis; algunos también, la poligrafía cardiorrespiratoria mediante el dispositivo ApneaLinkAirTM (Resmed Corp., RFA), utilizando el marcaje automático de eventos. La muestra fue de 40 casos (respiración oral, ronquidos) y 80 controles (sin respiración oral, ni ronquidos). La media del tamaño del habón fue de 7,9 mm en los casos y 4,1 mm en los controles (p꞊0,030). El índice de apnea-hipopnea fue positivo en 47 (39,1 por ciento) pacientes, de ellos, 36 (30 por ciento) casos y 11 (9,1 por ciento) controles (p=0,001). La sensibilidad y especificidad de la poligrafía cardiorrespiratoria mostró valores de 85,00 por ciento y 91,25 por ciento respectivamente que permiten afirmar el grado de eficacia de la prueba para diagnosticar apnea e hipopnea obstructiva del sueño. Los pacientes con síndrome de apnea-hipopnea obstructiva del sueño en los casos y controles presentaron incremento, con predominio para casos. La poligrafía cardiorrespiratoria con el dispositivo ApneaLink permite hacer el diagnóstico del síndrome de apnea-hipopnea obstructiva del sueño en rinitis alérgica(AU)

The association of allergic rhinitis and obstructive sleep apnea-hypopnea syndrome occurs at different ages. In allergic rhinitis and obstructive sleep apnea-hypopnea syndrome, sensitization to mites may be involved, mainly: Dermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis. With the objective to diagnose obstructive sleep apnea-hypopnea syndrome, 120 individuals were selected from the allergy registry of the Previsora Polyclinic, Camagüey, Cuba, with a presumptive diagnosis of allergic rhinitis and ages between 5 and 15 years old. All had the skin prick test with Dermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis; some also, cardio-respiratory polygraphy with the ApneaLink AirTM device (Resmed Corp., RFA), using automatic event marking. The sample consisted of 40 cases (oral breathing, snoring) and 80 controls (no oral breathing or snoring). The mean size of the wheal was 7.9 mm in the cases and 4.1 mm in the controls (p꞊0.030). The apnea and hypopnea index was positive in 47 (39.1 percent) patients, of which 36 (30 percent) were cases and 11 (9.1 percent) were controls (p=0.001). The sensitivity and specificity of the cardiorespiratory polygraphy showed values of 85.00 percent and 91.25 percent, respectively, which allow affirming the degree of efficacy of the test to diagnose obstructive sleep apnea-hypopnea. Patients with obstructive sleep apnea-hypopnea syndrome in cases and controls presented an increase, with a predominance for cases. Cardiorespiratory polygraphy with the ApneaLink device allows the diagnosis of obstructive sleep apnea-hypopnea syndrome in allergic rhinitis(AU)

Concordance in psychopharmacological treatment before and after first mental health consultation.

PURPOSE: To analyse concordance between treatment prescribed before and after the first mental health consultation. We understand concordance in two different senses: first, as a similar amount of equivalent doses and drug type; second, as a similar treatment for each patient. METHOD: This is an analytical, descriptive, retrospective study on psychopharmacological treatment before and after first mental health consultation of 1236 patients. Drugs were classified into four groups and the equivalent dose respect to reference medication was considered in each group in order to make a comparison between primary and mental health. RESULTS: Moderate concordance was found in prescribed treatments before and after first mental health consultation (except antidepressants). The average number of benzodiazepines decreased, as did average doses prescribed at mental health consultation respect to previously prescribed treatment; average doses of antidepressants, however, increased. From the patient's perspective, dose increase was more frequent than decrease. Nevertheless, a high percentage of polymedicated patients were found, although this percentage decreased after the first mental health consultation. CONCLUSION: There exists a moderate concordance between the pharmacological treatment prescribed before and after the first mental health consultation. However, the use of benzodiazepines diminished significantly after the first consultation, mainly due to a decrease in the percentage of polymedicated patients.

