Negative association of steroids with immunotherapy efficacy in a multi-tumor cohort: time and dose-dependent.

Previous studies have suggested a negative impact of steroids on the efficacy of immune checkpoint inhibitors (ICI), but how this effect is modulated by the dosage and time of administration is yet to be clarified. We have performed a retrospective analysis of 475 patients with advanced solid tumors treated with ICI as monotherapy from 2015 to 2022. Data regarding immune-related adverse events (irAEs) and clinical outcomes were collected. For each patient, the daily steroid dose (in mg/kg of prednisone) was registered until disease progression or death. The impact of cumulative doses on response rates and survival outcomes was analyzed within different periods. The objective response rate (ORR) was significantly lower among patients exposed to steroids within 30 days before the first cycle of ICI (C1) (20.3% vs. 36.7%, p < 0.01) and within the first 90 days of treatment (25.7% vs. 37.7%, p = 0.01). This negative association was confirmed by multivariable analysis. Higher mean steroid doses were observed among non-responders, and cumulative doses were inversely correlated with the disease control rate (DCR) around ICI initiation. Remarkably, poorer outcomes were observed even in patients belonging to the lowest dose quartile compared to the steroid-naïve population. The exposure to steroids after 6 months of ICI was not associated with worse survival outcomes. Our results suggest that the potential impact of steroids on ICI efficacy may be time-dependent, prevailing around ICI initiation, and dose-dependent, with modulation of neutrophil-to-lymphocyte ratio as a possible underlying mechanism.

Systematic Cholecystectomy During Cytoreductive Surgery Plus HIPEC: A Critical Analysis of an Empirical Tradition.

BACKGROUND: Some procedures performed during cytoreductive surgery (CRS) and hyperthermic intraoperative intraperitoneal chemotherapy (HIPEC) are based on empirical data. One of these procedures is systematic cholecystectomy. This study aimed to perform a critical analysis of the need for systematic cholecystectomy during CRS+HIPEC of patients with peritoneal carcinomatosis using long-term follow-up data. METHODS: Patients with peritoneal surface malignancies who were candidates for CRS+HIPEC and underwent surgery between January 2008 and December 2022 were analyzed. For patients with gallbladder involvement due to the disease or for patients whose preoperative study showed the presence of cholelithiasis, cholecystectomy was performed as part of the surgery, which was avoided for the remaining patients. All postoperative adverse events that occurred in the first 90 days were recorded, and clinical records focused on the development of biliary pathology during the follow-up period were studied. RESULTS: The results from a consecutive series of 443 patients with peritoneal surface malignancies who underwent surgery between January 2008 and December 2022 were analyzed. The average age of the cohort was 50 years. The median follow-up period for the cohort was 41 months (range, 12-180 months), with a disease-free survival of 17 months. For 373 of the patients, CRS+HIPEC was completed without an associated cholecystectomy, and in 16 of them, the appearance of cholelithiasis was detected during the follow-up period. Only two patients in the series showed complications derived from gallstones and required a delayed cholecystectomy. CONCLUSIONS: Although cholecystectomy is a safe procedure in the context of CRS+HIPEC, it is not risk free, and its routine performance may be unnecessary.

Feasibility Study of Experimental Protocol for the Time-Dependent Mechanical Response of Synthetic Tibia.

In this research, an experimental biomechanics construct was developed to reveal the mechanics of distal tibial fracture by submitting synthetic tibiae to cyclic loading, resulting in a combined stress state due to axial compression and bending loads. The synthetic tibia was fixed at the knee but allowed to rotate in the coronal and sagittal planes at the ankle. The first three loading regimes lasted for 4000 cycles/each, and the final until ultimate failure. After 12k±80 cycles, the observed failure patterns closely resembled distal tibial fractures. The collected data during cyclic loading were fitted into a phenomenological model to deduce the time-dependent response of the synthetic tibiae. Images were also collected and analyzed using digital image correlation to deduce the full-field state of strain. The latter revealed that longitudinal strain contours extended in the proximal-distal direction. The transverse strain contours exemplified a medial-to-lateral distribution, attributed to the combined contributions of the Poisson's effect and the flexural deformation from axial and bending components of the applied load, respectively. The experimental construct, full-field characterization, and data analysis approaches can be extended to elucidate the effect of different fixation devices on the overall mechanical behavior of the bone and validate computational models in future research.

Assessing the effectiveness and feasibility of the Experienced Carers Helping Others program in relatives of adolescents with eating disorders using an online application format with individual sessions.

Eating disorders (ED) usually involve hospital admission and a high relapse rate, with the return home being a critical moment for patients and their families. After their return home, they often have trouble incorporating the guidelines they have learned into their daily context. ECHOMANTRA intervention program aims to facilitate this transition by offering psychological strategies that involve both patients and their families and carers. Specifically, the ECHO program is aimed at the relatives of these patients. The present study aimed to analyze the efficacy of adding the ECHO program to the usual treatment (TAU) of relatives through a novel format based on individual intervention and with an online format and to examine the acceptability and feasibility of this new format. The study design was multi-center, randomized, controlled, with a longitudinal design and comparing two parallel groups. A total of 108 family members participated. Results indicated that relatives from both groups, TAU and ECHO + TAU, showed improvements in expressed emotion, accommodation, impact of the ED, emotional well-being, and caregiver skills. However, effect sizes in the ECHO + TAU group were slightly larger than the TAU group. In addition, the changes were greater in depression and caregiver skills when the ECHO component was added. Most caregivers (81.48%) completed the ECHO and indicated a high level of satisfaction with the program. These results suggest the efficacy and the feasibility of adding the ECHO intervention program to the usual treatment in an individual online format.

