[Association between obesity and chronic renal disease]. / Obesidad y enfermedad renal crónica: Una peligrosa asociación.

A higher frequency of chronic renal disease is observed in obese patients, suggesting a pathogenic association between both conditions. Obesity unmasks clinical manifestations of chronic kidney disease such as high blood pressure, which may accelerate its progression. Obesity also promotes hyper filtration and the appearance of microalbuminuria, activates the renin-angiotensin-aldosterone system and is associated with high levels of pro-inflammatory cytokines. Therefore weight reduction may slow the progression of chronic renal disease and reduce its associated cardiovascular risk factors.

Case report: Thrombotic thrombocytopenic purpura in a pregnant woman with lupus membranous nephropathy: a diagnostic challenge.

A 27-year-old female at 20th week of pregnancy was admitted with edema, foamy urine, but normal blood pressure. Her blood count was normal, she had proteinuria of 3 g/day, creatinine 0.4 mg/dl, albumin 2.4 g/dl, and cholesterol 355 mg/dl. Antinuclear antibodies 1/160, but Anti-DNA, anticardiolipin antibodies and lupus anticoagulant were negative, with normal serum C3 and C4. A renal biopsy showed secondary membranous glomerulopathy, most likely lupus class V pure. Steroids, azathioprine, and aspirin were initiated, up to 28 weeks of pregnancy, when she developed severe hypertension, photopsia, headache, anasarca, extensive bruising of the extremities, severe anemia, thrombocytopenia, and creatinine rose to 2.09 mg/dl with preserved diuresis. A female infant, 1045 grams, was delivered by emergency caesarean section. Following the surgery, she experienced diplopia, dysarthria, bradypsychia, and sensory alterations in the lower extremities, necessitating emergency hemodialysis due to pulmonary congestion. Blood smear revealed schistocytes, LDH elevated at 1148 IU/L, while transaminases and liver function remained normal, suggesting thrombotic thrombocytopenic purpura. ADAMTS13 revealed 6% activity with the presence of inhibitor. Mycophenolate and daily plasmapheresis with fresh frozen plasma replacement yielded unsatisfactory response, unaffected by the addition of methylprednisolone pulses and rituximab. Eventually, intravenous cyclophosphamide was introduced, resulting in complete hematological remission and normalization of ADAMTS13, however dialysis-dependence persisted and four years later, right renal cancer prompted bilateral nephrectomy. After a total follow-up of six years, she remained free of neoplastic recurrence and lupus activity, receiving prednisone and hydroxychloroquine. The differential diagnosis of microangiopathic syndrome in a pregnant lupus patient is discussed.

Efficacy and safety of proactive drug monitoring in inflammatory bowel disease treated with anti-TNF agents: A systematic review and meta-analysis.

BACKGROUND AND AIMS: A systematic review and a meta-analysis of the literature was conducted to assess efficacy and safety of proactive therapeutic drug monitoring (TDM) versus conventional management during maintenance treatment with anti-tumour necrosis factor (anti-TNFα) in patients with inflammatory bowel disease (IBD). METHODS: A search was conducted up to January 2022 (MEDLINE, EMBASE, and the Cochrane Library). The primary outcome was the ability to maintain clinical remission at 12 months. The certainty of evidence was determined using the GRADE approach. RESULTS: Nine studies were identified: one systematic review, six randomised clinical trials, and two cohort studies. No superior efficacy of proactive TDM [relative risk 1.16; 95% confidence interval (CI): 0.98-1.37, n=528; I2=55%] was shown. Proactive TDM could improve the durability of anti-TNFα treatment [odds ratio (OR) 0.12; 95%CI: 0.05-0.27; n=390; I2=45%), prevent acute infusion reactions (OR 0.21; 95%CI: 0.05-0.82; n=390; I2=0%), decrease adverse events (OR 0.38; 95%CI: 0.15-0.98; n=390; I2=14%), and reduce the probability of surgery, at lower economical expenditure. CONCLUSIONS: The analysed evidence did not confirm the superiority of proactive TDM of anti-TNFα treatment over conventional management in patients with IBD, so proactive TDM should not currently be recommended.

Into the Void: Single Nanopore in Colloidally Synthesized Bi2Te3 Nanoplates with Ultralow Lattice Thermal Conductivity.

