Transitioning insomnia patients from zolpidem to lemborexant: A multicenter, open-label study evaluating a next-dose transition approach to insomnia pharmacotherapy.

Objective: Few clinical studies have assessed real-world abrupt transitioning between insomnia medications. This study assessed strategies for directly transitioning patients from zolpidem tartrate (ZOL) immediate/extended release to the dual orexin receptor antagonist, lemborexant (LEM). Methods: This randomized, open-label, multicenter study (Study 312; E2006-A001-312) enrolled 53 adults age ≥18 years with insomnia disorder and ≥1-month history of intermittent (3-4 nights/week) or frequent (≥5 nights/week) ZOL use. Subjects recorded their ZOL use in a 3-week Pretreatment Phase, followed by a 2-week Treatment Phase (TRT; Titration) during which ZOL was discontinued. Intermittent ZOL users transitioned to LEM 5 mg (LEM5), Cohort 1, and frequent ZOL users were randomized 1:1 to LEM5, Cohort 2A, or LEM 10 mg (LEM10), Cohort 2B. One dose adjustment was permitted during the TRT. Subjects completing the TRT could continue LEM in the 12-week Extension Phase (EXT). The primary outcome was proportion of subjects who successfully transitioned and remained on LEM at the end of the TRT. Results: Most subjects (43 [81.1 %]) successfully transitioned to LEM (9 [90 %], 17 [81.0 %], and 17 [77.3 %] in Cohorts 1, 2A, and 2B, respectively). By the end of the EXT, 66.7 % in Cohort 1 and 60.0 % in Cohort 2A up-titrated to LEM10, whereas 41.2 % in Cohort 2B down-titrated to LEM5; 61.0 % were receiving LEM10 at study end. At the end of the TRT, more subjects taking LEM reported that it helped them return to sleep after waking, compared with those taking ZOL (71.7 % vs. 49.1 %). There were no important differences between treatments regarding how subjects reported feeling as they fell asleep. Most of the treatment-emergent adverse events with LEM were mild in severity. Conclusions: Most subjects transitioned successfully to LEM from ZOL (intermittent or frequent use). LEM was well tolerated.

Metabolic disorders across the body mass index spectrum in a Colombian population with nonalcoholic fatty liver disease.

BACKGROUND AND AIMS: The relationship between obesity and nonalcoholic fatty liver disease (NAFLD) has long been established, and the prevalence of both conditions has grown together. Recent interest in NAFLD in nonobese individuals has led to an increasing number of studies, especially in Asia. Despite the fact that the prevalence of NAFLD in Latin America is one of the highest in the world, there is a lack of information on lean NAFLD populations from the region. The aim of the present study was to assess the risk of metabolic comorbidities across the whole body mass index spectrum when nonalcoholic steatohepatitis (NASH) was first diagnosed in a Latin American population. METHODS: A single-center, cross-sectional study on Colombian patients newly diagnosed with NAFLD, within the time frame of 2010-2020, compared their metabolic biochemical profile, liver enzymes, risk of prevalent metabolic abnormalities, and liver disease. RESULTS: Data from 300 patients were collected. Ninety-two percent of the patients were men and the median patient age was 47 (IQR 20) years. We found no significant differences in the biochemical, metabolic profile, or liver enzyme plasma concentration between lean, overweight, and obese individuals. Obese patients had significantly higher LDL cholesterol, and a higher risk of dyslipidemia (OR 1.86, 95% CI 1.14-3.05). Every 1kg increase in body weight increased the risk of having NASH by 2% (95% CI 2-4). CONCLUSIONS: We evaluated the metabolic risk across the entire body mass index spectrum in a Colombian cohort with NAFLD and presented the characteristics of what we believe is the first Latin American lean NAFLD population to be described.

Simplification of Complex Insulin Regimens with IdegLira in People with Type 2 Diabetes: Literature Review and Clinical Recommendations.

INTRODUCTION: This study developed a simple algorithm based on clinical results described in medical literature and which allows one to simplify complex insulin regimes with IdegLira to avoid adverse events related to the complexity of some insulin treatments. METHODS: We conducted a systematic review of the literature that allowed us to identify studies that evaluated the clinical result of simplifying complex insulin regimes. The authors reviewed the common factors these simpler regimes had, including the type of patients who used them. RESULTS: We found nine clinical studies published between 2017 and 2022, eight performed in Europe and one in Latin America. The monitoring time of the studies ranged between 3 and 18 months. The size of the study populations was between 61 and 611 patients (the latter was in five countries). In all studies, HbA1c decreased by 0.6-1.7% and the weight decreased by 0.1-3.11 kg. CONCLUSIONS: On the basis of the findings of these studies, we made some recommendations for clinical practice to simplify treatment. The results of these studies support an algorithm that simplifies the treatment of complex insulin regimens.

Considerations when selecting an antidepressant: a narrative review for primary care providers treating adults with depression.