Eventos trombóticos y marcadores inflamatorios en pacientes con neumonía grave por síndrome respiratorio agudo severo coronavirus-2 (SARS-CoV-2) / Thrombotic events and inflammatory markers in patients with severe pneumonia due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) / Eventos trombóticos e marcadores inflamatórios em pacientes com pneumonia grave devido à síndrome respiratória aguda grave coronavirus-2 (SARS-CoV-2)

Resumen: Introducción: La neumonía por SARS-CoV-2 se asocia a secreción importante de citoquinas y aglomeramiento de células inmunológicas, que activan las células endoteliales condicionando coagulopatía, afectando al pulmón en una fase temprana, con un fenotipo clínico del síndrome de dificultad respiratoria aguda (SDRA), que posteriormente progresa a respuesta inflamatoria sistémica desregulada por marcadores inflamatorios que causan mayor lesión endotelial generando trombosis. Muchos pacientes presentan niveles elevados de dímero D (DD), así como de proteína-C-reactiva (PCR), interleucina-6 (IL-6) y ferritina, supeditando la formación de coágulos, con la interrupción de la circulación (arterial o venosa) a cualquier nivel del sistema circulatorio. Objetivos: Determinar si existe relación entre los niveles elevados de marcadores inflamatorios y eventos trombóticos en pacientes con neumonía por SARS-CoV-2 con ventilación mecánica invasiva (VMI). Material y métodos: Realizamos estudio de una cohorte, observacional, retrospectivo y longitudinal, en pacientes que ingresaron a la Unidad de Terapia Respiratoria del Centro Médico ABC, de abril a julio de 2020, con diagnóstico de neumonía por SARS-CoV-2 con VMI. Utilizamos el programa STATA para el análisis estadístico. Efectuamos un análisis lineal de medidas repetitivas por regresión logística para evaluar el comportamiento cronológico de las variables inflamatorias. Posteriormente, ajustamos los marcadores inflamatorios con variables demográficas, para la obtención de certeza diagnóstica y predicción de riesgo de eventos trombóticos. Resultados: Analizamos un total de 100 pacientes, predominando el sexo masculino en 78%. El 18% presentó trombosis. Inicialmente, los marcadores inflamatorios estadísticamente significativos fueron DD (p = 0.010) con niveles de 1375.5 ng/mL (967-2651) y ferritina (p = 0.030) con niveles 1391.5 ng/mL (622-1779). Con el ajuste de variables inflamatorias por edad, género, índice de masa corporal (IMC) y escalas de gravedad, las variables estadísticamente significativas fueron DD (p = 0.001) y ferritina (p = 0.004), obteniendo certeza diagnóstica de 80.57% para predecir el riesgo de eventos trombóticos. Conclusión: El control estricto de los parámetros de laboratorio y un alto índice de sospecha son vitales para formular un enfoque de tratamiento personalizado para los pacientes, y también pueden ayudar a clasificar a los pacientes con alto riesgo de presentar eventos trombóticos. Nuestro modelo enfatiza que hay que tener precaución con niveles elevados de DD y ferritina.