Bi2Te3 is a well-known thermoelectric material that was first investigated in the 1960s, optimized over decades, and is now one of the highest performing room-temperature thermoelectric materials to-date. Herein, we report on the colloidal synthesis, growth mechanism, and thermoelectric properties of Bi2Te3 nanoplates with a single nanopore in the center. Analysis of the reaction products during the colloidal synthesis reveals that the reaction progresses via a two-step nucleation and epitaxial growth: first of elemental Te nanorods and then the binary Bi2Te3 nanoplate growth. The rates of epitaxial growth can be controlled during the reaction, thus allowing the formation of a single nanopore in the center of the Bi2Te3 nanoplates. The size of the nanopore can be controlled by changing the pH of the reaction solution, where larger pores with diameter of ∼50 nm are formed at higher pH and smaller pores with diameter of ∼16 nm are formed at lower pH. We propose that the formation of the single nanopore is mediated by the Kirkendall effect and thus the reaction conditions allow for the selective control over pore size. Nanoplates have well-defined hexagonal facets as seen in the scanning and transmission electron microscopy images. The single nanopores have a thin amorphous layer at the edge, revealed by transmission electron microscopy. Thermoelectric properties of the pristine and single-nanopore Bi2Te3 nanoplates were measured in the parallel and perpendicular directions. These properties reveal strong anisotropy with a significant reduction to thermal conductivity and increased electrical resistivity in the perpendicular direction due to the higher number of nanoplate and nanopore interfaces. Furthermore, Bi2Te3 nanoplates with a single nanopore exhibit ultralow lattice thermal conductivity values, reaching ∼0.21 Wm-1K-1 in the perpendicular direction. The lattice thermal conductivity was found to be systematically lowered with pore size, allowing for the realization of a thermoelectric figure of merit, zT of 0.75 at 425 K for the largest pore size.

Development and validation of a clinical score for identifying patients with high risk of latent autoimmune adult diabetes (LADA): The LADA primary care-protocol study.

BACKGROUND: Latent autoimmune diabetes in adults (LADA) is a type of diabetes mellitus showing overlapping characteristics between type 1 Diabetes Mellitus and type 2 Diabetes Mellitus (T2DM), and autoimmunity against insulin-producing pancreatic cells. For its diagnosis, at least one type of anti-pancreatic islet antibody (GADAb is the most common) is required. Many authors recommend performing this measure in all newly diagnosed patients with DM, but it is not possible in Primary Health Care (PHC) due to its high cost. Currently, a relevant proportion of patients diagnosed as T2DM could be LADA. Confusing LADA with T2DM has clinical and safety implications, given its different therapeutic approach. The main objective of the study is to develop and validate a clinical score for identifying adult patients with DM at high risk of LADA in PHC. METHODS: This is an observational, descriptive, cross-sectional study carried out in Primary Care Health Centers with a centralized laboratory. All people over 30 years of age diagnosed with diabetes within a minimum of 6 months and a maximum of 4 years before the start of the study will be recruited. Individuals will be recruited by consecutive sampling. The study variables will be obtained through clinical interviews, physical examinations, and electronic medical records. The following variables will be recorded: those related to Diabetes Mellitus, sociodemographic, anthropometric, lifestyle habits, laboratory parameters, presence of comorbidities, additional treatments, personal or family autoimmune disorders, self-perceived health status, Fourlanos criteria, and LADA diagnosis (as main variable) according to current criteria. DISCUSSION: The study will provide an effective method for identifying patients at increased risk of LADA and, therefore, candidates for antibody testing. However, a slight participation bias is to be expected. Differences between participants and non-participants will be studied to quantify this potential bias.

[Organizational procedures and health care management. A point of view from primary care centres]. / Medidas organizativas y práctica asistencial. Una perspectiva desde los centros de salud.

OBJECTIVE: We aimed to know how the directive teams perceive the implementation of organizational procedures in relation with the health care management in the primary care setting. DESIGN: Multicentre cross-sectional descriptive study. SETTING: Area 11 Madrid Primary Care Service, Spain. PARTICIPANTS: All directive teams of primary care centres (PCC) (n=38). MEASUREMENTS: Data were collected with a self-administered semiestructured questionnaire which included 21 main questions about procedures and use of internal organizational measures relating to the health care management in PCC, grouped in five sections: predictable and non predictable consultations(clinical and administrative), clinical schedules and office management. RESULTS: 100% response rate. 69% of PCC use internal procedures and computerized applications for the renewal of medical chronic prescriptions and 55% for temporary disability. 71% show nurse involvement in terms of dispensing medical prescriptions during clinical consultations. 42% keep on performing administrative procedures of specialized care. 21% don't get compliance with routine control of programs and in 29% of consultations duplicity of visits among medicine and nursing are expected. 97% follow a specific process for urgent attention. 84% request subsequent appointment in the previous clinical consultation. 29% have open schedules availables for 6 months. CONCLUSIONS: A wide variability of the implementation of organizational procedures in PCC was observed. Further research is needed to determine whether any organizational and professional changes could contribute to improve efficiency and patient satisfaction.