Major depressive disorder (MDD) is a debilitating mental disorder that can be treated with a number of different antidepressant therapies, each with its own unique prescribing considerations. Complicating the selection of an appropriate antidepressant for adults with MDD is the heterogeneity of clinical profiles and depression subtypes. Additionally, patient comorbidities, preferences, and likelihood of adhering to treatment must all be considered when selecting an appropriate therapy. With the majority of prescriptions being written by primary care practitioners, it is appropriate to review the unique characteristics of all available antidepressants, including safety considerations. Prior to initiating antidepressant treatment and when patients do not respond adequately to initial therapy and/or exhibit any hypomanic or manic symptoms, bipolar disorder must be ruled out, and evaluation for psychiatric comorbidities must be considered as well. Patients with an inadequate response may then require a treatment switch to another drug with a different mechanism of action, combination, or augmentation strategy. In this narrative review, we propose that careful selection of the most appropriate antidepressant for adult patients with MDD based on their clinical profile and comorbidities is vital for initial treatment selection.Strategies must be considered for addressing partial and inadequate responses as well to help patients achieve full remission and sustained functional recovery. This review also highlights data for MDD clinical outcomes for which gaps in the literature have been identified, including the effects of antidepressants on functional outcomes, sleep disturbances, emotional and cognitive blunting, anxiety, and residual symptoms of depression.

Major depressive disorder (MDD) is a leading cause of disability worldwide and can affect each patient differently. Antidepressants play a critical role in treatment; however, with multiple antidepressant options available, it is important that providers select the best fit for each patient. Rather than use a "one size fits all" approach, it is important to consider each patient's symptoms, medical and psychiatric comorbidities, as well as their treatment preferences. A clear summary of each antidepressant's distinctive characteristics is essential for providers to select antidepressants to best match each patient's needs.This narrative review aims to discuss the latest information on available antidepressants, including their risks and benefits and how they impact symptoms of MDD such as sleep disturbances, anxiety, emotional blunting, and changes in cognition, as well as different treatment goals, such as the ability to function in everyday life. This information can guide clinical practice recommendations and further enable shared decision-making between the provider and patient, incorporating individual treatment needs and preferences.In addition, many patients do not reach their treatment goals with the first antidepressant or may continue to have symptoms of depression after treatment. This review discusses strategies to increase the likelihood of symptom improvement and creates awareness of patient-specific considerations.Overall, careful, personalized selection of antidepressant treatment is critical for finding the right balance of maximized antidepressant effect with minimized side effects, leading to the best possibility for patients to tolerate the medication and ultimately helping patients reach their treatment goals.

Practical Advice for Primary Care Clinicians on the Safe and Effective Use of Vortioxetine for Patients with Major Depressive Disorder (MDD).

Primary care clinicians have a vital role to play in the diagnosis and management of patients with major depressive disorder (MDD). This includes screening for MDD as well as identifying other possible psychiatric disorders including bipolar disorder and/or other comorbidities. Once MDD is confirmed, partnering with patients in the shared decision-making process while considering different treatment options and best management of MDD over the course of their illness is recommended. Vortioxetine has been approved for the treatment of adults with MDD since 2013, and subsequent US label updates indicate that vortioxetine may be particularly beneficial for specific populations of patients with MDD, including those with treatment-emergent sexual dysfunction and patients experiencing certain cognitive symptoms. Given these recent label updates, this prescribing guide for vortioxetine aims to provide clear and practical guidance for primary care clinicians on the safe and effective use of vortioxetine for the treatment of MDD, including how to identify appropriate patients for treatment.

A Randomized, Double-Blind, Placebo-Controlled Trial to Evaluate the Efficacy and Safety of AR19, a Manipulation-Resistant Formulation of Amphetamine Sulfate, in Adults With Attention-Deficit/Hyperactivity Disorder.

Objective: To assess the efficacy and safety of AR19 in the treatment of attention-deficit/hyperactivity disorder (ADHD) diagnosed by DSM-5 criteria in adults from 18 through 55 years of age. AR19 is a pellets-in-capsule, immediate-release amphetamine sulfate investigational formulation with physical and chemical barriers designed to resist manipulation to deter snorting, smoking, and intravenous injection.Methods: This randomized, double-blind, placebo-controlled, fixed-dose, forced titration, multicenter trial investigated the safety and efficacy of AR19 from September 2018 to April 2019. Study participants were randomized and titrated to 20 mg or 40 mg AR19 daily or placebo. Study medication was dosed once in the morning and again 4 to 6 hours later for a period of 5 weeks. The primary efficacy measure was the total score on the Adult ADHD Investigator Symptom Rating Scale (AISRS).Results: Participants (N = 320) were randomized and received at least 1 dose of study medication. Demographics and baseline characteristics were similar across treatment groups. The least squares mean treatment differences versus placebo (97.5% CI) were -7.2 (-11.3 to -3.1) for the AR19 20-mg group and -7.3 (-11.4 to -3.2) for the AR19 40-mg group (each P < .001). The most common treatment-emergent adverse events occurring in participants in the AR19 treatment groups were insomnia, dry mouth, decreased appetite, palpitations, headache, and tachycardia and are consistent with the known safety profile of amphetamine sulfate.Conclusions: AR19 demonstrated efficacy on all endpoints and was generally well tolerated, supporting the efficacy and safety of AR19 20 mg and 40 mg in adults with ADHD.Trial Registration: ClinicalTrials.gov Identifier: NCT03659929.

