Clinical guideline for the treatment of dual pathology in the adult population.

Editorial del vol 28-1.

Impact of substance use on the physical health of patients with bipolar disorder.

OBJECTIVE: To describe the impact of tobacco, alcohol and cannabis on metabolic profile and cardiovascular risk in bipolar patients. METHOD: Naturalistic, cross-sectional, multicenter Spanish study. Current use of tobacco, alcohol and cannabis was determined based on patient self-reports. Metabolic syndrome was defined using the National Health and Nutrition Examination Survey 1999-2000 and the American Heart Association/National Heart, Lung and Blood Institute criteria, and cardiovascular risk using the Framingham and the Systematic Coronary Risk Evaluation functions. RESULTS: Mean age was 46.6 years, 49% were male. Substance use: 51% tobacco, 13% alcohol and 12.5% cannabis. Patients who reported consuming any substance were significantly younger and a higher proportion was male. After controlling for confounding factors, tobacco was a risk factor for coronary heart disease (CHD) (unstandardized linear regression coefficient 3.47, 95% confidence interval 1.85-5.10). CONCLUSION: Substance use, mainly tobacco, was common in bipolar patients. Tobacco use negatively impacted CHD risk.

The blind men and the elephant: Systematic review of systematic reviews of cannabis use related health harms.

Cannabis is the third most used psychoactive substance worldwide. The legal status of cannabis is changing in many Western countries, while we have very limited knowledge of the public health impact of cannabis-related harms. There is a need for a summary of the evidence of harms and risks attributed to cannabis use, in order to inform the definition of cannabis risky use. We have conducted a systematic review of systematic reviews, aiming to define cannabis-related harms. We included systematic reviews published until July 2018 from six different databases and following the PRISMA guidelines. To assess study quality we applied the AMSTAR 2 tool. A total of 44 systematic reviews, including 1,053 different studies, were eligible for inclusion. Harm was categorized in three dimensions: mental health, somatic harm and physical injury (including mortality). Evidence shows a clear association between cannabis use and psychosis, affective disorders, anxiety, sleep disorders, cognitive failures, respiratory adverse events, cancer, cardiovascular outcomes, and gastrointestinal disorders. Moreover, cannabis use is a risk factor for motor vehicle collision, suicidal behavior and partner and child violence. Cannabis use is a risk factor for several medical conditions and negative social consequences. There is still little data on the dose-dependency of these effects; evidence that is essential in order to define, from a public health perspective, what can be considered risky use of cannabis. This definition should be based on quantitative and qualitative criteria that informs and permits the evaluation of current approaches to a regulated cannabis market.

Extraperitoneal laparoscopic ventral hernia repair: one step beyond.

PURPOSE: The objective of the study was to analyze the experience of the Department of Surgery of two institutions of high complexity in Colombia, with the extra peritoneal ventral hernia repair by laparoscopy during the last 2 years and characterize the clinical and surgical aspects most relevant in the procedures performed. METHODS: Observational, descriptive, retrospective study, case series type: collection of data by clinical history and analysis thereof including calculation of frequency and central tendency measurements. RESULTS: 59 Cases of Ventral Hernia Repair by laparoscopy, 41 with Transabdominal Preperitoneal approach and 18 totally Extraperitoneal. In total, 7 complications were presented as follows: 1 Case of recurrence, 1 case of chronic pain, 2 complications Dindo-Clavien IIIa and 1 complication IIIb. CONCLUSIONS: The repair of the ventral hernia by Extraperitoneal route is an innovative approach of increasing popularity, which avoids the contact of the mesh with the intestines, thus avoiding the potential complications that this situation generates with good outcomes and at a lower cost.

Personality disorders, addictions and psychopathy as predictors of criminal behaviour in a prison sample.