Effect of CYP3A4, CYP3A5, MDR1 and POR Genetic Polymorphisms in Immunosuppressive Treatment in Chilean Kidney Transplanted Patients.

Cyclosporine (CsA) and tacrolimus (TAC) are immunosuppressant drugs characterized by a narrow therapeutic range and high pharmacokinetic variability. The effect of polymorphisms in genes related to the metabolism and transport of these drugs, namely CYP3A4, CYP3A5, MDR1 and POR genes, has been evaluated in diverse populations. However, the impact of these polymorphisms on drug disposition is not well established in Latin American populations. Using TaqMan® probes, we determined the allelic frequency of seven variants in CYP3A4, CYP3A5, MDR1 and POR in 139 Chilean renal transplant recipients, of which 89 were treated with CsA and 50 with TAC. We tested associations between variants and trough and/or 2-hour concentrations, normalized by dose (C0/D and C2/D) at specific time points post-transplant. We found that CYP3A5*3/*3 carriers required lower doses of TAC. In TAC treated patients, most CYP3A5*3/*3 carriers presented higher C0/D and a high proportion of patients with C0 levels outside the therapeutic range relative to other genotypes. These results reinforce the value of considering CYP3A5 genotypes alongside therapeutic drug monitoring for TAC treated Chilean kidney recipients.

Switching from Premixed Insulin To Basal Insulin Analogue For Type 2 Diabetes and Role of Dipeptidyl Peptidase-4 Inhibitors.

INTRODUCTION: This study aimed to confirm the usefulness of basal insulin analogue plus oral antidiabetic drugs (OADs) for type 2 diabetes (T2D) patients inadequately controlled with premixed insulin with/without OADs and assess the role of dipeptidyl peptidase-4 (DPP-4) inhibitors within this regimen in clinical practice. METHODS: Spanish retrospective observational study that included 186 T2D patients with glycosylated hemoglobin (HbA1c) >7% (53 mmol/mol) despite premixed insulin with/without OADs who had been switched to basal insulin analogue plus OADs. Study data describing the situation before the treatment switch and 6 months later was retrospectively retrieved from patients' medical charts. RESULTS: Switching to a basal insulin plus OADs decreased HbA1c (-1.0%, p<0.001), fasting (-38.1 mg/dl, p<0.001) and postprandial glycemia (-36.1 mg/dl, p<0.001), with reduced body weight (-1.1 kg, p<0.001) and hypoglycemic episodes (-17.5%, p<0.001). 68 (36.6%) patients received a basal insulin plus DPP-4 inhibitor±metformin and 74 (39.8%) plus metformin only. The DPP-4 inhibitor±metformin group showed a greater HbA1c reduction than the metformin group (1.3±1.4% vs. 0.9±1.0%, p=0.022), with no significant differences between groups in hypoglycemic episodes. CONCLUSIONS: Basal insulin analogue plus OADs may be a useful treatment for type 2 diabetes patients inadequately controlled with premixed insulin. Administering DPP-4 inhibitors within this regimen may contribute to improve patients' glycemia, with a favorable weight-change profile and without increasing hypoglycemia risk.

