Prevalence and Impact of Treatment-Resistant Depression in Latin America: a Prospective, Observational Study.

Approximately one-third of patients with major depressive disorder (MDD) have treatment-resistant depression (TRD). The TRAL study will evaluate the prevalence and impact of TRD among patients with MDD in four Latin American countries. In this multicenter, prospective, observational study, patients with MDD were recruited from 33 reference sites in Mexico, Colombia, Brazil, and Argentina. Patients were assessed for TRD, defined as failure to respond to ≥ 2 antidepressant medications of adequate dose and duration. Demographics, previous/current treatments, depressive symptoms, functioning, healthcare resource utilization, and work impairment were also collected and evaluated using descriptive statistics, chi-square test, Fisher exact test, t-test for independent samples, or the Mann-Whitney nonparametric test, as appropriate. 1475 patients with MDD were included in the analysis (mean age, 45.6 years; 78% women); 89% were receiving relevant psychiatric treatment. 429 patients met criteria for TRD, and a numerically higher proportion of patients with TRD was present in public versus private sites of care (31% vs 27%). The mean Montgomery-Asberg Depression Rating Scale score was 25.0 among all MDD patients and was significantly higher for patients with TRD versus non-TRD (29.4 vs 23.3; P < 0.0001). Patients with TRD, versus those with non-TRD, were significantly more likely to be older, have a longer disease duration, have more comorbidities, be symptomatic, have a higher median number of psychiatric consultations, and report greater work impairment. Patients with TRD have a disproportionate burden of disease compared to those with non-TRD. Appropriate treatment for TRD is a substantial unmet need in Latin America. https://www.ClinicalTrials.gov identifier NCT03207282, 07/02/2017.

Effects and Assessment of the Optic Pathway After Management with Stereotactic Radiosurgery for Intracranial Tumors: A Comprehensive Literature Review.

Intracranial tumors are treated through a minimally invasive procedure called stereotactic radiosurgery (SRS), which uses precisely targeted radiation beams. When SRS is used to treat tumors in or near the optic pathway, which is responsible for transmitting visual information from the eyes to the brain, it is essential to assess the effects of treatment on visual function. The optic pathway is considered relatively radiation-sensitive, and high doses of radiation can lead to visual impairment or loss. Various methods can be used to assess the effects of SRS on the optic pathway, including visual acuity testing, visual field testing, and imaging studies. These assessments can be performed before and after treatment to track changes in visual function and detect potential complications or side effects. Assessing the optic pathway after management with SRS for intracranial tumors is essential to the treatment process to ensure that patients receive the best possible outcomes while minimizing the risk of complications. Close collaboration between the multidisciplinary team is often necessary to optimize treatment planning and monitoring of treatment response. In this review, we conducted an extensive analysis of the effects of radiation in patients with intracranial tumors after receiving radiotherapy.

Latin American consensus recommendations for the management and treatment of patients with treatment-resistant depression (TRD).

Despite the abundance of literature on treatment-resistant depression (TRD), there is no universally accepted definition of TRD, and available treatment pathways for the management of TRD vary across the Latin American region, highlighting the need for a uniform definition and treatment principles to optimize the management of TRD in Latin America. METHODS: Following a thematic literature review and pre-meeting survey, a Latin America expert panel comprising 14 psychiatrists with clinical experience in managing patients with TRD convened and utilized the RAND/UCLA appropriateness method to develop consensus-based recommendations on the appropriate definition of TRD and principles for its management. RESULTS: The expert panel agreed that 'treatment-resistant depression' (TRD) is defined as 'failure of two drug treatments of adequate doses, for 4-8 weeks duration with adequate adherence, during a major depressive episode'. A stepwise treatment approach should be employed for the management of TRD - treatment strategies can include maximizing dose, switching to a different class, and augmenting or combining treatments. Nonpharmacological treatments, such as electroconvulsive therapy, are also appropriate options for patients with TRD. CONCLUSION: These consensus recommendations on the operational definition of TRD and approved treatments for its management can be adapted to local contexts in the Latin American countries but should not replace clinical judgement. Individual circumstances and benefit-risk balance should be carefully considered while determining the most appropriate treatment option for patients with TRD.

Tig1 regulates proximo-distal identity during salamander limb regeneration.

Salamander limb regeneration is an accurate process which gives rise exclusively to the missing structures, irrespective of the amputation level. This suggests that cells in the stump have an awareness of their spatial location, a property termed positional identity. Little is known about how positional identity is encoded, in salamanders or other biological systems. Through single-cell RNAseq analysis, we identified Tig1/Rarres1 as a potential determinant of proximal identity. Tig1 encodes a conserved cell surface molecule, is regulated by retinoic acid and exhibits a graded expression along the proximo-distal axis of the limb. Its overexpression leads to regeneration defects in the distal elements and elicits proximal displacement of blastema cells, while its neutralisation blocks proximo-distal cell surface interactions. Critically, Tig1 reprogrammes distal cells to a proximal identity, upregulating Prod1 and inhibiting Hoxa13 and distal transcriptional networks. Thus, Tig1 is a central cell surface determinant of proximal identity in the salamander limb.

[Low-risk alcohol drinking limits based on associated mortality.] / Límites para el consumo de bajo riesgo de alcohol en función de la mortalidad asociada.