The Rapid Mood Screener (RMS): a novel and pragmatic screener for bipolar I disorder.

OBJECTIVE: Depressive episodes and symptoms of bipolar I disorder are commonly misdiagnosed as major depressive disorder (MDD) in primary care. The novel and pragmatic Rapid Mood Screener (RMS) was developed to screen for manic symptoms and bipolar I disorder features (e.g. age of depression onset) to address this unmet clinical need. METHODS: A targeted literature search was conducted to select concepts thought to differentiate bipolar I from MDD and screener tool items were drafted. Items were tested and refined in cognitive debriefing interviews with individuals with self-reported bipolar I or MDD (n = 12). An observational study was conducted to evaluate predictive validity. Participants with clinical interview-confirmed bipolar I or MDD diagnoses (n = 139) completed a draft 10-item screening tool and other questionnaires. Data were analyzed to identify the smallest possible subset of items with optimized sensitivity and specificity. RESULTS: Adults with confirmed bipolar I (n = 67) or MDD (n = 72) participated in the observational study. Ten draft screening tool items were reduced to 6 final RMS items based on the item-level analysis. When 4 or more items of the RMS were endorsed ("yes"), sensitivity was 0.88 and specificity was 0.80; positive and negative predictive values were 0.80 and 0.88, respectively. These properties were an improvement over the Mood Disorder Questionnaire in the same analysis sample while using 60% fewer items. CONCLUSION: The pragmatic 6-item RMS differentiates bipolar I disorder from MDD in patients with depressive symptoms, providing real-world guidance to primary care practitioners on whether a more comprehensive assessment for bipolar I disorder is warranted.

Effects of hydroxyapatite on PMMA-HAp cement for biomedical applications.

OBJECTIVE: The main goal of this study was to examine the influence of hydroxyapatite (HAp) macroaggreate concentrations on thermal and mechanical properties of radioactive bone cement and to study the relation of glass transition Tg with its mechanical properties. METHODS: The bone cement as (1-x)PMMA-xHAp binary system was prepared in six [x] distinct concentration parameters of 0.0 up to 0.5. The HAp was synthesized using a solgel procedure following calcination by thermal treatment. The composite was prepared in cold based (non-radioactive) mixing polymethyl methacrylate (PMMA) and HAp. Differential scanning calorimetry (DSC), thermogravimetric analysis (TGA) and mechanical compressive strength (CS) were used to measure the thermal and mechanical properties. RESULTS: The DSC and TGA thermal profiles in function to concentration parameter [x] were presented. The CS lies in a range of 3.71-7.37 MPa and the glass transition temperature Tg = 126.27 °C. There was a direct relationship between the PMMA-HAp thermoplastic properties with mechanical and thermal properties in function of HAp concentrations. CONCLUSION: The specific PMMA-HAp composite, with a concentration ratio of 1:1 and HAp thermal treatment at the Tg, provides a material with a compression strength of 7.37 MPa and a suitable amount of porous similar to a trabecular bone, possible to apply in bone cement implants, regardless of whether they are radioactive or not.

Systematic Review: Nonmedical Use of Prescription Stimulants: Risk Factors, Outcomes, and Risk Reduction Strategies.

OBJECTIVE: To review all literature on the nonmedical use (NMU) and diversion of prescription stimulants to better understand the characteristics, risk factors, and outcomes of NMU and to review risk-reduction strategies. METHOD: We systematically searched PubMed, PsycINFO, and SCOPUS from inception to May 2018 for studies containing empirical data about NMU and diversion of prescription stimulants. Additional references identified by the authors were also assessed for inclusion. RESULTS: A total of 111 studies met inclusion criteria. NMU and diversion of stimulants are highly prevalent; self-reported rates among population samples range from 2.1% to 58.7% and from 0.7% to 80.0%, respectively. A variety of terms are used to describe NMU, and most studies have examined college students. Although most NMU is oral, non-oral NMU also occurs. The majority of NMU is associated with no, or minor, medical effects; however, adverse medical outcomes, including death, occur in some individuals, particularly when administered by non-oral routes. Although academic and occupational performance enhancement are the most commonly cited motivations, there is little evidence that academic performance is improved by NMU in individuals without attention-deficit/hyperactivity disorder. CONCLUSION: NMU of stimulants is a significant public health problem, especially in college students, but variations in the terms used to describe NMU and inconsistencies in the available data limit a better understanding of this problem. Further research is needed to develop methods to detect NMU, identify individuals at greatest risk, study routes of administration, and devise educational and other interventions to help reduce occurrence of NMU. Colleges should consider including NMU in academic integrity policies.