Quality of Life and Clinical Impairment in Spanish Adolescent Anorexia Nervosa Patients.

Eating disorders have serious physical, mental and social consequences that can affect the quality of life of the sufferer. This study aimed to evaluate the relationship between the severity of ED-related psychopathology and clinical impairment in adolescents with anorexia nervosa (AN) as well as their perception of health-related quality of life. Eighty-six Spanish young women with AN completed a set of questionnaires assessing eating disorder pathology, clinical impairment, and quality of life. The set included the following instruments: the Eating Disorder Examination Questionnaire, Clinical Impairment Assessment, Short Form-12 Item Health Survey, and the Eating Disorder-Specific Heath-Related Quality of Life instrument. Descriptive and regression analyses were applied to identify associations between variables. Higher scores on clinical impairment domains were associated with greater impairment of mental and physical health. Moreover, clinical impairment domains and concerns due to ED were related to a lower quality of life. In conclusion, adolescents with AN have a poor quality of life. Moreover, the findings suggest that the clinical features of impairment may serve as severity indicators of quality of life.

Relationship between Carotid Intima-Media Thickness, Periodontal Disease, and Systemic Inflammation Biomarkers in an Adult Population.

A positive relationship has been reported between advanced periodontitis and carotid intima-media thickness (cIMT) measurement. The aim of this study was to investigate this relationship with parameters for periodontitis, such as PISA and systemic inflammation biomarkers. An observational descriptive cross-sectional study was conducted. A blood sample was collected from 75 subjects to analyze glucose, total cholesterol, HDL, LDL, and cytokine values. Increased cIMT was found in 32% of the patients with fewer teeth. Patients with periodontitis had a larger periodontal inflamed surface area (PISA) (p = 0.000) and had a 1.42-times-higher risk of having increased cIMT values compared to periodontally healthy individuals, though without a statistically significant association. Higher values in the left cIMT, IL-8, and TNF-α were found in men than in women with significant differences. In the multivariate analysis involving cytokines, age continues to be linked to increased cIMT values. INF-γ showed a trend towards a protective effect; as the IMT-M decreases, there is an increase in the expression of INF-γ, and a higher proportion of subjects with elevated INF-γ concentrations demonstrated normal IMT-C. This study did not find a statistically significant association between cIMT and periodontal disease, but the risk of having increased cIMT is 1.42-times higher for individuals with periodontitis.

Co-Formulation of Recombinant Porcine IL-18 Enhances the Onset of Immune Response in a New Lawsonia intracellularis Vaccine.

Pig is one of the most consumed meats worldwide. One of the main conditions for pig production is Porcine Enteropathy caused by Lawsonia intracellularis. Among the effects of this disease is chronic mild diarrhea, which affects the weight gain of pigs, generating economic losses. Vaccines available to prevent this condition do not have the desired effect, but this limitation can be overcome using adjuvants. Pro-inflammatory cytokines, such as interleukin 18 (IL-18), can improve an immune response, reducing the immune window of protection. In this study, recombinant porcine IL-18 was produced and expressed in Escherichia coli and Pichia pastoris. The protein's biological activity was assessed in vitro and in vivo, and we determined that the P. pastoris protein had better immunostimulatory activity. A vaccine candidate against L. intracellularis, formulated with and without IL-18, was used to determine the pigs' cellular and humoral immune responses. Animals injected with the candidate vaccine co-formulated with IL-18 showed a significant increase of Th1 immune response markers and an earlier increase of antibodies than those vaccinated without the cytokine. This suggests that IL-18 acts as an immunostimulant and vaccine adjuvant to boost the immune response against the antigens, reducing the therapeutic window of recombinant protein-based vaccines.

New Formulation of a Subunit Vaccine Candidate against Lawsonia intracellularis Increases Humoral and Cellular Immune Responses.

Previously, we designed a subunit vaccine candidate based on three L. intracellularis antigens with promising results in pigs. In this study, antigens were produced individually to achieve an even antigen ratio in the formulation. The emulsion characterization included the drop size and the mechanical and thermal stability. Immune response was evaluated by indirect and sandwich ELISAs, qPCR, and flow cytometry. The vaccine candidate's safety was assessed by histopathology and monitoring the clinical behavior of animals. The average production yielded for the chimeric antigen as inclusion bodies was around 75 mg/L. The formulation showed mechanical and thermal stability, with a ratio Hu/Ho > 0.85 and a drop size under 0.15 nm. Antigens formulated at a ratio of 1:1:1 induced a significant immune response in inoculated pigs that persisted until the end of the experiment (week 14). The dose of 200 µg significantly activated cellular response measured by transcriptional and translational levels of cytokines. The cell proliferation assay revealed an increment of lymphocytes T CD4+ at the same dose. Animals gained weight constantly and showed proper clinical behavior during immunization assays. This research demonstrated the immunological robustness of the new subunit vaccine candidate against Porcine Proliferative Enteropathy evenly formulated with three chimeric antigens of L. intracellularis.