Abstract: Introduction: SARS-CoV-2 pneumonia is associated with an important secretion of cytokines and agglomeration of immune cells, which activate endothelial cells conditioning coagulopathy, affecting the lung at an early stage, with a clinical phenotype of Acute Respiratory Distress Syndrome (ARDS), which later progresses to a systemic inflammatory response deregulated by inflammatory markers that cause greater endothelial injury generating thrombosis. Many patients present high levels of D-dimer (DD), as well as C-reactive protein (CRP), interleukin-6 (IL-6) and ferritin, subordinating the formation of clots, with the interruption of circulation (arterial or venous) at any level of the circulatory system. Objectives: To determine if there is a relationship between elevated levels of inflammatory markers and thrombotic events in patients with SARS-CoV-2 pneumonia with invasive mechanical ventilation (IMV). Material and methods: We conducted an observational, retrospective and longitudinal cohort study in patients admitted to the Respiratory Therapy Unit of the ABC Medical Center, from April to July 2020, with a diagnosis of SARS-CoV-2 pneumonia with IMV. We use the STATA program for statistical analysis. We performed a linear analysis of repetitive measures by logistic regression to evaluate the chronological behavior of the inflammatory variables. Subsequently, we adjusted the inflammatory markers with demographic variables, to obtain diagnostic certainty and prediction of risk of thrombotic events. Results: We analyzed a total of 100 patients, the male sex prevailing in 78%. 18% had thrombosis. Initially the statistically significant inflammatory markers were DD (p = 0.010) with levels of 1375.5 ng/mL (967-2651) and ferritin (p = 0.030) with levels 1391.5 ng/mL (622-1779). With the adjustment of inflammatory variables by age, gender, Body Mass Index (BMI) and severity scales, the statistically significant variables were DD (p = 0.001) and ferritin (p = 0.004), obtaining a diagnostic certainty of 80.57% to predict risk of thrombotic events. Conclusion: Tight control of laboratory parameters and a high index of suspicion are vital to formulating a personalized treatment approach for patients, and can also help classify patients at high risk for thrombotic events. Our model emphasizes that caution must be exercised with elevated levels of DD and ferritin.

Resumo: Introdução: A pneumonia por SARS-CoV-2 está associada à secreção significativa de citocinas e aglomeração de células imunes, que ativam as células endoteliais, causando coagulopatia, afetando o pulmão em estágio inicial, com um fenótipo clínico de Síndrome do Desconforto Respiratório Agudo (SDRA), que posteriormente progride para uma resposta inflamatória sistêmica desregulada por marcadores inflamatórios que causam maior lesão endotelial gerando trombose. Muitos pacientes apresentam níveis elevados de D-dímero (DD), bem como de proteína C-reativa (PCR), Interleucina-6 (IL-6) e ferritina, causando formação de coágulos, com interrupção da circulação (arterial ou venosa) em qualquer nível do sistema circulatório. Objetivos: Determinar se existe uma relação entre níveis elevados de marcadores inflamatórios e eventos trombóticos em pacientes com pneumonia por SARS-CoV-2 com ventilação mecânica invasiva (VMI). Material e métodos: Foi realizado um estudo de coorte observacional, retrospectivo e longitudinal em pacientes internados na Unidade de Terapia Respiratória do Centro Médico ABC, de abril a julho de 2020, com diagnóstico de pneumonia por SARS-CoV-2 com VMI. Usamos o programa STATA para análise estatística. Realizamos uma análise linear de medidas repetitivas por regressão logística para avaliar o comportamento cronológico das variáveis inflamatórias. Posteriormente, ajustamos os marcadores inflamatórios com variáveis demográficas, para obter certeza diagnóstica e predizer o risco de eventos trombóticos. Resultados: Analisamos um total de 100 pacientes, com predominância do sexo masculino em 78%. 18% apresentaram trombose. Inicialmente, os marcadores inflamatórios estatisticamente significativos foram DD (p = 0.010) com níveis de 1375.5 ng/mL (967-2651) e ferritina (p = 0.030) com níveis de 1391.5 ng/mL (622-1779). Com o ajuste das variáveis inflamatórias por idade, sexo, índice de massa corporal (IMC) e escalas de gravidade, as variáveis estatisticamente significativas foram DD (p = 0.001) e ferritina (p = 0.004), obtendo-se certeza diagnóstica de 80.57% para predizer o risco de eventos trombóticos. Conclusão: O controle estrito dos parâmetros laboratoriais e um alto índice de suspeita são vitais na formulação de uma abordagem de tratamento personalizado para os pacientes, e também podem ajudar a classificar os pacientes com alto risco de apresentar eventos trombóticos. Nosso modelo enfatiza que deve-se ter cautela com níveis elevados de DD e ferritina.

Teaching strategies and outcomes in 3 different times of the COVID-19 pandemic through a dynamic assessment of medical skills and wellness of surgical trainees.