AIMS: Disturbances in personality and addictions are associated with an increased risk of committing crimes and therefore of being imprisoned. In this study, the relationship between these factors is analyzed through a sample of inmates in the Prison of Pereiro de Aguiar, Ourense. MATERIAL AND METHOD: 204 inmates participated in this transversal simple blind design study. The following variables were analyzed: presence of personality disorders and psychopathy, history of addictive psychoactive substance use, criminal history and socio-demographic variables. RESULTS: 101 (49.5%) inmates received a diagnosis of personality disorder, the most frequent being: narcissistic, 43 (21.08%); antisocial, 38 (18.63%); and paranoid, 29 (14.22%). The presence of any personality disorder was associated with an increase in the risk of committing crimes, especially violence and crimes against property. The most frequent personality disorders were associated with higher scores in the psychopathy assessment tools. Higher scores in the Psychopathy Checklist Reviewed (PCL-R) correlated with an increased risk of committing the following crimes: violent, against public health, against property and disorderly conduct. The consumption of addictive psychoactive substances was associated with the commission of crimes against property. Methadone stood out for its protective role against the commission of violent crimes. DISCUSSION: This sample shows that inmates have a higher prevalence of personality disorders, psychopathy and consumption of addictive psychoactive substances. These three variables significantly increased the risk of committing crimes.

Pandemia COVID-19: ¿Qué más puedo hacer? / COVID-19 Pandemic: What Else Can I Do?

En estas últimas semanas marcadas por la pandemia de COVID-19, en Europa se ha popularizado una frase que traducida de su original italiano dice: "Recuerda que a nuestros abuelos se les ordenó ir a la guerra, ¡a nosotros todo lo que se nos pide es quedarnos en el sillón!".Aunque científicos de diferentes países y organizaciones están trabajando de manera acelerada en el desarrollo de una vacuna efectiva y en tener fármacos que ayuden en el tratamiento de esta enfermedad, hasta ahora lo mejor que se puede hacer para evitar la propagación acelerada del virus son las medidas higiénicas y de distanciamiento preventivo. Sin embargo, muchos nos preguntamos ¿qué más podemoshacer además de evitar o retrasar la infección? ¿Es posible mejorar nuestras dificultades de enfrentarexitosamente esta enfermedad?

In these last weeks about by the COVID-19 pandemic, a phrase has become popular in Europe that, translated from its Italian antive says: "Remember that our grandparents were ordered to go to war; ¡all that is asked of us, is just to stay on the couch!". Although scientists from different countries and organizations are working rapidly to develop an effective vaccine and to have drugs that help treat this disease, until now the best thing to do to prevent the rapid spread of the virus is through measures hygienic and preventive distancing. However, many of us wonder what else we can do besides avoiding or delaying infection? Is it possible to improve our chances of successfully dealing with this disease?

Prevalencia de endoparásitos gastrointestinales y ectoparásitos en serpientes ex situ en Barranquilla, Colombia / Prevalence of gastrointestinal endoparasites and ectoparasites in ex situ snakes in Barranquilla, Colombia

RESUMEN Objetivo. Identificar la prevalencia de endoparásitos y ectoparásitos en serpientes ex situ en la Fundación Botánica y Zoológica de Barranquilla "Barranquilla Zoo". Materiales y métodos. Para esto se analizaron muestras de materia fecal y ectoparásitos de 2 colúbridos (Leptophis ahaetulla y Spilotes pullatus), 2 dipsadinos (Oxybelys aeneus y Thamnodynastes paraguanae) y 13 boidos (9 individuos de la especie Boa constrictor, 2 de Epicrates maurus y 2 de Eunectes murinus) utilizando los métodos de flotación en solución saturada de azúcar y observación directa. Resultados. Los resultados obtenidos mostraron que el 65% (11/17) de los animales evaluados fueron positivos a la presencia de parásitos, de los cuales el 91% (10/11) de los ejemplares pertenece a la familia Boidae presentando en su mayoría nematodos, mientras que en los dipsadinos se observaron principalmente protozoarios y los colúbridos resultaron negativos. Finamente como ectoparásitos se identificaron 2 especies de garrapatas (Amblyomma dissimile y Ornothodoros turicata) halladas en ejemplares de Boa constrictor, Epicrates maurus y Spilotes pullatus. Conclusiones. La identificación de las formas parasitarias en este trabajo representa una contribución para el conocimiento de los parásitos en serpientes ex situ en Colombia. Provee información para desarrollar medidas profilácticas y permite comparar los datos sobre las formas parasitarias encontradas con muestreos de estas especies en vida silvestre y bajo cuidados humanos.