Addressing Diagnosis and Treatment Gaps in Adults With Attention-Deficit/Hyperactivity Disorder.

Attention-deficit/hyperactivity disorder (ADHD) was originally defined in children but is now recognized to persist into adulthood for some patients. Despite this recognition, adult ADHD remains underdiagnosed. This narrative review describes the negative impact of ADHD across multiple functional domains, diagnostic guidelines for adult ADHD and its clinical features, the importance of screening tools and clinical interviews to help evaluate adults for ADHD, and adult ADHD treatment options. Diagnostic guidelines for ADHD now incorporate adult-specific symptoms and behavioral manifestations, which may aid in diagnosing adult ADHD. However, diagnosis of ADHD is complicated by symptom overlap between ADHD and psychiatric disorders that might be comorbid with ADHD. Screening tools, such as the Adult ADHD Self-Report Screening Scale for DSM-5, can identify adults requiring evaluation for ADHD. However, clinical interviews and longitudinal family histories provide critical information that diagnoses ADHD and differentiates ADHD from psychiatric comorbidities. Various pharmacologic and nonpharmacologic treatments are available for adults diagnosed with ADHD. First-line pharmacologic treatment of ADHD usually consists of treatment with a psychostimulant, and a variety of short-acting and long-acting formulations are available for use in adults. When developing a treatment plan for adults with ADHD, it is important to recognize that the demands of adult life, both at work and at home, necessitate symptom control throughout the entire day and into the evening and indicate that a long-acting medication formulation is often preferable. Furthermore, there are important safety concerns, including the potential for drug dependence and serious cardiovascular events, which must be considered before prescribing stimulants.​.

¿Conoce cuál es su riesgo de tener diabetes? / Do you know your risk of having diabetes?

La diabetes mellitus tipo 2 (DM2) es una enfermedad silenciosa que afecta hasta el 20% de nuestra población y de ella, hasta el 50% desconoce que la padece. Esta enfermedad se asocia a una alta prevalencia sobre factores de riesgo como el sobrepeso, la obesidad y la inactividad física. Con frecuencia, la DM2 se diagnostica en forma tardía y a veces genera diversas complicaciones asociadas que podrían evitarse

Etiología y perfil de resistencia antimicrobiana en infecciones del pie diabético / Etiology and antimicrobial resistance profile in diabetic foot infections

El pie diabético infectado (PDI) es aquel que presenta infección de piel y partes blandas u óseas por debajo del maléolo; constituye la complicación más frecuente de diabetes que causa hospitalización y amputación. En nuestro hospital los pacientes con pie diabético son asistidos en un consultorio multidisciplinario; el 40% presenta infección leve moderada o grave

Fibromuscular dysplasia: unusual cause of abdominal pain.

Spontaneous dissection of the renal artery is a rare phenomenon, and is more common amongst men. It is not a frequent cause of abdominal pain², which is why diagnosis is often late. The case under study is a 45 year old patient that presented sudden pain in the left renal fossa of 12 hours evolution, with no findings from the basic laboratory tests (lab testing, urinary sediment and ultrasound), an abdominal CAT was therefore carried out, which showed areas of renal infarction, as well as an emergency arteriogram, which gave findings of a possible Fibromuscular Dysplasia of the left intrarenal artery as the first diagnostic probability with a partially thrombosed focal dissection.

Incidencia y origen parental de las aneuploidias en blastocistos: comparación entre dos centros de reproducción asistida en México / Incidence and parental origin of aneuploidies in blastocysts: comparison between two centers of assisted reproduction in Mexico

Resumen: OBJETIVO: determinar la incidencia y origen de las aneuploidias en blastocistos de dos centros mexicanos de reproducción asistida. MATERIALES Y MÉTODOS: estudio de cohorte, retrospectivo, efectuado entre los meses de enero de 2014 a diciembre de 2015 de blastocistos de día 5 y 6 obtenidos durante tratamientos de fecundación in vitro y analizados con el tamizaje genético previo a la implantación, en su variante de microarreglos de polimorfismo de nucleótido único (SNP microarrays) con el algoritmo Parental Support (Natera, USA), que permite evaluar la ploidía de los 24 cromosomas. Comparación de variables continuas: T de Student y categóricas X2. RESULTADOS: se analizaron 450 blastocistos de 80 pacientes. En el centro A: 132 blastocistos fueron de día 5 y 108 de día 6. En el centro B: 94 blastocistos fueron de día 5 y 116 de día 6. Las pacientes del centro A tuvieron mayor edad materna (37.3 ± 3.8 vs 32.4 ± 5.6; p<0.05). La incidencia total de blastocistos con aneuploidias fue similar en ambos centros; al diferenciar entre embriones de día 5 y día 6 sí hubo diferencia. El centro A reportó aumento de blastocistos aneuploides de día 6 vs blastocistos de día 5 (61.1 vs 36.3%; p<0.05). En el centro B la incidencia de embriones aneuploides fue similar entre blastocistos de día 5 y día 6 (48.9 vs 43.1; p > 0.05). El origen de las aneuploidias fue, principalmente, materno (centro A, 68.7%; centro B, 60.75%) seguido por origen mixto (centro A, 19.65%; centro B, 28.1%) y, finalmente, origen paterno (centro A, 11.6%; centro B, 11.1%). CONCLUSIONES: la incidencia de aneuploidias embrionarias entre embriones de día 5 y día 6 fue diferente entre centros. El origen fue, principalmente, materno, seguido de mixto y finalmente paterno.