Cut-off points of neck and waist circumference as predictors of obstructive sleep apnea in the Colombian population: a comparison with polysomnography

ABSTRACT BACKGROUND: Neck circumference (NC) is a useful anthropometric measure for predicting obstructive sleep apnea (OSA). Ethnicity and sex also influence obesity phenotypes. NC cut-offs for defining OSA have not been established for the Latin American population. OBJECTIVES: To evaluate NC, waist circumference (WC), and body mass index (BMI) as predictors of OSA in the Colombian population and to determine optimal cut-off points. DESIGN AND SETTING: Diagnostic tests were conducted at the Javeriana University, Bogota. METHODS: Adults from three cities in Colombia were included. NC, WC, and BMI were measured, and a polysomnogram provided the reference standard. The discrimination capacity and best cut-off points for diagnosing OSA were calculated. RESULTS: 964 patients were included (57.7% men; median age, 58 years) and 43.4% had OSA. The discrimination capacity of NC was similar for men and women (area under curve, AUC 0.63 versus 0.66, P = 0.39) but better for women under 60 years old (AUC 0.69 versus 0.57, P < 0.05). WC had better discrimination capacity for women (AUC 0.69 versus 0.57, P < 0.001). There were no significant differences in BMI. Optimal NC cut-off points were 36.5 cm for women (sensitivity [S]: 71.7%, specificity [E]: 55.3%) and 41 cm for men (S: 56%, E: 62%); and for WC, 97 cm for women (S: 65%, E: 69%) and 99 cm for men (S: 53%, E: 58%). CONCLUSIONS: NC and WC have moderate discrimination capacities for diagnosing OSA. The cut-off values suggest differences between Latin- and North American as well as Asian populations.

Efectividad de la aplicación del programa Echomantra en una adolescente con anorexia nerviosa y su familiar: Un estudio de caso / Effectiveness of the application of the Echomantra in an adolescent girl with anorexia nervosa and her caregiver: A case study

El programa ECHOMANTRA tiene como finalidad facilitar la transición de las pacientes con un trastorno de la conducta alimentaria desde el ingreso hospitalario a su vida cotidiana. Consta de una intervención para los/las familiares (ECHO; Treasure et al., 2015) y otra para las pacientes (MANTRA, Schmidt, et al, 2014). El objetivo de este estudio fue evaluar la efectividad del programa ECHOMANTRA, aplicado junto al tratamiento usual, en una adolescente de 15 años con anorexia nerviosa (AN) y su madre. Se utilizó un diseño de caso único y medidas pre-post, con seguimiento a los 3 y 6 meses. En la paciente se evaluó: patología alimentaria (EDE-Q), estado emocional (DASS-21), ajuste psicosocial (EQ-5D-5L y el CIA 3.0) y motivación al cambio; y en la madre: emoción expresada (FQ), impacto de los síntomas (EDSIS), acomodación a la enfermedad (EAISA), estado emocional (DASS-21) y habilidades de cuidadora (CSS). Ambos programas constaban de 8 sesiones online individuales y semanales. Los resultados mostraron una reducción en la sintomatología de AN, aumento del IMC, mejora del estado emocional, motivación al cambio y ajuste psicosocial; y en la madre, mejoró el estado emocional y las habilidades de cuidado, y disminuyó la acomodación a la enfermedad, la emoción expresada y el impacto de los síntomas. Estos cambios se mantuvieron en el seguimiento. Ambas valoraron el programa como satisfactorio. La aceptabilidad y la eficiencia del tratamiento de la AN puede mejorarse utilizando el ECHOMANTRA para preparar la transición de la atención hospitalaria, apoyando a las pacientes y familiares. (AU)

The aim of the ECHOMANTRA program is to facilitate the transition from hospital back into the community. ECHOMANTRA is based on interventions for carers (Experienced Carers Helping Others, ECHO; Treasure et al. 2016) and patients (Maudsley Model of Anorexia Nervosa Treatment for Adults, MANTRA; Schmidt, et al., 2014). The aim of this study was to evaluate the effectiveness of the ECHOMANTRA program, applied together with the usual treatment, in a 15-yearold adolescent girl with anorexia nervosa (AN) and her mother. A single case design and pre-post measures were used, as well as follow-up at 3 and 6 months. The patient was assessed for: eating pathology (EDE-Q), emotional state (DASS-21), psychosocial adjustment (EQ-5D-5L and CIA 3.0) and motivation to change. In the mother: expressed emotion (FQ), symptom impact (EDSIS), accommodation to illness (EAISA), emotional state (DASS-21) and her caregiver skills (CSS) were assessed. Both programs consisted of 8 on-line sessions, which were conducted individually and on a weekly basis. The results showed a reduction in AN symptomatology, increased BMI, improved emotional state, motivation to change and psychosocial adjustment; and in the mother, improved emotional state and caregiving skills, and reduced accommodation to illness, expressed emotion and the impact of symptoms. These changes were maintained at follow-up. Both patient and family valued the program as satisfactory. Both the acceptability and efficiency of treatment for AN may be improved by using ECHOMANATRA to prepare for transition from inpatient care, by giving support to both patients and their carers. (AU)

Diagnostic error as a scientific and ethical challenge in establishing the activity of rheumatoid arthritis / El error de diagnóstico como reto científico y ético en el establecimiento de la actividad de la artritis reumatoide

ABSTRACT Introduction: The articular examination is an essential part of the physical examination of the patient with rheumatoid arthritis, since it gives information about the disease status at a given time and allows monitoring of its evolution over time. Despite the importance of the physical examination of the joints, it is noteworthy that there is no standardized technique. Methods: This paper aims to frame a discussion on whether standardization of the joint examination is justified, presenting arguments for and against. Results and discussion: The paper raises several arguments about diagnostic error as a scien-tific and ethical challenge in establishing the activity of rheumatoid arthritis. Conclusion: It is time to adopt a standardized physical joint examination technique that allows better assessment of the inflammatory activity status of the disease, avoids risks resultant from poor disease status classification, adheres to ethical principles and does not incur unnecessary expenses. Failure to do so would have scientific, economic, ethical, and public health implications.