BACKGROUND: The coronavirus disease 2019 pandemic had a substantial impact on surgical training programs. This study describes the teaching strategies and outcomes in 3 different times of the coronavirus disease 2019 pandemic through a dynamic assessment of medical skills and well-being of trainees. METHODS: Three surveys were administered during 2020 to general surgery residents and fellows in a university hospital in Argentina. Perceptions on the impact of coronavirus disease 2019 were described. The stress rate and risk factors were analyzed. RESULTS: The study included 124 answers. In total, 59% were men, 82% of trainees reported concerns about the loss of surgical skills in early phase 1. Time spent with academic activities increased in 94.5% of the cases. Owing to the prompt implementation of changes, by the end of 2020, 73% participated in a greater number of procedures (P = .003); personal protective equipment use related problems dropped from 40% to 14% (P = .031), and the lack of adequate spaces where trainees could express reduced from 28% to zero. Half of the trainees felt stressed, and 18% required psychological assistance; reporting problems with personal protective equipment use was identified as a risk factor (P = .012). CONCLUSION: Assessing trainees' perceptions at 3 different times of the coronavirus disease 2019 pandemic enabled the implementation of dynamic changes. The negative impact on surgical training was partially offset by the optimal use of virtual learning. Half of them felt stressed, identifying problems in the use of personal protective equipment as a predisposing factor.

Formación de un divertículo epifrénico como complicación de la cirugía antirreflujo: importancia de la fluoroscopia / Development of an epiphrenic diverticulum as a complication of antireflux surgery: importance of fluoroscopy

En este artículo se muestran los hallazgos radiológicos en el esofagograma del divertículo epifrénico en un paciente con disfagia para sólidos y pérdida de peso, con antecedente de cirugía antirreflujo. Además, se encuentra una plicatura muy apretada y, como consecuencia, la formación del divertículo epifrénico, entidad de rara presentación. Las técnicas de fluoroscopia siguen vigentes para la valoración anatómica y funcional del tracto gastrointestinal

This article demonstrates the radiological findings in the esophagogram of the epiphrenic diverticulum in a patient with solid dysphagia and weight loss with a history of antireflux surgery. In this case, a very tight plication was found and as a consequence the formation of the epiphrenic diverticulum, a rare entity Fluoroscopy techniques are still used for anatomical and functional evaluation of the gastrointestinal tract.

Amyand's hernia complicated with appendicitis.

Introduction: The finding of a vermiform appendix within the peritoneal sac of an indirect inguinal hernia occurs in approximately 1% of cases. However, the presence of appendicitis within an inguinal hernial sac is found only in 0.08% of the general population. Case Report: We present the case of a 58-year-old male patient that was admitted with abdominal pain associated with a small non-reducible right groin mass. Discussion: To establish the correct diagnosis preoperatively, an abdominal and pelvic CT scan is mandatory. Conclusion: Acute appendicitis in an Amyand's hernia is a very rare entity that can be easily misdiagnosed preoperatively. CT is extremely useful in reaching the correct preoperative diagnosis.

Introducción: El hallazgo de un apéndice vermiforme dentro del saco peritoneal de una hernia inguinal indirecta ocurre en aproximadamente el 1% de los casos. Sin embargo, la presencia de apendicitis dentro de un saco herniario inguinal se encuentra sólo en el 0.08% de la población general. Caso clínico: Presentamos el caso de un paciente masculino de 58 años que ingresa por dolor abdominal asociado a una pequeña masa inguinal derecha no reducible. Discusión: Para establecer el diagnóstico correcto preoperatorio, es obligatoria una tomografía computarizada de abdomen y pelvis. Conclusión: La apendicitis aguda en la hernia de Amyand es una entidad muy rara que puede diagnosticarse erróneamente fácilmente en el preoperatorio. La TC es de gran utilidad para llegar al correcto diagnóstico preoperatorio.

Resilience, Emotional Intelligence, and Occupational Performance in Family Members Who Are the Caretakers of Patients with Dementia in Spain: A Cross-Sectional, Analytical, and Descriptive Study.