Abstract: OBJECTIVE: To determine the incidence and origin of aneuploidies in blastocysts of two assisted reproduction centers in México. MATERIAL AND METHODS: Retrospective cohort study. In the period from january 2014 to December 2015, we incluided blastocysts on day 5 and day 6 of developmet, analyzed with preimplantation genetic screening; in two assisted reproduction centers. Blastocysts biopsied on day 7 and embryos that did not perform genetic diagnosis made, were excluded. The comparison of continuous variables: "T of student", categorical: X2. RESULTS: Were analized 450 blastocysts obtained from 80 patients. In center A, 132 blastocysts were on day five and 108 on day six; In the center B; 94 blastocysts were on day five and 116 on day six. Maternal age was higher in center A (37.3 ± 3.8 vs 32.4 ± 5.6 years, p <0.05). The total incidence of aneuploid blastocysts was similar in both centers; By differentiating between embryos from day five and day six if there was difference. The center A presented aneuploid blastocysts increase of day 6 compared with blastocysts of day 5 (61.1 vs 36.3%, p <0.05). In Center B the incidence of aneuploid embryos was similar between blastocysts from day 5 and 6 (48.9 vs 43.1; p> 0.05). In both centers, the main origin of aneuploidies was the maternal cause (center A, 68.7%, center B, 60.75%), followed by mixed origin (center A, 19.65%, center B, 28.1%) and finally of paternal cause (center A, 11.6%, center B, 11.1%). CONCLUSIONS: The incidence of embryonic aneuploidies between embryos from day 5 and day 6 was different between centers. The origin was mainly maternal, followed by mixed and paternal.

Frecuencia de aneuploidias segmentarias en biopsias de trofoectodermo durante un ciclo de FIV y su relación con la edad materna / Frequency of segmental aneuploidies in trophectoderm biopsies during an IVF cycle and its relationship with maternal age

Resumen ANTECEDENTES: las aneuploidias segmentarias se han propuesto como posible explicación para el subgrupo de embriones euploides transferidos al útero, que no logran un recién nacido saludable. OBJETIVO: conocer la frecuencia de aneuploidias cromosómicas segmentarias en biopsias de trofoectodermo durante un ciclo de fertilización in vitro y su relación con la edad materna. MATERIALES Y MÉTODOS: estudio retrospectivo efectuado en un centro privado de reproducción asistida de México de ciclos (2015-2016) en los que se obtuvieron embriones en estadio de blastocisto (día 5 y 6). Análisis mediante tamizaje genético preimplantacional, en su variante de microarreglos de polimorfismo de nucleótido único (SNP microarrays). Análisis con el algoritmo "Parental Support" (Natera) que permite la identificación de aneuploidias numéricas y segmentarias (pérdidas-duplicaciones). RESULTADOS: se incluyeron 615 blastocistos de 148 ciclos; los resultados se dividieron en 4 rangos, dependiendo de la edad materna: menos de 35, de 35 a 37, de 38 a 40 y más menos 40 años de edad. El 50.3% de los blastocistos fueron aneuploides, y de éstos 10.2% tuvieron aneuploidias segmentarias (6.8% solo pérdidas-duplicaciones y 3.4% pérdidas-duplicaciones más aneuploidias numéricas). Las pérdidas-duplicaciones disminuyeron con el aumento de la edad materna. Todos los resultados tuvieron tendencias más claras cuando solo se tomaron en cuenta los blastocistos aneuploides. CONCLUSIONES: las pérdidas-duplicaciones se encuentran en gran porcentaje de embriones en estadio de blastocisto y tienen una relación inversamente proporcional a la edad materna.

Abstract BACKGROUND: Segmental aneuploidies have been suggested as a possible explanation for the subgroup of euploid embryos transferred to the uterus, which have failed to produce a healthy child. OBJECTIVE: know the frequency of segmental chromosome aneuploidies in trophectoderm biopsies during IVF cycle and its relationship with maternal age. MATERIALS AND METHODS: 615 blastocysts from 148 cycles (2014-2016) were included, which were analyzed with preimplantation genetic screening (PGS), in its variant of single nucleotide polymorphism (SNP microarray), using the algorithm "Parental Support", which allows the identification of numerical aneuploidies and segmental aneuploidies (Deletions/Duplications). The results were divided into four ranges, depending of maternal age "<35", "35 to 37", "38 to 40" and "≥41". RESULTS: 50.3% of the blastocysts were aneuploid, of which 10.2% had segmental aneuploidies (6.8% only Deletions/Duplications and 3.4% Deletions/Duplications plus numerical aneuploidies). Deletions/Duplications decreased with increasing maternal age. The aforementioned results presented clearer trends when only aneuploid blastocysts were taken into account. CONCLUSIONS: The Deletions/Duplications is present in a large percentage of embryos in the blastocyst stage and show an inversely proportional relation to maternal age.