R E S U M E N Introducción: El examen articular es una parte fundamental del examen físico del paciente con artritis reumatoide ya que permite obtener información sobre el estado de la enfermedad en un momento determinado, así como monitorizar su evolución en el tiempo. A pesar de la importancia del examen físico de las articulaciones, no existe una técnica estandarizada. Métodos: Este ensayo tiene como objetivo desarrollar una discusión sobre si la estandarización del examen conjunto está justificada, para lo cual se presentan argumentos a favor y en contra. Resultados y discusión: El ensayo plantea varios argumentos acerca del error diagnóstico como un desafío científico y ético cuando se trata de establecer la actividad de la artritis reumatoide. Conclusión: Es el momento de adoptar una técnica de exploración física conjunta y estandarizada, que permita una mejor valoración del estado de actividad inflamatoria de la artritis reumatoide, evite los riesgos derivados de una mala clasificación del estado de la enfermedad, respete los principios éticos y no incurra en gastos innecesarios. Dejar de hacerlo tendría implicaciones científicas, económicas, éticas y de salud pública.

Síndrome de Loeffler, ¿más frecuente de lo que pensamos?: un caso asociado a Ascaris lumbricoides y Strongyloides stercolaris

El síndrome de Loeffler consiste en una neumonía eosinofílica aguda consecuencia de una reacción inmunológica de tipo alérgico, principalmente secundario a la fase pulmonar de los ciclos de algunos parásitos. Los parásitos más frecuentemente asociados son los nemátodos, y, entre ellos, Ascaris lumbricoides que es el principal causante de Síndrome de Loeffler. Clínicamente puede cursar con tos, dificultad respiratoria de distinto grado, sibilancias y subcrepitantes en la auscultación y fiebre. Como hallazgos radiológicos suelen apreciarse infiltrados intersticiales y en los exámenes de laboratorio destaca la presencia de eosinofilia en el hemograma. Se trata de un síndrome con muy baja incidencia a nivel global, probablemente debido a su infradiagnóstico, por lo que presentamos el caso de un paciente de 14 años con diagnóstico de Síndrome de Loeffler asociado a Ascaris lumbricoides y a Strongyloides stercolaris. (provisto por Infomedic International)

Loeffler's syndrome consist of an acute eosinophilic pneumonia due to an immunnologic reaction, mainly owing to the pulmonary phase of the life's cycles of some parasites. Nematodes are the most common parasites related to the syndrome, and between them, Ascaris lumbricoides is the one that causes most of the Loeffler's Syndrome. Symptoms that can be caused by the syndrome are cough, breath difficulties of different grades, fever and wheezing and crackling on auscultation. Radiological findings are bilateral interstitial infiltrates and in laboratory test eosinophilia stands out in blood count. The global incidence of the syndrome is very low, maybe due to an underdiagnosis, so we present the case of a 14-year-old male child with Loeffler´s Syndrome caused by Ascaris lumbricoides and Strongyloides stercolaris. (provided by Infomedic International)

Opciones terapéuticas para la retirada de “superpegamentos” de la piel / Therapeutic options for removing superglues from the skin

El cianocrilato es un compuesto adhesivo que se utiliza en la fabricación de “superpegamentos”. En contacto con tejidos de algodón o lana puede producir quemaduras térmicas. Por el contrario, en contacto sobre piel sana se han descrito dermatitis de contacto o alérgica pero no quemaduras. Caso clínico. Niña de 8 años que acude a urgencias tras haber derramado de manera accidental un “superpegamento” directamente sobre una mano y ambas extremidades inferiores, permaneciendo con el pegamento en contacto con la piel durante 3 horas sin poder retirarlo en domicilio. En la exploración destacaba gran eritema en varias regiones subyacentes al pegamento, sin ampollas, heridas ni sangrado. El pegamento se retiró bajo sedoanalgesia con lavavajillas líquido diluido en agua tibia, sin apreciarse solución de continuidad ni quemadura. Conclusiones. Existen numerosas medidas para la retirada de adhesivos de la piel. Escoger la opción terapéutica viene determinado, entre otros factores, por la presencia de lesiones cutáneas bajo el adhesivo. La aplicación de acetona está contraindicada en pieles con lesiones debido a que puede empeorar la irritación de las mismas. La demora hasta la retirada del adhesivo puede influir en el éxito del tratamiento; así como en la aparición de posibles secuelas (AU)

Cyanoacrylate is an adhesive used as a component in most of “super glues”. It can cause thermal burns if in contact with wool or cotton fabric. Nevertheless, in contact with intact skin it can cause contact or allergic dermatitis, but no thermal burns have been described.Clinical case: 8-year-old girl who had suffered an accidental fall of one of these glues directly on one of her hands and both lower extremities, and who had remained with the glue in contact with the skin for 3 hours. On examination we observed erythema on several regions underlying the glue, without blisters, wounds or bleeding. The glue was removed with warm water and detergent. No open wounds or burns were noticed.Conclusions: There are different ways to remove adhesives from the skin. Choosing the correct therapeutic option is determined, among other factors, by the presence of skin lesions under the adhesive. The use of acetone is contraindicated in injured skin because it can worsen the irritation. The delay in the removal of the adhesive can influence the success of the treatment and the type of treatment to be applied. (AU)

Interval cytoredutive surgery and HIPEC in advanced ovarian cancer with small-bowel disease: results and reflections