BACKGROUND: The concern in the scientific community for the study of people with dementia and their families is comprehensible, especially the importance of knowing the effects that caring for the patient has on their family dynamic, paying special attention to the main caregiver. The objective of this study was to analyze the relationship of resilience and emotional intelligence with functional performance in the main caregivers of people with dementia in Spain according to the phase of the disease. METHODS: A cross-sectional, descriptive, and analytical study was carried out. A total of 144 primary family caregivers of patients with dementia in Spain were included in the study. The following variables were measured: sociodemographic, psychosocial, and occupational, as well as resilience and emotional intelligence. RESULTS: The caregivers obtained a low moderate resilience (mean = 64.01 ± 14.5), an emotional intelligence bordering between moderate and high (mean = 78.48 ± 14.82), and a 61.8% self-care categorized as somewhat and quite a bit. The presence of higher levels of resilience in family caregivers of people with dementia were positively related to the time spent on self-care (r = 0.227; p = 0.033) and leisure (r = 0.262; p = 0.014), especially in the moderate phase of the disease, while in the severe phase, this relationship appeared with productivity (r = 0.355; p = 0.034). The higher levels of emotional intelligence were positively related to a greater time dedicated to self-care (r = 0.233, p = 0.005), as well as the data observed in the moderate and severe phase (r = 0.214; p = 0.046 and r = 0.398; p = 0.016 respectively). CONCLUSIONS: The primary caregivers of relatives with dementia who have higher levels of resilience and emotional intelligence spend more time on self-care and leisure activities, especially in the moderate phase of the disease.

Recurrent primary enterolithiasis with no apparent cause. Presentation of a case / [Enterolitiasis primaria recurrente idiopática. Presentación de un caso]

Enterolithiasis is a rare cause of intestinal obstruction. It occurs with a low frequency and its etiology can be primary or secondary. They present nonspecifically clinically and their resolution is usually surgical. We present a case of a 45-year-old patient who presented two episodes, one year apart, of intestinal obstruction due to enteroliths of unknown cause. The recurrence of this pathology, for no apparent reason, is what makes this publication interesting.

La enterolitiasis es una causa poco frecuente de obstrucción intestinal. Su etiología puede ser primaria o secundaria, según el sitio de formación de los litos. Se presentan clínicamente de manera inespecífica y su resolución es habitualmente quirúrgica. Se presenta un caso de una paciente de 45 años que presentó dos episodios, separados por un año, de obstrucción intestinal por enterolitos de causa desconocida. La recurrencia de esta patología, sin causa de base aparente, es lo que hace interesante esta publicación.

Falls Prevention and Quality of Life Improvement by Square Stepping Exercise in People with Parkinson's Disease: Project Report.

Parkinson's disease (PD) is a chronic neurodegenerative disorder that affects physical, psychological, and social quality of life. Square Stepping Exercise (SSE) is an effective balance training program to prevent falls and to stimulate cognitive function in the elderly; however, no study has analyzed the effect of SSE in people with PD. The main objective is to investigate whether the application of SSE is safe, applicable, and can improve balance, and is effective in preventing falls, improving cognitive and psychological aspects and thus maximize quality of life in people with PD. Methods/Design: SSE will be performed three times per week for 8 weeks with an additional month follow-up after the intervention. Sixty people with PD will participate, randomly distributed into two groups: experimental group (SSE: n = 30) and control group (Usual care: n = 30). The primary measurements will be: (1) Applicability, (2) Safety, (3) Balance, and (4) Annual number of falls. Secondary measurements will be: (1) Sociodemographic information, (2) Physical condition, (3) Health-related quality of life, (4) Depressive symptoms, (5) Cognitive aspects, (6) Perceived functional social support, and (7) Anticipatory cognition.

KCC2 is required for the survival of mature neurons but not for their development.