ABSTRACT Objective. Identify the prevalence of internal and external parasites in ex situ snakes at the Fundación Botánica y Zoológica de Barranquilla "Barranquilla Zoo". Materials and methods. Stool samples and ectoparasites of 2 colubrids (Leptophis ahaetulla and Spilotes pullatus), 2 diapsids (Oxybelys aeneus and Thamnodynastes paraguanae) and 13 boids (9 individuals of Boa constrictor, 2 of Epicrates maurus and 2 Eunectes murinus) were analyzed using flotation method in saturated sugar solution and direct observation. Results. The results showed that 65% (11/17) of the population was positive to the presence of parasites. In relation to the positive specimens, 91% (10/11) belong to the Boidae family, presenting mostly nematodes, in the dipsadid's samples mainly protozoans were observed and the colubrid's samples were negative. Regarding ectoparasites, 2 species of ticks (Amblyomma dissimile and Ornothodoros turicata) were found in specimens of Boa constrictor, Epicrates maurus and Spilotes pullatus. Conclusions. The identification of parasitic forms in this paper represents a contribution to the knowledge of parasites in snakes ex situ in Colombia. It provides information to develop prophylactic measures against these pathological agents and also allows comparing the data about the parasitic forms found with other researches in the wild and in captivity.

Psychoneuroendocrinological and immunological parameters in cancer patients: involvement of stress and depression.

Plasma noradrenaline (NA), adrenaline (A), dopamine (DA), platelet serotonin (pS), free serotonin (fS), cortisol (CRT), growth hormone (GH), peripheral blood lymphocytes (lymph), lymphocyte subpopulations (LSS) and CD4/CD8 ratio were serially assessed in 50 non-medicated, advanced cancer patients (spontaneous evolution) and in age- and sex-paired controls. Clonidine tests and psychiatric evaluations were also serially performed. Patients showing long symptomless periods had all normal values except for raised pS, whereas those who remained free of symptoms for only a short time had raised NA, A and CRT, plus lowered pS values. Further increases in NA, A and CRT, plus additional increases in DA and fS, occurred during exacerbation periods, during which times reductions in lymph, LSS and NK also were observed. Patients in terminal stages showed maximal decreases of all neurotransmitters and immunological parameters; only DA and fS remained raised. Psychiatric interviews performed simultaneously with the clonidine tests revealed a low incidence of moderate depression during symptomless periods and no depression during exacerbation periods. Several significant positive and negative correlations between neurotransmitters and immunological parameters were found during exacerbation periods. Pain, although not intense, and other symptoms required occasional administration of low doses of non-opiate analgesics.

Trastornos de la personalidad, adicciones y psicopatía como predictores de la conducta delictiva en una muestra penitenciaria / Personality disorders, addictions and psychopathy as predictors of criminal behaviour in a prison sample

Objetivo: Las perturbaciones de la personalidad y las adicciones se asocian con un aumento del riesgo de cometer delitos y, con ello, de ingresar en prisión. En este estudio se analiza la relación entre estos factores con una muestra de internos en el Centro Penitenciario de Pereiro de Aguiar de Ourense. Material y método: 204 internos participaron en este estudio transversal retrospectivo con un diseño ciego simple. Se analizaron las siguientes variables: trastornos de la personalidad y psicopatía, consumo de sustancias, historial delictivo y variables sociodemográficas. Resultados: 101 (49,5%) internos recibieron un diagnóstico de trastorno de la personalidad. Los más frecuentes fueron: narcisista, 43 (21,08%); antisocial, 38 (18,63%); y paranoide, 29 (14,22%). La presencia de cualquier trastorno de la personalidad se asoció a un aumento en el riesgo de cometer delitos, especialmente delitos violentos y contra la propiedad. Los trastornos de la personalidad más frecuentes se asociaron a puntuaciones más elevadas en los instrumentos de valoración de la psicopatía. Puntuaciones elevadas en la escala de evaluación de psicopatía de Hare revisada (Psychopathy Checklist Reviewed, PCL-R) se correlacionaron con un mayor riesgo de cometer delitos violentos, contra la salud pública, contra la propiedad y de alteración del orden público. El consumo de sustancias adictivas se asoció a la comisión de delitos contra la propiedad. La metadona destacó por su papel protector frente a la comisión de delitos violentos. Discusión: En esta muestra, se objetiva que los internos presentan una mayor prevalencia de trastornos de la personalidad, psicopatía y consumo de sustancias adictivas. Estas tres variables aumentaron de forma significativa el riesgo de cometer delitos