Dengue's mortality in department of Meta, Colombia 2010 -2014 / Mortalidad por dengue en el departamento del Meta, Colombia 2010 -2014 / Mortalidade por dengue na departamento do Meta, Colômbia 2010-2014

Introduction.\r\n Dengue is a priority in the health system in Colombia. In department of Meta, it is endemic and generates mortality, \r\neven though the Department has good coverage and access to health services. \r\nObjectives.\r\n To describe mortality by dengue, \r\nsocio-demographic characteristics and possible determinants associated to mortality in department of Meta. \r\nMaterials and \r\nMethods.\r\n A retrospective descriptive revision study was performed of clinical files and notification cards in the Sivigila medical \r\nvigilance system. \r\nInclusion criteria.\r\n Notification card, availability of complete clinic history and laboratory results, confirmation \r\nof death by dengue. \r\nExclusion criteria.\r\n Non-confirmed cases by pathology or laboratory. \r\nResults. \r\n35 cases of death by dengue \r\nwere studied between 2010 and 2014; average age 27.3 years old; 51.43% younger than 10 years old; 51.4% male. The time between the beginning of the appearance of symptoms and consultation with the health system was 4 days. The main symptoms asso\r\n-\r\nciated with mortality were fever, myalgia, arthralgia, abdominal pain and vomiting. \r\nConclusions.\r\n People younger than 10 years \r\nold, with scarce resources and from the subsidized system have a greater risk of mortality. Abdominal pain and vomit are impor\r\n-\r\ntant predictors of shock, it was also evidenced that the use of Aines (Spanish acronym for non steroidal anti-inflammatory agents) \r\naugments the risk, tests of liver function presented the greatest alterations, and hemoconcentration is not used to evaluate the \r\nrisk of severe dengue. It is necessary to better the education and information given to the community to enhance the chance in \r\nconsultation. It is also important to continue to improve medical education to guarantee the adherence to dengue management \r\nmethods, especially to teach patients to recognize the warning signs of dengue.

Este es un estudio descriptivo retrospectivo de revisión de \r\nhistorias clínicas y fichas de notificación en el sistema de \r\nvigilancia epidemiológica (Sivigila). Su objetivo es describir \r\nla mortalidad por dengue, características sociodemográficas \r\ny los posibles determinantes asociados a la mortalidad en \r\nel departamento del Meta, Colombia. Se analizaron la ficha \r\nde notificación, la disponibilidad de la historia clínica y de \r\nlaboratorio con resultados completos y la confirmación de \r\nla muerte por el dengue. Se excluyeron los casos no confir\r\n-\r\nmados por patología o laboratorio. Se estudiaron 35 casos de \r\nmuerte por dengue entre enero de 2010 y mayo de 2014; la \r\nedad promedio fue de 27,3 años de edad; 51,43% menores de \r\n10 años de edad; 51,4% hombres. El tiempo entre la aparición \r\nde los síntomas y la consulta con el sistema de salud fue de \r\ncuatro días. Los principales síntomas encontrados fueron: \r\nfiebre, mialgias, artralgias, vómitos y dolor abdominal. El \r\n90% de los pacientes presentaron variaciones en las pruebas \r\nhepáticas TGP y TGO, y en alteraciones de la función renal se \r\nobservó la mayor alteración en BUN. De acuerdo con los resul\r\n-\r\ntados, las personas menores de 10 años de edad, con escasos \r\nrecursos y del régimen subsidiado tienen un mayor riesgo d\r\ne \r\nmortalidad. El dolor abdominal y vómito son predictores \r\nimportantes de choque; también se puso de manifiesto \r\nque el uso de antiinflamatorios no esteroides aumenta \r\nel riesgo; las pruebas de función hepática presentan las \r\nmayores alteraciones y la hemoconcentración no se utiliza \r\npara evaluar el riesgo de dengue grave.