Introduction: Small-bowel involvement in patients with ovarian cancer has been strongly correlated with the possibility of cytoreduction and thus with survival. The main objective of this study was to evaluate the prognostic significance of small-bowel involvement in patients undergoing optimal-complete interval cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC).Methods: We included a series of patients diagnosed with stage IIIC-IVA (pleural effusion) high-grade serous epithelial ovarian cancer and in whom CRS + HIPEC was indicated after neoadjuvant systemic chemotherapy (NACT). The study period extended from January 2008 to January 2020, with a minimum follow-up of 12 months from the inclusion of the last patient. A multivariate analysis using Cox regression allowed us to identify the variables that were independently related to disease-free survival.Results: A total of 144 patients were selected, 13 (9%) of whom were excluded from the analysis, because their disease was considered unresectable. The study included a series of 131 patients with a median age of 62 years (34-79 years) and a median Peritoneal Cancer Index (PCI) calculated during surgery of 9 (1-35). The median PCI of bowel areas 9-12 (SB-PCI) was 3 (1-10). Performance of a CC-1 cytoreduction (HR: 1.93, 95% CI: 1.02-3.64, p = 0.042) and SB-PCI greater than 3 (HR: 2.25, 95%CI: 1.13-4.48, p = 0.21) were independent factors associated with shorter disease-free survival.Conclusion: Small-bowel involvement, even in patients with a macroscopically complete resection, showed a correlation with worse prognostic outcomes and could be considered as a variable in the postoperative management of these patients. (AU)

Prevalencia de la Ortorexia Nerviosa en estudiantes universitarios españoles: relación con la imagen corporal y con los trastornos alimentarios / Prevalence of Orthorexia Nervosa in Spanish university students: relationship with body image and eating disorders

Antecedentes: El objetivo de este estudio fue examinar la prevalencia de la Ortorexia Nerviosa (ON), y analizar su relación con la imagen corporal y conductas características de los Trastornos de la Conducta Alimentaria (TCA), en estudiantes universitarios. Método: Estudio transversal en el que participaron 534 estudiantes universitarios españoles, 422 mujeres y 112 hombres, con una edad media de 22.04 años (DT = 3.41). Se administraron los siguientes instrumentos: cuestionarios variables sociodemográficas y de hábitos alimentarios, el cuestionario ORTO-11-Es, la Teruel Ortorexia Scale (TOS), el Multidimensional Body Shape Relations Questionnaire (MBSRQ-45) y el Eating Attitudes Test (EAT-26). Resultados: El 30.5% de los estudiantes presentó un alto riesgo de ON. Se observaron mayores tendencias ortoréxicas en mujeres. El grupo que presentaba alto riesgo de ON frente al de bajo riesgo mostró un IMC medio-alto, seguían en mayor medida una alimentación de tipo vegano/vegetariano y presentaban puntuaciones significativamente superiores en el MBSRQ-45 (p < .00) y el EAT-26 (p < .00). Conclusiones: Los resultados obtenidos muestran una elevada prevalencia de ON en estudiantes universitarios y su relación con una peor imagen corporal, una mayor preocupación por el aspecto físico y con conductas características de los TCA.(AU)

Background: The aim of this study was to examine the prevalence of ON and analyze its relationship with self-image and ED behavior in university students. Method: Cross-sectional study with a sample of 534 Spanish university students, 422 women and 112 men with an age mean of 22.04 (SD = 3.41). Questionnaires administered: a sociodemographic and lifestyle questionnaire, the ORTHO-11-Es, the Teruel Orthorexia Scale (TOS), the Multidimensional Body Self Relations Questionnaire (MBSRQ-45) and the Eating Attitudes Test (EAT-26). Results: 30.5% of the sample were on high risk of developing ON. Higher orthorexic tendencies were observed in women. Those at high risk of ON showed higher BMI, higher proportion of veganism/vegetarianism and significantly higher scores on the MBSRQ-45 (p < .00) and EAT-26 (p < .00). Conclusions: Results showed a high prevalence of ON and its relationship with a worse self-image, concern with physical appearance and ED behaviors.(AU)

Utilidad del índice UDT-65 en adultos con dolor torácico y electrocardiograma normal o no diagnóstico / Usefulness of the CPU-65 index in adults with chest pain and normal or non-diagnostic electrocardiogram

Resumen Objetivo: Evaluar la utilidad del índice UDT-65 para la estratificación del dolor torácico en urgencias en una población colombiana en la que se sospecha enfermedad coronaria. Método: Se condujo la validación externa del índice UDT-65 en una cohorte concurrente que incluyó pacientes que ingresaron a urgencias de una clínica cardiovascular en Bogotá con dolor torácico no traumático, y electrocardiograma normal o no diagnóstico. Se evaluaron 1320 pacientes de 18 o más años y se determinó la utilidad del índice en términos de calibración (uso de gráfico, ji al cuadrado para datos agrupados y prueba de bondad de ajuste de Hosmer-Lemeshow) y de capacidad de discriminación del modelo (curva de características operativas del receptor [ROC] y área bajo ella [AUC]). Resultados: El índice UDT-65 en esta población suministró evidencia de su utilidad en términos de calibración y capacidad de discriminación, para efectuar una buena aplicación de él en aquellos pacientes que consulten al servicio de urgencias de una clínica cardiovascular por dolor torácico no traumático de posible origen coronario. La capacidad de discriminación del índice UDT-65 fue adecuada, pues con un área bajo la curva ROC de 0.867 (IC 95% 0-847-0.885), que se acerca al valor obtenido (AUC 0.87) en la población española en que se desarrolló el índice. Conclusiones: Se necesitan más estudios similares en otras instituciones, dado el buen resultado, en beneficio de más pacientes.