Revisión de los perfiles aerodinámicos apropiados para turbinas eólicas de eje horizontal y de pequeña escala en zonas boscosas / A review of horizontal axis small wind turbine blades suitable for wooded areas / Revisão dos perfis aerodinâmicos apropriados para turbinas eólicas de eixo horizontal e pequena escala nas zonas arborizadas

Resumen Introducción: la energía eólica ha crecido de forma acelerada en los últimos 20 años y los sitios para instalar parques eólicos se empiezan a agotar. Las turbinas eólicas de pequeña escala representan una alternativa viable, en particular en zonas boscosas: de bajo potencial eólico y alta turbulencia. Objetivo: presentar una revisión de los perfiles aerodinámicos para aerogeneradores de pequeña escala, para determinar su posible aplicación en zonas boscosas. Materiales y métodos: se efectúa una revisión literaria en las bases de datos Web of Science y Scopus, sobre turbinas eólicas de pequeña escala de eje horizontal, en las revistas Energy, Journal of Wind Engineering and Industrial Aerodynamics, Renewable and Sustainable Energy Reviews y Renewable Energy, entre otras. Se define una clasificación de tres grandes grupos para los perfiles aerodinámicos: de uso muy frecuente, de uso con frecuencia media y de uso con baja frecuencia. Resultados: los perfiles de uso muy frecuente son el SG6043, S809 y NACA0012, siendo el primero de ellos el que presenta mejor desempeño aerodinámico. A pesar de esto, otros perfiles como el SH3055 son ampliamente usados en turbinas eólicas de pequeña escala. Conclusiones: un perfil adecuado para una turbina eólica de pequeña escala para zonas boscosas debe ser diseñado para regulación por pérdida (stall) y poseer una alta robustez ante cambios de rugosidad superficial. El perfil con mayor potencial, según la literatura para esta aplicación, es el SG6043, siendo 110 % y 85 % más eficiente que NACA0012 y S809, respectivamente, para un Re de 2 x 105; empero, se requiere más investigación en temas como desempeño aerodinámico de los perfiles ante altos niveles de turbulencia.

Abstract Introduction: Wind energy has grown rapidly in the last 20 years and sites to install full-scale wind farms are starting to run out. Small-scale wind turbines represent a feasible alternative, particularly in forested areas of low wind potential and high turbulence. Objective: to present a review of the aerodynamic profiles for small-scale wind turbines, to determine their possible application in wooded areas. Materials and methods: a review of small-scale horizontal axis wind turbines is carried out using the Web of Science and Scopus databases mainly on the journals: Energy, Wind Engineering and Industrial Aerodynamics, Renewable and Sustainable Energy Reviews, and Renewable Energy. A classification of three large groups is defined for the aerodynamic profiles: very frequent use, medium frequency use and low frequency use. Results: the profiles of very frequent use are the SG6043, S809 and NACA0012, the first of them is the one having the best aerodynamic performance. Despite this, other profiles such as the SH3055 are widely used in the small-scale wind turbine field. Conclusions: a suitable profile for a small-scale wind turbine for forested areas should be designed for stall regulation and have low sensitivity against changes in surface roughness. The profile with the greatest potential, according to the literature for this application, is the SG6043, being 110 % y 85 % more efficient than NACA0012 and S809, respectively, for a Re of 2 x 105; however, more research is required on issues such as aerodynamic performance of the profiles at high levels of turbulence.

Resumo Introdução: a energia eólica há crescido de forma acelerada nos últimos 20 anos e os sítios para instalar parques eólicos empeçam a diminuir. As turbinas eólicas de pequena escala representam uma alternativa viável, em particular nas zonas arborizadas: de baixo potencial eólico e alta turbulência. Objetivo: apresentar uma revisão dos perfis aerodinâmicos para aerogeradores de pequena escala, para determinar uma possível aplicação nas zonas arborizadas. Materiais e métodos: efetuou-se uma revisão literária nas bases de dados Web of Science e Scopus, sobre turbinas eólicas de pequena escala de eixo horizontal, nos jornais Energy, Journal of Wind Engineering and Industrial Aerodynamics, Renewable and Sustainable Energy Reviews e Renewable Energy, entre outras. Define-se uma classificação dos três grandes grupos para os perfis aerodinâmicos: de uso muito frequente, de uso com frequência meia e de uso com baixa frequência. Resultados: os perfis de uso muito frequente são o SG6043, S809 y NACA0012, sendo o primeiro deles o que apresenta melhor desempenho aerodinâmico. Apesar disso, os perfis como o SH3055 são amplamente usados nos negócios das turbinas eólicas. Conclusões: um perfil adequado para uma turbina eólica de pequena escala para zonas arborizadas deve ser projetado para regulação por stall e possuir uma alta robustez ante mudanças na rugosidade superficial. O perfil com maior potencial, segundo a literatura e para essa aplicação é o SG6043, sendo 110 % e 85 % mais eficiente que NACA0012 e S809, respectivamente, para um Re de 2x 105, no entanto, requere mais investigação em temas como o desempenho aerodinâmico dos perfis

Obesidad y enfermedad renal crónica: Una peligrosa asociación / Association between obesity and chronic renal disease

A higher frequency of chronic renal disease is observed in obese patients, suggesting a pathogenic association between both conditions. Obesity unmasks clinical manifestations of chronic kidney disease such as high blood pressure, which may accelerate its progression. Obesity also promotes hyper filtration and the appearance of microalbuminuria, activates the renin-angiotensin-aldosterone system and is associated with high levels of pro-inflammatory cytokines. Therefore weight reduction may slow the progression of chronic renal disease and reduce its associated cardiovascular risk factors.