Aims: Disturbances in personality and addictions are associated with an increased risk of committing crimes and therefore of being imprisoned. In this study, the relationship between these factors is analyzed through a sample of inmates in the Prison of Pereiro de Aguiar, Ourense. Material and method: 204 inmates participated in this transversal simple blind design study. The following variables were analyzed: presence of personality disorders and psychopathy, history of addictive psychoactive substance use, criminal history and socio-demographic variables. Results: 101 (49.5%) inmates received a diagnosis of personality disorder, the most frequent being: narcissistic, 43 (21.08%); antisocial, 38 (18.63%); and paranoid, 29 (14.22%). The presence of any personality disorder was associated with an increase in the risk of committing crimes, especially violence and crimes against property. The most frequent personality disorders were associated with higher scores in the psychopathy assessment tools. Higher scores in the Psychopathy Checklist Reviewed (PCL-R) correlated with an increased risk of committing the following crimes: violent, against public health, against property and disorderly conduct. The consumption of addictive psychoactive substances was associated with the commission of crimes against property. Methadone stood out for its protective role against the commission of violent crimes. Discussion: This sample shows that inmates have a higher prevalence of personality disorders, psychopathy and consumption of addictive psychoactive substances. These three variables significantly increased the risk of committing crimes

A simple analytical expression to calculate the backscatter factor for low energy X-ray beams.

A simple analytical expression aiming to calculate the backscatter factor used in dosimetry protocols to determine the absorbed dose in water for low energy X-rays beams is presented. This expression is based on the linear dependence of the backscatter factor with the generating potential, for fixed values of the half-value layer. The results of a recent work in which 74 X-ray beams with different spectroscopic characteristics, generated with the code (xcomp5r) and transported with the Monte Carlo code (penelope) have been used. The expression derived permits to calculate the backscatter factor within 5% accuracy. The predictive power of this expression has been tested for 20 X-ray beams generated with potentials from 50 to 250 kV, for which half-value layers and backscatter factors have been experimentally determined.

Comunidades Embera y Wounaan del departamento de Chocó: prácticas de cuidado durante el proceso de gestación / Communities Wounaan and Embera Chocó department: care practices during pregnancy

OBJETIVO: describir las prácticas durante el proceso de gestación en las comunidades Embera y Wounaan del departamento de Chocó. METODOLOGIA: se realizó un estudio cualitativo de tipo exploratorio, por medio de entrevistas en profundidad a mujeres indígenas gestantes, mujeres indígenas líderes en salud y hombres líderes y promotores de los pueblos Embera y Wounaan del departamento de Chocó, para un total de 19 entrevistas, y se utilizó el diseño metodológico de Taylor y Bogdan para el análisis de las mismas. RESULTADOS : las comunidades realizan unas prácticas durante la gestación enfocadas básicamente en los cuidados buscados por la pareja para la gestante, cuidados ofrecidos por la familia a la gestante, alimentación durante la gestación y actividades realizadas por la gestante. CONCLUSION:las comunidades Embera y Wounaan realizan diversas prácticas de cuidado alrededor de la gestación que propenden por la protección de la vida de la gestante y del bebé, es así como la pareja, la familia y la comunidad en algunos momentos acompañan a la mujer.