Abstract Objective: To evaluate the clinical usefulness, in the emergency service, of the UDT-65 index for chest pain stratification in colombian population with suspected coronary disease. Method: The external validation of the UDT-65 index was conducted in a concurrent cohort that included patients admitted to the emergency service of the cardiovascular clinic in Bogotá with non-traumatic chest pain and normal or non-diagnostic electrocardiogram. 1320 patients were evaluated and the usefulness of this instrument was determined in terms of calibration (use of graph, Chi-square test for group data and the Hosmer-Lemeshow goodness-of-fit test) and discrimination capacity of the model (curve of receiver operating characteristics [ROC] and by finding the area under the curve [AUC]). Results: The UDT-65 index in the population under study, provided evidence of its usefulness in terms of calibration and discrimination capacity; this, in pursuance of a good application of the instrument in those patients who consult the Emergency Department of the cardiovascular clinic for non-traumatic chest pain of possible coronary origin. The discrimination capacity of the UDT65 index was adequate, with an area under the ROC curve of 0.867 (95 % CI 0.847-0.885), which is close in value to the one obtained (AUC 0.87) in the Spanish population where the original index was developed. Conclusions: More similar studies are needed in other institutions, due to the excellent and beneficial outcomes.

¿Es la fuerza de prensión manual un buen indicador de condición física y composición corporal en pacientes con cáncer de mama que han terminado los tratamientos centrales de la enfermedad? Estudio EFICAN / A força de preensão manual é um bom indicador da condição física e da composição corporal em doentes com cancro da mama que completaram os tratamentos centrais da doença? Estudo EFICAN / Is handgrip strength a good indicator of physical fitness and body composition in breast cancer patients who have completed their core treatments? The EFICAN study

Objetivo: evaluar la asociación entre la fuerza de prensión manual (FPM) y diversos parámetros de condición física y composición corporal en mujeres supervivientes de cáncer de mama.Método: se realizó un estudio transversal con los datos basales del ensayo clínico EFICAN (Ejercicio FÍsico para supervivientes de CÁNcer de mama). Participaron 60 mujeres supervivientes de cáncer de mama que habían terminado los tratamientos centrales de la enfermedad en los 10 años previos al comienzo del estudio, que no presentaban enfermedad pulmonar o cardiovascular, cáncer de mama metastásico, ni tenían prevista una intervención para reconstrucción mamaria en un plazo de 3 meses desde el comienzo del estudio. Se evaluó la fuerza de prensión manual mediante dinamometría manual, la fuerza muscular isométrica pico mediante dinamometría electromecánica funcional, el fitness cardiorrespiratorio (VO2máx) se estimó a través del Siconolfi step test, la amplitud de movimiento (ADM) en flexión de hombro mediante goniometría digital, y la composición corporal mediante bioimpedancia.Resultados: se observó una asociación positiva de la FPM con la masa muscular (r=0.423), y con la fuerza isométrica de miembro superior (r=0.523) e inferior (r=0.335), y una asociación negativa de la FPM con el porcentaje de grasa corporal (r=-0.405). Sin embargo, no se encontró asociación entre FPM y VO2máx ni ADM del hombro (P>0.05).Conclusiones: estos resultados sugieren que la FPM puede ser un buen indicador de fuerza muscular, así como de composición corporal en mujeres supervivientes de cáncer de mama. Futuros estudios prospectivos deberán evaluar el valor predictivo de la FPM en esta población. (AU)

Objectives: this study evaluated the association between handgrip strength (HGS) and various parameters of physical fitness and body composition in female breast cancer survivors.Methods: a cross-sectional study was conducted with the baseline data from the EFICAN (Ejercicio FÍsico para supervivientes de CÁNcer de mama) clinical trial. 60 female breast cancer survivors who had completed the core treatments of the disease in the 10 years prior to the study beginning, who didn’t have any cardiovascular or pulmonary disease, metastatic breast cancer or awaited breast cancer reconstruction in the following 3 months, participated. Handgrip strength was assessed using a digital dynamometer, peak isometric strength was determined using an electromechanical dynamometer, cardiorespiratory fitness (VO2máx) was estimated through the Siconolfi step test, shoulder flexion mobility was assessed through digital goniometry and body composition was determined using a bioelectrical impedance device.Results: positive associations between HGS and muscle mass (r=0.423), isometric upper-limb (r=0.523) and lower-limb (r=0.335) strength were found, and a negative association between HGS and fat mass percentage (r=-0.405) was also found. However, no associations between HGS and VO2máx or shoulder flexion mobility were found (P>0.05).Conclusions: these results suggest that HGS may be a good indicator of muscular strength and body composition in female breast cancer survivors. Future prospective studies are needed to assess the predictive value of HGS in this population. (AU)

Objetivo: avaliar a associação entre a força de preensão manual (FPM) e vários parâmetros de condição física e composição corporal em mulheres sobreviventes de cancro da mama.Método: foi realizado um estudo transversal utilizando dados de base do ensaio clínico EFICAN (Physical Exercise for Breast Cancer Survivors). Participaram sessenta mulheres sobreviventes de cancro da mama que tinham concluído os tratamentos centrais da doença nos 10 anos anteriores ao início do estudo, que não tinham doenças pulmonares ou cardiovasculares, cancro da mama metastásico, ou que não estavam programadas para se submeterem à reconstrução da mama nos 3 meses seguintes ao início do estudo. A força de preensão manual foi avaliada por dinamometria manual, o pico de força muscular isométrica por meio de dinamometria electromecânica funcional, a capacidade cardiorrespiratória (VO2máx) foi estimada pelo Siconolfi step test, a amplitude de movimento (ADM) em flexão do ombro por meio de goniometria digital, e a composição corporal por bioimpedância.Resultados: observámos uma associação positiva de FPM com massa muscular (r=0,423), e com força isométrica de membro superior (r=0,523) e membro inferior (r=0,335), e uma associação negativa de FPM com percentagem de gordura corporal (r=-0,405). Contudo, não foi encontrada qualquer associação entre FPM e VO2max ou ADM de ombro (P>0.05).Conclusões: estes resultados sugerem que a FPM pode ser um bom indicador da força muscular, bem como da composição corporal das mulheres sobreviventes de cancro da mama. Os futuros estudos prospectivos devem avaliar o valor preditivo do FPM nesta população. (AU)