Introdução. A dengue é uma prioridade no sistema de saúde \r\nda Colômbia. No departamento do Meta, ela é endêmica e \r\ncausa mortalidade, ainda que o Departamento tenha uma boa \r\ncobertura e acesso a serviços de saúde. Objetivos\r\n.\r\n Descrever \r\na mortalidade por dengue, características sociodemográ\r\n-\r\nficas e possíveis determinantes associados à mortalidade no \r\ndepartamento do Meta. Materiais\r\ne\r\nmétodos\r\n.\r\n Estudo descri\r\n-\r\ntivo retrospectivo de revisão de prontuários médicos e cartões \r\nde notificação para o sistema de vigilância epidemiológica, \r\nSivigila. Critério de inclusão. Cartão de notificação, disponi\r\n-\r\nbilidade de prontuário médico e laboratorial com resultados \r\ncompletos e confirmação da morte por dengue. Critério de \r\nexclusão. Casos não confirmados por patologia ou laboratório. \r\nResultados. 35 casos de morte por dengue foram estudados \r\nentre janeiro de 2010 e maio de 2014; idade média de 27,3 \r\nanos de idade; 51,43% menores de 10 anos de idade; 51,4% do \r\nsexo masculino. O tempo entre o início do aparecimento de \r\nsintomas e a consulta com o sistema de saúde foi de 4 dias. \r\nOs principais sintomas encontrados foram: febre, mialgia, \r\narthralgia, vômitos e dor abdominal. 90% dos pacientes apre\r\n-\r\nsentaram alterações nos testes de função hepática, TGP e TGO, \r\ne, nas alterações da função renal, foi observada uma maior \r\nalteração no BUN. Conclusões. Pessoas menores de 10 anos \r\nde idade, com recursos escassos e que recebem subsídio do \r\ngoverno, têm um maior risco de mortalidade; a dor abdominal \r\ne vômito são importantes preditores de choque. Também \r\nfoi evidenciado que o uso de Aines (NSAIDs em português) \r\naumenta o risco de choque e morte por dengue. Testes de \r\nfunção hepática apresentaram as maiores alterações e não \r\nse utiliza hemoconcentração para avaliar o risco de dengue \r\ngrave. É necessário melhorar a educação e a informação dada \r\nà comunidade para aumentar a chance de consulta. Também \r\né importante melhorar a educação médica contínua, para \r\ngarantir a adesão aos protocolos relacionados à dengue, espe\r\n-\r\ncialmente para ensinar aos pacientes a reconhecer os sinais de \r\nalerta de dengue.

Tactics to improve adherence in depressed primary care patients.

Follow the case of Mr K, a 28-year-old patient who becomes intentionally nonadherent to his antidepressant due to adverse effects. Mr K's symptoms at follow-up suggest that the clinician should consider alternative diagnoses besides major depressive disorder. Reassessment may require additional screening tools and collateral information from patients' family members or friends. Regardless of diagnosis, medication adherence is important. By changing the way that questions are phrased and spending a few extra minutes explaining instructions for successful treatment, clinicians may be able to improve adherence.

Attributable mortality of carbapenem-resistant Klebsiella pneumoniae infections in a prospective matched cohort study in Italy, 2012-2013.

BACKGROUND: In Italy, infections with carbapenem-resistant Klebsiella pneumoniae (CRKP) have increased markedly since 2009, creating unprecedented problems in healthcare settings and limiting treatment options for infected patients. AIM: To assess the attributable mortality due to CRKP in ten Italian hospitals and to describe the clinical characteristics of patients with an invasive CRKP and carbapenem-susceptible K. pneumoniae (CSKP) infection. METHODS: We conducted a matched cohort study, and calculated crude and attributable mortality for CRKP. The attributable mortality was calculated by subtracting the crude mortality rate of the patients with CSKP from the crude mortality rate of the patients with CRKP. We also described the clinical characteristics of CRKP and CSKP patients and analysed the determinants of mortality by using conditional Poisson regression. FINDINGS: The study included 98 patients, 49 with CRKP and 49 with CSKP. CRKP patients had undergone more invasive procedures and also tended to have more serious conditions, measured by higher Simplified Acute Physiology Score II. The attributable mortality of CRKP at 30 days was 41%. CRKP patients were three times more likely to die within 30 days [matched incidence rate ratio (mIRR): 3.0; 95% confidence interval (CI): 1.5-6.1]. Adjusting for potential confounders, the risk remained the same (adjusted mIRR: 3.0; 95% CI: 1.3-7.1). CONCLUSION: CRKP infection had a marked effect on patient mortality, even after adjusting for other patient characteristics. To control the spread of CRKP we recommend prioritization of control measures in hospitals where CRKP is found.

Diagnosing binge eating disorder in a primary care setting.

Binge eating disorder (BED), now recognized as a distinct eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, is the most prevalent eating disorder. Although nearly half of individuals with BED are obese, BED also occurs in nonobese individuals. Despite the relatively high percentage of weight loss treatment-seeking individuals meeting BED criteria, primary care physicians may not be familiar with or have ever diagnosed BED. Many providers may also have difficulty distinguishing BED as a contributory factor in obesity. This review differentiates BED from other causes of obesity by describing how obese individuals with BED differ from obese individuals without BED and from nonobese individuals with BED in areas including psychopathology, behavior, genetics, physiology, quality of life and productivity. The ways in which health-care providers can identify individuals who may have BED are also highlighted so the proper course of treatment is pursued. Overall, obese individuals with BED demonstrate a number of key characteristics that differentiate them from obese individuals without eating disorders, including increased impulsivity in response to food stimuli with loss of control over eating, resulting in the consumption of more calories. They also experience significant guilt and other negative emotions following a meal. In addition, individuals with BED patients have more psychiatric comorbidity, display more psychopathology, exhibit longer binge durations, consume more meals as snacks during the day and have less dietary restraint compared with individuals with BED who are not obese. However, the differences between individuals with BED who are obese versus not obese are not as prominent. Taken together, the evidence appears to support the conclusion that BED is a unique and treatable neurobehavioral disorder associated with distinct behavioral and psychological profiles and distinct medical and functional outcomes, and that it is not merely a subtype of obesity.