The K+/Cl- cotransporter KCC2 (SLC12A5) allows mature neurons in the CNS to maintain low intracellular Cl- levels that are critical in mediating fast hyperpolarizing synaptic inhibition via type A γ-aminobutyric acid receptors (GABAARs). In accordance with this, compromised KCC2 activity results in seizures, but whether such deficits directly contribute to the subsequent changes in neuronal structure and viability that lead to epileptogenesis remains to be assessed. Canonical hyperpolarizing GABAAR currents develop postnatally, which reflect a progressive increase in KCC2 expression levels and activity. To investigate the role that KCC2 plays in regulating neuronal viability and architecture, we have conditionally ablated KCC2 expression in developing and mature neurons. Decreasing KCC2 expression in mature neurons resulted in the rapid activation of the extrinsic apoptotic pathway. Intriguingly, direct pharmacological inhibition of KCC2 in mature neurons was sufficient to rapidly induce apoptosis, an effect that was not abrogated via blockade of neuronal depolarization using tetrodotoxin (TTX). In contrast, ablating KCC2 expression in immature neurons had no discernable effects on their subsequent development, arborization, or dendritic structure. However, removing KCC2 in immature neurons was sufficient to ablate the subsequent postnatal development of hyperpolarizing GABAAR currents. Collectively, our results demonstrate that KCC2 plays a critical role in neuronal survival by limiting apoptosis, and mature neurons are highly sensitive to the loss of KCC2 function. In contrast, KCC2 appears to play a minimal role in mediating neuronal development or architecture.

Analysis of Consultation Demand in a Mental Health Centre during the Recent Economic Recession.

The economic recession that recently affected most European countries has led to a worsening of the mental health situation in the general population and an associated rise in outpatient psychiatric care. The aim of this study was to analyse the socio-demographic, clinical and assistential features of the demand for specialist mental health attention. A descriptive and analytical study was conducted in the period 2011-2015 (N = 1252). The principal relations among variables were analysed by an χ2 test, followed by a Z test with Bonferroni's correction. For a global perspective a Multiple Correspondence Analysis was performed. 2 The most frequent disorders were adjustment, anxiety and mood disorders, and in addition there were a large number of patients without diagnosis. The percentage of unemployed or inactive patients was high, as it was for those with a low academic level. The younger patients were more prone to have adjustment disorders, especially among the unemployed ones, while anxiety disorders were more frequent in the patients with jobs. A close association seems to exist between unemployment, low academic level and mental health problems. The high demand for mental health attention reveals a clear need to optimize the utilization of specialized care in mental health.

Inmunoterapia con alérgenos de ácaros en pacientes con rinitis alérgica y apnea obstructiva del sueño / Immunotherapy with mite allergens in patients with allergic rhinitis and obstructive sleep apnea

Para confirmar la presencia de apneea obstructiva del sueño (OSA) en rinitis alérgica (RA), se realizó poligrafía cardiorrespiratoria (CRP) y para tratar ambas condiciones, inmunoterapia alérgeno específica (ITAE). El diseño fue descriptivo en el universo de pacientes del servicio de Alergología del policlínico Previsora en Camagüey, Cuba, desde diciembre 2018 a marzo 2020. Se seleccionaron 326 pacientes en orden consecutivo de asistencia a la consulta, teniendo en cuenta los criterios: ≥5 años con RA, sospecha de OSA y prueba cutánea con ácaros: Dermatophagoides pteronyssinus, Dermatophagoides siboney y Blomia tropicalis, producidos en: Centro Nacional de Biopreparados de Cuba. Todos recibieron ASIT por ≥10 meses y se realizó CRP antes y después de la ASIT. La CRP se realizó utilizando el marcaje automático de eventos de ApneaLink AirTM (Resmed Corp., RFA), validado para estudiar los trastornos del sueño en el hogar. Los resultados de la prueba cutánea y de CRP se evaluaron antes y después de la ASIT; también la eficacia de la ASIT según criterios de pacientes y profesionales. De la muestra, 152 fueron del sexo femenino y 174 del sexo masculino para un 46,6 por ciento y 53,4 por ciento respectivamente; aquellos con habón de 5 a 6 mm fueron los más representados (p=0,04). Hubo descenso en los niveles de gravedad de OSA después de la ASIT (p=0,025). En la valoración de la eficacia de la ASIT, hubo un número significativo de mejorados (p=0,012). La CRP proporciona el diagnóstico de OSA en RA, y la ASIT cambia el curso de ambas condiciones(AU)