Opinión de los psiquiatras sobre el tratamiento ambulatorio involuntario / Psychiatrists' opinion about involuntary outpatient treatment

INTRODUCCIÓN: El tratamiento ambulatorio involuntario (TAI) es una forma de tratamiento obligatorio de carácter extrahospitalario aplicado en la comunidad, que pretende mejorar la adhesión al tratamiento de las personas con una enfermedad mental grave, sin conciencia de enfermedad, en los que el abandono terapéutico supone un riesgo alto de recaída, con aparición de conductas disruptivas y/o autoagresivas o heteroagresivas, hospitalizaciones repetidas y urgencias frecuentes. La aplicación del TAI no está exenta de polémica y, por tanto, la necesidad o no de su regulación legislativa en España es un tema controvertido desde hace varios años, que encuentra tanto defensores como detractores. OBJETIVO: Recoger la opinión de los psiquiatras clínicos y médicos internos residentes en psiquiatría acerca del tratamiento ambulatorio involuntario y su regulación legislativa. MATERIAL Y MÉTODO: Se trata de un estudio de carácter descriptivo. La población de estudio está compuesta por 42 profesionales clínicos de la salud mental (32 psiquiatras y 10 médicos internos residentes en psiquiatría), los cuales estaban ejerciendo en alguno de los dispositivos de los que se compone el Servicio de Psiquiatría del Complejo Hospitalario Universitario de Huelva al inicio del estudio (en marzo de 2018). Se realizó una encuesta personal en formato papel constituida por diez cuestiones sobre el TAI a cada uno de los miembros de la muestra. RESULTADOS: El 85,7% de los clínicos conoce la iniciativa actual de intentar llevar a cabo la regulación legislativa del TAI, estando de acuerdo con dicha regulación el 92,8% de ellos. En este sentido, un 83,3% está en contra de que estén reguladas medidas más coercitivas para el paciente psiquiátrico, como el internamiento involuntario o la incapacitación civil, y no lo esté el TAI. Por otra parte, un 78,6% de los profesionales de la salud mental cree que el TAI es beneficioso para los pacientes, mientras que un 95,2% piensa que también es beneficioso para sus familias. Por otro lado, el 78,6% de los clínicos no considera estigmatizante la aplicación del TAI a los enfermos mentales graves. CONCLUSIÓN: La gran mayoría de los clínicos ve necesaria la regulación legislativa del tratamiento ambulatorio involuntario en España, al considerarlo beneficioso para el enfermo mental grave y su familia

INTRODUCTION: Involuntary outpatient treatment (IOT) is a kind of compulsory outpatient treatment, whose aim is to improve the adherence to the treatment in people with severe mental illness and with no awareness of disease. In these cases, therapeutic abandonment involves a high risk of relapse, with appearance of disruptive and/or self-aggressive or hetero-aggressive behavior, repeated hospitalizations and frequent emergencies. The application of IOT is not an issue without contention. Therefore, the need of legislative regulation in Spain has been a controversial subject for several years, and there are both advocates and opponents. OBJECTIVE: The objective of this study is to bring together the opinion of clinical psychiatrists and resident doctors in psychiatry on the involuntary outpatient treatment and its legislative regulation. MATERIAL AND METHOD: This study is descriptive in nature. The study population consists of 42 clinical professionals in mental health (32 psychiatrists and 10 resident doctors in psychiatry). At the beginning of this study (March 2018), some of these professionals were working in the Psychiatry Department's facilities of the University Hospital Complex of Huelva. A personal survey in paper form consisting of ten questions about IOT was carried out to each member of this study. RESULTS: 85.7% of clinicians know the current initiative that tries to carry out the legislative regulation of IOT, and 92.8% of them agree to such regulation. In this sense, 83.3% of them are against the fact that more coercive measures for the psychiatric patients such as the involuntary commitment or the civil incapacitation are regulated and IOT is not. On the one hand, 78.6% of the professionals in mental health believe that IOT is beneficial for the patients. Moreover, 95.2% of them think that is beneficial for their relatives, too. On the other hand, 78.6% of clinicians do not consider that the application of IOT to mentally-ill patients is stigmatizing. CONCLUSIONS: The vast majority of clinicians think that the legislative regulation of involuntary outpatient treatment is necessary in Spain, and they think this treatment is beneficial not only for the patient but also for their family

El mercurio como contaminante y factor de riesgo para la salud humana / Mercury as a pollutant and risk factor for human health / Mercúrio como poluente e fator de risco para a saúde humana

Resumen El mercurio (Hg) es considerado en la actualidad un contaminante a nivel mundial, que además impacta de manera negativa sobre la salud de las personas que están expuestas a este. Dentro de sus efectos más graves se encuentran afectaciones a nivel del sistema nervioso, por lo cual se considera un problema de salud pública que requiere la atención adecuada. El mercurio puede entrar al cuerpo a través de la ingesta, inhalación y absorción, por lo cual las poblaciones expuestas a actividades como la minería en pequeña escala representa un factor de riesgo importante sobre el cual se deben establecer estrategias para la mitigación de la exposición al mercurio. Teniendo en cuenta lo anterior, este artículo de revisión presenta los avances y tendencias significativas reportadas por bibliografía indexada, tanto a nivel nacional como latinoamericano e internacional. Las evidencias son claras: la intervención de estrategias de mayor escala es urgente para controlar la contaminación por mercurio de las fuentes de abastecimiento de agua y alimentos y prevenir afectaciones graves a la salud de los seres humanos.