Observatorio Nacional de Cáncer Colombia / The Colombian National Cancer Observatory / Observatório Nacional de Câncer Colômbia

En Colombia el cáncer es un problema de salud pública en aumento, que representa grandes repercusiones psicoafectivas, sociales y económicas imponiendo un reto para el sistema de salud. Según las estadísticas del Globocan, para Colombia en el año 2012, aproximadamente 104 personas fallecieron cada día por esta enfermedad y 196 personas enfermaron de cáncer. Esto exige generar intervenciones oportunas, eficaces y articuladas para promover los factores protectores, aumentar la detección temprana, reducir la discapacidad y mortalidad evitables, mejorar la calidad de vida de los pacientes afectados, así como asegurar un desempeño costo-efectivo del sistema sanitario. Aunque se presentan unas cifras breves para revisar el panorama del cáncer en el país, no es el propósito de este artículo proporcionar información estadística que ya se encuentra disponible en el Ministerio de Salud y Protección Social, el Instituto Nacional de Cancerología (inc), el Instituto Nacional de Salud (ins) y los registros poblacionales de cáncer en el país. En su lugar, este artículo describe de forma general los avances y desarrollos del Observatorio Nacional de Cáncer (ONC) Colombia en el marco del Sistema de Información Nacional en Cáncer SINCan, puntualizando las fuentes de información en cáncer disponibles en sispro, el set de indicadores para monitorear el panorama en el país, los planes de análisis y las salidas de información (canales de acceso y divulgación de la evidencia y publicaciones relevantes) como herramientas necesarias para gestionar adecuadamente el conocimiento sobre mortalidad, morbilidad, acceso a servicios y acciones para reducir las desigualdades en cáncer en Colombia.

In Colombia, cancer is a public health problem on the rise that has major psycho-affective, social and economic repercussions. This poses a challenge for the health system. According to the statistics presented by Globocan, in 2012 approximately 104 people died each day in Colombia from this disease, and 196 developed it. This requires generating timely, effective and articulated interventions to promote protective factors, increase early detection, reduce avoidable disability and mortality, improve the quality of life of affected patients and ensure cost-effective health system performance. Although brief figures are presented to review the status of cancer in the country, this paper's authors do not intend to provide statistical data that has already been made available by the Ministry of Health and Social Protection, the National Cancer Institute, the National Institute of Health and the Cancer Population Records of Colombia. Instead, this article aims to broadly describe the progress and developments of the National Cancer Observatory (NCO) of Colombia within the National Information System on Cancer (SINCan). It also describes the cancer information sources available in SISPRO, the set of indicators to monitor the status of this disease in the Country, the analysis plans and the information output mechanisms (channels of access and dissemination of evidence and relevant publications) as the necessary tools to properly manage the knowledge on mortality, morbidity, health service access and actions to reduce cancer inequalities in Colombia.

Na Colômbia o câncer é um problema de saúde pública em aumento, que representa grandes repercussões psicoafetivas, sociais e econômicas impondo um desafio para o sistema de saúde. Segundo as estatísticas do Globocan, para a Colômbia no ano 2012, ao redor de 104 pessoas morreram cada dia e 196 pessoas adoeceram de câncer.Isto exige gerar intervenções oportunas, eficazes e articuladas para alavancar os fatores protetores, aumentar a detecção precoce, reduzir a deficiência e mortalidade evitáveis, melhorar a qualidade de vida dos pacientes afetados, bem como garantir um desempenho custo-efetivo do sistema sanitário. Embora sejam apresentadas umas curtas cifras para analisar o panorama do câncer no país, não é a intenção deste artigo fornecer informação estatística já disponível no Ministério da Saúde e Assistência Social, no Instituto Nacional de Cancerologia INC, no Instituto Nacional de Saúde INS e nos Registros Populacionais de Câncer no país. Em vez disso, este artigo descreve, grosso modo, os avanços e progressos do Observatório Nacional de Câncer (ONC) Colômbia no quadro do Sistema de Informação Nacional em Câncer SINCan, salientando as fontes de informação em câncer disponíveis em SISPRO, o conjunto de indicadores para monitorar o panorama no país, os planos de análise e as saídas de informação (canais de acesso e divulgação da evidência e publicações relevantes) como ferramentas necessárias para gerenciar adequadamente o conhecimento sobre mortalidade, morbilidade, acesso a serviços e ações para reduzir as desigualdades em câncer na Colômbia.