To confirm the presence of obstructive sleep apnea (OSA) in allergic rhinitis (AR), cardiorespiratory polygraphy (CRP) was performed, and to treat both conditions, the allergen specific immunotherapy (ASIT) was used in order to change their course. Descriptive study in the universe of patients from Previsora polyclinic Allergology service, Camagüey, Cuba was carried-out from December 2018 to March 2020. 326 patients were selected in consecutive order of attendance at the consultation, taking into account the criteria: ≥5 years with AR, suspicion of OSA and positive skin test to: Dermatophagoides pteronyssinus, Dermatophagoides siboney and Blomia tropicalis, supplied by the National Center for Biopreparations in Cuba. All patients received ASIT for ≥10 months and CRP was performed before and after ASIT. The CRP results were taken from the automatic scoring of the ApneaLink AirTM device (Resmed Corp., Australia), validated to study OSA at home. The skin test and CRP results were evaluated before and after the ASIT. In addition, the assessment of the ASIT efficacy according to criteria of patients and professionals was performed. The sample was made-up of 152 female patients (46.6 percent) and 174 males (53.4 percent); those with 5 to 6 mm wheal were the most represented (p=0.04). There was decrease in OSA severity levels after ASIT (p=0.025). The ASIT efficacy was proved with a significant number of improvements (p=0.012). CRP provides the diagnosis of OSA in AR, and ASIT changes the course of both conditions(AU)

Spanish Adaptation of the Dimensional Apathy Scale (DAS) in Amyotrophic Lateral Sclerosis.

Aim: To adapt, translate, and utilize the Dimensional Apathy Scale (DAS) in Amyotrophic Lateral Sclerosis (ALS) to the Spanish population. Method: We recruited 104 ALS patients (67 of their caregivers) and 49 controls. Participants completed the Spanish-translated DAS, Geriatric Depression Scale- Short form. Patients were also administered the ALS Functional Rating Scale-Revised (ALSFRS-R). Caregivers additionally completed the informant/caregiver-rated Spanish-translated DAS. The DAS was translated to Spanish using a back-translation method. Test-retest and internal consistency reliability were examined. Divergent validity was assessed by comparing the DAS with the depression scale (GDS-15). Principal Component Analysis (PCA) was applied to explore the substructure of the Spanish DAS. Results: The internal consistency reliability of self-rated Spanish DAS was 0.72 and of the informant/caregiver-rated Spanish DAS was 0.84. Correlations between self-rated DAS subscales and GDS-15 were not statistically significant, with a good test-retest reliability. PCA analysis showed a similar substructure to the original DAS. ALS patients had significantly higher Initiation apathy than controls. Additionally, ALS patient informant/caregiver-rated DAS Emotional apathy was significantly higher than the self-rated, with no significant differences observed in the Executive and Initiation subscales. No association was found between DAS and functional impairment using the ALS Functional Rating Scale (ALSFRS-R). Conclusion: The Spanish translation of the DAS is valid and reliable for use in assessing multidimensional apathy in the Spanish population. Availability of the Spanish DAS will allow for future research to explore different apathy subtypes and their impact in ALS and other conditions.

Secondary Ablation of Recanalized Saphenous Vein after Endovenous Thermal Ablation.