Abstract Mercury (Hg) is currently considered a global pollutant, which also has a negative impact on the health of people who are exposed to it. Among its most serious effects are affectations at the level of the nervous system, which is why it is considered a public health problem that requires adequate attention. Mercury can enter the body through ingestion, inhalation and absorption, which is why populations exposed to activities such as small-scale mining represent an important risk factor on which strategies must be established to mitigate mercury exposure. Taking the foregoing into account, this review article presents the progress and trends of 50 articles consulted from different indexed journals, both nationally and at the Latin American and international level. The evidence is clear: the intervention of larger-scale strategies is urgent to control mercury contamination of food and water supplies and prevent serious damage to human health.

Resumo O mercúrio (Hg) é atualmente considerado um poluente global, que também tem um impacto negativo na saúde das pessoas que estão expostas a este. Entre seus efeitos de maior gravedade estão as afecções do sistema nervoso, por isso é considerado um problema de saúde pública que requer atenção adequada. O mercúrio pode entrar no corpo através da ingestão, inalação e absorção, razão pela qual populações expostas a atividades como a mineração em pequena escala representam um importante fator de risco sobre o qual estratégias devem ser estabelecidas para mitigar a exposição ao mercúrio. Tendo em conta o exposto, este artigo de revisão apresenta os avanços e tendências significativas relatadas pela bibliografia indexada, tanto no âmbito nacional, quanto latino-americano e internacional. A evidência é clara: a intervenção de estratégias em larga escala é urgente para controlar a contaminação por mercúrio das fontes de abastecimento de água e alimentos e prevenir sérios danos à saúde humana.

Hipercolesterolemia familiar: serie de 36 casos con fenotipo de hipercolesterolemia familiar homocigótica / Familial hypercholesterolaemia: A study of 36 cases with a phenotype of homozygous familiar hypercholesterolaemia

Resumen Introducción: La hipercolesterolemia familiar homocigótica (HFHo) se caracteriza por niveles muy elevados de cLDL y por enfermedad aterosclerótica temprana. Aunque la frecuencia es baja (1/300.000), las complicaciones son muy severas y pueden ser evitadas. Encontrar y tratar esta población de manera temprana podría reducir la mortalidad. Se describen 36 casos en Colombia, en donde se calcula que haya entre 160 y 200 casos. Resultados: Un total de 36 pacientes con fenotipo sugestivo de HFHo fueron identificados y tratados en un período de observación de cuatro años. La media de edad fue 27 años (24 mujeres). 34 pacientes tuvieron un puntaje según la Red de Clínicas de Lípidos de Holanda (RCLH) mayor de 8 (diagnóstico definitivo) y los restantes 2 tenían puntaje equivalente a diagnóstico probable. Un cuarto de los casos procedían de la costa norte colombiana. En las pruebas genéticas, 14 fueron homocigóticos verdaderos para mutación del gen que codifica para el receptor de LDL (LDLR), 12 heterocigóticos compuestos, 2 heterocigóticos dobles y uno autosómico recesivo (LDLRAP1); 5 pacientes fueron heterocigóticos simples (LDLR) y 2 pacientes no autorizaron la prueba. En los homocigóticos verdaderos, la variante más frecuente encontrada fue la c.11G>A. 14 pacientes cursaron con enfermedad coronaria, 9 con estenosis carotídea, 8 con estenosis aórtica y 2 tuvieron ataques cerebrovasculares (ACV). 34 pacientes recibían estatinas (24 rosuvastatina), 30 recibían ezetimibe, 2 recibían evolocumab y 20 recibían lomitapide (dosis promedio 12,7mg). Ninguno recibió aféresis de cLDL. Los medicamentos, en general, fueron bien tolerados y la reducción promedio de cLDL con la terapia fue de 533,7mg/dl a 245,1mg/dl (54%). Conclusiones: Todos los pacientes recibieron tratamiento hipolipemiante y se encontraron alteraciones genéticas diagnósticas en todos aquellos que autorizaron el examen. Los niveles elevados de cLDL conllevan tanto riesgo que el tratamiento debe establecerse aún sin conocer el diagnóstico genético.

Abstract Background: Homozygous familial hypercholesterolemia (HoFH) is characterized for very high levels of cLDL and early cardiovascular disease. Although incidence is low (1/300 000), complications are very severe and can be avoided. Finding and treating this population promptly could reduce mortality. We describe 36 cases in Colombia, where 160 to 200 cases are expected. Results: 36 patients with phenotype of HoHF were identified and treated in a follow-up of 4 years. The mean age was 27 years (24 women). 34 of them had at least 8 points in the FH Dutch Lipid Clinic Criteria (definitive diagnosis) and two had probable diagnosis. A quarter of the cases came from the Colombian North Coast. In molecular tests, 14 were true homozygous for LDLR, 12 were compound heterozygous for LDLR, 2 double heterozygous and one was autosomal recessive; 5 were heterozygous and 2 patients did not authorized genetic test. In true homozygous subjects, the most frequent variant was c.11G>A. 14 patients had coronary disease, 9 carotid stenosis, 8 aortic stenosis and 2 had stroke. 34 patients were on statins (25 rosuvastatin), 30 were receiving ezetimibe, 2 were receiving a PSCK9 inhibitor (evolocumab) and 20 were on lomitapide with mean doses of 12.7mg. None received lipoprotein apheresis. Medications were very well tolerated. Changes in cLDL after therapy was from 533.7 mg/dL to 245 mg/dL, (54%). Conclusions: Treatment was started in all patients. We found genetic mutations in all patients with genetic tests. The high levels of cLDL mean such a high risk that treatment must be started promptly, even without a genetic test.