Pacto suicida en gemelos / Suicide pact in twins

Los pactos suicidas son excepcionales. Presentamos la muerte suicida simultánea de 2 hermanos gemelos monocigóticos de 46 años de edad, por atropello de tren. Ambos gemelos presentaban antecedentes psiquiátricos de tipo ansioso-depresivo que precisaron ingresos hospitalarios involuntarios tras tentativa autolítica, además de trastornos por consumo de alcohol. Los 2 planearon de forma conjunta su muerte «en pareja» y acudieron a las inmediaciones de una estación de ferrocarril para colocarse en el trayecto del tren, de pie, abrazados el uno al otro, hasta la llegada del convoy. El estudio necrópsico demostró las lesiones propias de este tipo de suicidios, y la presencia de unos niveles considerables de etanol en sangre. Se presenta el contexto del caso, el resultado de la autopsia psicológica, la presencia de antecedentes médicos comunes, incluyendo los psiquiátricos, y se revisa la bibliografía existente(AU)

Suicide pacts are exceptional cases. We present a simultaneous suicide of two 46 year-old monozygotic twins run over by a train. Both twins experienced psychiatric anxiety-depressive disorders that required involuntary hospitalization after suicidal tentative. Previous alcohol intake was also detected. They both meticulously planned their dyadic death and went near a railway station where they remained in the train trajectory, hugging each other, before the convoy arrived. Necroscopic analysis showed the typical injuries of this type of suicide as well as a considerable presence of ethanol in blood. The context of the case, the result of the psychological autopsy and the presence of coincident medical records-psychiatric ones included-are presented, while current bibliography is revised(AU)

Efecto de la alimentación complementaria y micronutrientes enel estado nutricional del niño / Effect of complementary feeding and micronutrients in nutritional status of children

El objetivo de este trabajo es determinar la influencia de la alimentación complementaria y el aporte de los micronutrientes en los niños. Es conocida la falta de un aporte nutricional adecuado en la población más vulnerable de nuestro país, como son los lactantes y pre-escolares, debido a un conjunto de factores socioeconómicos que derivan en estados carenciales importantes.

Medidas organizativas y práctica asistencial. Una perspectiva desde los centros de salud / Organizational procedures and health care management. A point of view from primary care centres

ObjetivoConocer la utilización de medidas organizativas relacionadas con la práctica asistencial de los centros de salud (CS) a través de la valoración de las comisiones directivas.DiseñoEstudio multicéntrico, descriptivo, transversal.EmplazamientoÁrea 11 Atención Primaria, Madrid.ParticipantesComisiones Directivas de los Equipos de Atención Primaria (n=38).MedicionesSe utilizó un cuestionario semiestructurado autoadministrado con 21 preguntas principales sobre procedimientos y utilización de medidas organizativas internas relacionadas con la práctica asistencial en los CS, agrupadas en 5 apartados: consultas previsibles y no previsibles (carácter asistencial o administrativo) y gestión de agendas/atención al usuario.ResultadosTasa de respuesta 100%. El 69% dispone de circuito interno y/o aplicación informática para renovación de recetas crónicas y el 55% para incapacidad temporal. En el 71%, las consultas de enfermería participan en emisión y entrega de recetas crónicas. El 42% realiza trámites administrativos atribuibles a atención especializada. El 21% no se ajusta a la frecuencia recomendada de visitas de seguimiento en los programas asistenciales y el 29% duplica la actividad entre medicina y enfermería. El 97% dispone de circuito específico interno para atención urgente. El 84% facilita citación autoconcertada desde las consultas y un 29% tiene agenda disponible para un período superior a 6 meses.ConclusionesExiste variabilidad en la utilización de determinadas medidas organizativas y procedimientos relacionados con la práctica asistencial en los centros de salud. Sería recomendable una mayor investigación para determinar si los cambios organizativos y del profesional pudieran contribuir a una mejor eficiencia y satisfacción del paciente(AU)