OBJECTIVE: to describe the care practices during pregnancy of the Embera and Wounaan communities from the Chocó department. METHODOLOGY: an exploratory qualitative study was carried out;data was collected through in-depth interviews with pregnant indigenous women, indigenous women who are health leaders in their communities and with men who are leaders and promoters among the Wounaan and Embera communities in the Chocó department.A total of 19 interviews were conducted and the Taylor & Bogdan methodological design was used to analyze them. RESULTS :the practices performed by these communities during pregnancy mainly involve the mother being taken care of by her partner and their family; they also involve a particulardiet during gestation as well assome activities of the mother. CONCLUSION:the Wounaan and Embera communities perform various care practices regarding pregnancy in order to protect the life of both the mother and her child. As a result of this, the partner, the family and, at times, the community support the mother.

Gangrena de Fournier en asociación con el uso de anti-inflamatorios no esteroideos: Reporte de un caso pediátrico / An unusual presentation of Fournier's gangrene: ¿Is there a relationship with NSAID use? Pediatric case report

La gangrena de Fournier es una enfermedad amenazante para la vida, que se caracteriza por fascitis necrosante del área perineal. Afecta con mayor frecuencia a pacientes adultos con inmunosupresión y son pocos los casos reportados en la población pediátrica. El uso de fármacos anti-inflamatorios no esteroideos (AINEs) se ha asociado con fascitis necrosante, probablemente por supresión de la inmunidad durante la infección. Describimos el caso de un paciente con 6 meses de edad sin factores inmu-nosupresores, con gangrena de Fournier, probablemente asociada a la ingesta de AINEs.

Founier's gangrene is a rare but life-threatening disease characterized by necrotizing fasciitis of the perineal area. It mostly affects adult patients with an immunosuppressant factor and there are only a few cases reported in children. Use of nonsteroidal anti-inflammatory drugs has been associated with necrotizing fasciitis probably because of suppressing host immunity during infection. We describe a case of a six month old infant without im-munosuppressant factors, with Founier´s gangrene probably associated with nonsteroidal anti-inflammatory intake.

The occult intrasacral meningocele.

Three cases of occult intrasacral meningocele, one of them with an intrasacral and presacral neurofibroma, are reported. The literature is briefly reviewed. Pathogenesis, clinical picture, radiological findings and surgical treatment are discussed.

Percutaneous rhizotomy of the articular nerve of Luschka for low back and sciatic pain.

The results of percutaneous facet rhizotomy for the treatment of low back and sciatic pain in 30 patients are reported. Satisfactory results were obtained in 76% of cases. No complications were found. This procedure should be tried in every patient with low back and extremity pain and no major neurological deficit before resorting to laminectomy.

Immunological diagnosis of echinococcosis.

Our results with the immunofluorescence technique in the diagnosis of hydatid disease are reported. The sera of 28 patients with surgically proven hydatid disease, of 30 healthy individuals, and of 1 patient with cysticercosis were used. With a dilution of 1:100 a sensitivity of 96% was obtained in the patients affected by the disease. In the control group all but one of the sera were negative. A brief review of the immunological methods used at present for the diagnosis of echinococcosis is made. The most important problems connected with the immunodiagnosis of this disease are discussed.

Increased intracranial pressure associated with spinal cord tumours.

Two cases of spinal cord tumour associated with increased intracranial pressure are reported and the 44 cases described in the literature are reviewed. The different hypotheses produced to explain the pathogenic mechanism of this syndrome are discussed. We think that several factors working together, rather than an isolated mechanism, take part in the production of this syndrome.

Changes in serum and cerebrospinal fluid enzyme activity after head injury.

We studied simultaneously in serum (S) and CSF (L) the enzyme activities of GOT, GPT, LDH, ICDH, MDH, ALD, and CPK in 28 patients with head injuries divided into three groups according to the severity of the trauma. We found a correlation between severity of brain lesion and enzyme activity. The best correlation was found for SGOT, SCPK, LGOT, LLDH, LMDH and LCPK. We do not believe that enzyme activity is of prognostic value. We think that further studies should be made of the specific isoenzymes of the Central Nervous System.