BACKGROUND: To describe the occlusion rate and clinical response of a redo ablative procedure in symptomatic patients with recanalization of saphenous vein after endovascular thermal ablation. METHODS: A retrospective cohort study was performed in a prospectively collected data of symptomatic patients with recanalization of the great saphenous vein (GSV) or small saphenous vein (SSV) after endovascular thermal ablation who underwent a secondary ablation (SA) from June 2015 to May 2018. RESULTS: Ten patients (15 limbs) with recanalization of the GSV or SSV were treated with SA. The median age was 67 years and 60% were men. The median time from the first ablation was 7.3 years (interquartile range [IQR] 6.5-9.6). For SA, radiofrequency ablation was performed in 12 limbs (80%) and ultrasound-guided foam sclerotherapy in 3 cases (20%). The GSV was the treated vessel in 14 cases (93.3%). No complications were reported. Median follow-up was 13 months. Preoperative and 1-year follow-up Venous Clinical Severity Score was 9 (IQR 5-10) and 4 (IQR 2-8), respectively. Duplex ultrasound evaluation after 1 year showed an occlusion rate of 93.3% evidencing a partially recanalized vein in 1 treated limb. CONCLUSIONS: In this study, the occlusion rate was 93.3% at 1 year after SA; clinical improvement and no complications were reported. SA appears to be a valid option for the treatment of symptomatic patients with recanalized GSV or SSV.

Coping strategies and stress-induced natural killer cell redistribution in women with eating disorders.

BACKGROUND: Patients with eating disorders (ED) are very sensitive and responsive to psychosocial stress. Stress response includes changes in immune cell distribution and may be modulated by the capability to cope with stressors. Thus, the present study sought to analyze the association between coping strategies and immune response (natural killer [NK] cell redistribution following psychosocial stress) in patients with anorexia nervosa (AN) and bulimia nervosa (BN) and healthy controls (HC). METHOD: Twenty-four AN patients, 29 BN patients, and 58 HC were studied. A multidimensional assessment tool, the COPE Inventory, was used to assess coping strategies. The number of NK cells was quantified in peripheral blood before and after the application of the Trier Social Stress Test (TSST). Potentially mediating variables, such as weight status, severity of eating pathology, depression, anxiety, and impulsivity were controlled. RESULTS: The three groups differed in intensity and direction of cell redistribution: The TSST was followed in BN patients by a significant decrease in the number of NK cells, whereas HC displayed a moderate decrease and AN a clear increase. Specific correlations between coping strategies and NK cell mobilization were found, especially in BN patients (positive for "planning" and negative for "substance abuse"). CONCLUSION: Recognition and subsequent modification of the dysfunctional coping strategies used by patients with ED could contribute to improving their immune status, strengthening their resilience and increasing their ability to overcome the disease.

ANTECEDENTES: Los pacientes con trastornos de la conducta alimentaria (TCA) son muy sensibles y respondedores ante el estrés psicosocial. La respuesta al estrés incluye cambios en la distribución de las células inmunes y parece estar modulada por la capacidad de afrontamiento del individuo. En este contexto, el objetivo del presente estudio fue analizar la asociación entre estrategias de afrontamiento y redistribución tras el estrés de las células agresoras naturales (natural killer, NK) en pacientes de sexo femenino con anorexia nervosa (AN) y bulimia nervosa (BN), y controles sanos (CS). MÉTODO: Treinta y cuatro pacientes con AN, 29 pacientes con BN y 58 CS fueron estudiados. Para evaluar las estrategias de afrontamiento se utilizó un instrumento multidimensional, el Inventario COPE. El número de células NK en sangre periférica fue cuantificado antes y después de la aplicación del Trier Social Stress Test (TSST). Las posibles variables mediadoras, como el estado ponderal, la gravedad de la patología alimentaria, depresión, ansiedad e impulsividad fueron control. RESULTADOS: Los tres grupos difirieron en la intensidad y la dirección de la redistribución de células NK: el TSST fue seguido de una notable reducción en el número de células NK en las pacientes con BN, de una disminución moderada en las CS y de un claro incremento en las pacientes con AN. Se encontraron correlaciones específicas entre estrategias de afrontamiento y movilización de células NK, especialmente en las pacientes con BN (positiva para "planificación" y negativa para "abuso de sustancias"). CONCLUSIÓN: El reconocimiento y la modificación consiguiente de las estrategias de afrontamiento disfuncionales utilizadas por las pacientes con TCA pueden contribuir a mejorar su estado inmunológico, incrementando su resistencia y su capacidad para superar la enfermedad.