ObjectiveWe aimed to know how the directive teams perceive the implementation of organizational procedures in relation with the health care management in the primary care setting.DesignMulticentre cross-sectional descriptive study.SettingArea 11 Madrid Primary Care Service, Spain.ParticipantsAll directive teams of primary care centres (PCC) (n=38).MeasurementsData were collected with a self-administered semiestructured questionnaire which included 21 main questions about procedures and use of internal organizational measures relating to the health care management in PCC, grouped in five sections: predictable and non predictable consultations(clinical and administrative), clinical schedules and office management.Results100% response rate. 69% of PCC use internal procedures and computerized applications for the renewal of medical chronic prescriptions and 55% for temporary disability. 71% show nurse involvement in terms of dispensing medical prescriptions during clinical consultations. 42% keep on performing administrative procedures of specialized care. 21% don’t get compliance with routine control of programs and in 29% of consultations duplicity of visits among medicine and nursing are expected. 97% follow a specific process for urgent attention. 84% request subsequent appointment in the previous clinical consultation. 29% have open schedules availables for 6 months.ConclusionsA wide variability of the implementation of organizational procedures in PCC was observed. Further research is needed to determine whether any organizational and professional changes could contribute to improve efficiency and patient satisfaction(AU)

Antropometria en menores de 5 años en la localidad de Coroico, La Paz / Anthopometric measurements in children under 5 years of age

Objetivo general.- Evaluar el estado nutritivo de la población pediátrica menor de 5 años en la licalidad de Coroico del departamento de La Paz. Material y métodos. Estudio descriptivo de corte transversal, basado en la realización de una encuesta elaborada con preguntas cerradas referente a edad, peso y talla para así determinar el grado de desnutrición de niños menores de 5 años. Las mediciones antropométricas se efectuaron con técnica estandarizada (tablas de SVEN), tallimetros y balanzas previamente calibradas. Pacientes.- Se estudiaron en el mes de noviembre del 2002, un total de 323 niños menores de 5 años, se anotó el peso en kilogramos y la talla en centímetros. Resultados. La relación Talla/edad, que es un indicador de desnutrición crónica demostró que 160 niños (49.5 por ciento) se encontraban en el rango -1 y -2 DE. En las medianas de Peso/Edad, 198 niños (61.3 por cieto) se encontraban en el rango de -1y -2 DE, que refleja la deficiencia de alimentación que reciben estos niños. La relación Peso/talla, representa quizá el indicador más importante de desnutrición aguda y en este trabajo se observo que un alto porcentaje de losniños, 207 del total de 323 (64 por ciento) se encontraban en la mediana mientras que un 29.1 presentaba entre -1 y -2 DE. Conclusiones. Casi el 50 Por ciento de la población estudiada presentaban algún grado de desnutrición crónica por la relación Talla/Edad, 61 por ciento tenian una desnutrición global por la relación Peso/edad y 64 por ciento presentaban desnutrición aguda por la relación Peso/talla.

Análisis del suicidio a través de la autopsia psicológica (Santa Fe de Bogotá) / Analysis of suicide through the psychological autopsy (Santa Fé de Bogotá)

Se presenta la revisión de 61 casos de suicidio ocurridos en la ciudad de Santafé de Bogotá durante el año 1994. Se encontró aumento en el número total de suicidios del 2% con relación a estudios anteriores y aumento de frecuencia en poblaciones más jóvenes. Por el método de autopsia psicológica se hizo una aproximación psicológica y social a las características de los suicidas. Se identificaron como rasgos predominantes de personalidad los de tipo límite y narcisista, siendo el diagnóstico clínico predominante la depresión. Se halló una importante alteración en la comunicación y dinámica familiar en las familias de los suicidas...

A review of 61 cases of suicide in the city of Santafé de Bogotá during the year 1994 was made. It showed an increase of 2% in the total number of suicides with relation to previous studies as well as a greater number of cases in younger people. By means of the psychological autopsies we made a psychological and social approach to the characteristics of the person that committed suicide. Most of the them were found to have prevailing borderline and narcisistic personality traits, and "Depression" was the most frequent clinical diagnosis. Also a very important disturbance in the family communication and dinamics was found...