BACKGROUND: Alcohol is associated with all-cause mortality increase. However, when this increase takes place has not been clearly established. The objective of this study was to establish the levels of alcohol consumption that can be considered low risk for overall mortality. METHODS: Systematic review of cohort studies published since 2014 that established a relationship between general mortality and alcohol consumption in the general population. Those studies not conducted in countries with Spain socio-cultural environment and those that present conflicts of interest were excluded. RESULTS: The median of alcohol consumption (in grams) from which mortality increased was 23-25 g/day. Differentiating by sex, these values were 20 g/day in women and 24 g/day in men. The minimum value of the median from which an increase in mortality was observed was 17-21 g/day of alcohol; 12 g/day in women and 20 g/day in men. CONCLUSIONS: If we take into account caution principle, taking more conservative levels of average alcohol consumption from which an increase in mortality was observed, low-risk consumption should be 20 g/day in men and 10 g/day in women, assuming that there is no safe level of alcohol consumption.

OBJETIVO: El alcohol está relacionado con un aumento de la mortalidad por todas las causas, sin embargo, no está clara la cantidad a partir de la cual se produce este incremento. El objetivo de este estudio fue establecer los niveles de consumo de alcohol que pueden ser considerados de bajo riesgo de mortalidad general. METODOS: Revisión sistemática de estudios de cohortes publicados desde 2014 que establecieran una relación entre la mortalidad general y cantidades consumidas de alcohol en población general. Se excluyeron aquellos estudios no realizados en países de nuestro entorno sociocultural y aquellos que presentaran conflictos de intereses. RESULTADOS: La mediana de los gramos de consumo de alcohol a partir de los que la mortalidad aumentaba fueron de 23-25 g/día. Al diferenciar por sexo estos valores fueron de 20 g/día en mujeres y 24 g/día en hombres. El valor mínimo de la mediana a partir de los que se observó un aumento de la mortalidad fue de 17-21 g/día de alcohol; 12 g/día en mujeres y 20 g/día en hombres. CONCLUSIONES: Si tenemos en cuenta el principio de precaución y tomamos aquellos niveles más conservadores de consumo promedio de alcohol a partir de los cuales se ha observado un aumento de la mortalidad, los consumos de bajo riesgo deberían situarse en 20 g/día en hombres y 10 g/día en mujeres, asumiendo que no hay un riesgo cero.

[Autonomy and heteronomy, a necessary alliance to address smoking cessation. Views of professionals and patients]. / Autonomía y heteronomía, una alianza necesaria para el abordaje del tabaquismo. Visión de profesionales y pacientes.

OBJECTIVE: To explore the perception of professionals and patients with regard to ethical issues involved in addressing the habit of smoking in primary care consultations. METHOD: A qualitative study was designed, consisting of 12 semi-structured interviews with professionals, 7 interviews with patients and 2 focus groups with 6 professionals and 7 primary care patients (a total of 32 participants). An intentional sampling was conducted, including profiles of professionals and patients of both sexes, different ages and experience in relation to smoking. A content analysis was performed with an inductive analytical approach from data to the creation of theoretical categories. RESULTS: Four main categories were identified: 1) ethical issues related to the responsibility of the professional when treating patients who smoke; 2) issues related to attitude to patients who smoke; 3) issues related to fair and equitable distribution of resources and to the role of the different levels of government in relation to the control of smoking; and 4) issues related to smokers' autonomy regarding their habit and smoking cessation. CONCLUSIONS: An alliance is needed between the ethics that support the autonomy of patients who smoke and the regulation of tobacco consumption. This approach should be included in clinical training programmes dealing with tobacco use, dependence and cessation.

Smokefree legislation effects on respiratory and sensory disorders: A systematic review and meta-analysis.

AIMS: The aim of this systematic review and meta-analysis is to synthesize the available evidence in scientific papers of smokefree legislation effects on respiratory diseases and sensory and respiratory symptoms (cough, phlegm, red eyes, runny nose) among all populations. MATERIALS AND METHODS: Systematic review and meta-analysis were carried out. A search between January 1995 and February 2015 was performed in PubMed, EMBASE, Cochrane Library, Scopus, Web of Science, and Google Scholar databases. Inclusion criteria were: 1) original scientific studies about smokefree legislation, 2) Data before and after legislation were collected, and 3) Impact on respiratory and sensory outcomes were assessed. Paired reviewers independently carried out the screening of titles and abstracts, data extraction from full-text articles, and methodological quality assessment. RESULTS: A total number of 1606 papers were identified. 50 papers were selected, 26 were related to symptoms (23 concerned workers). Most outcomes presented significant decreases in the percentage of people suffering from them, especially in locations with comprehensive measures and during the immediate post-ban period (within the first six months). Four (50%) of the papers concerning pulmonary function reported some significant improvement in expiratory parameters. Significant decreases were described in 13 of the 17 papers evaluating asthma hospital admissions, and there were fewer significant reductions in chronic obstructive pulmonary disease admissions (range 1-36%) than for asthma (5-31%). Six studies regarding different respiratory diseases showed discrepant results, and four papers about mortality reported significant declines in subgroups. Low bias risk was present in 23 (46%) of the studies. CONCLUSIONS: Smokefree legislation appears to improve respiratory and sensory symptoms at short term in workers (the overall effect being greater in comprehensive smokefree legislation in sensory symptoms) and, to a lesser degree, rates of hospitalization for asthma.

[Spain's process of passing effective smoking prevention legislation]. / El proceso en españa de la adopción de una legislación eficaz para la prevención del tabaquismo.

The prevention movement has been the key agent involved in smoking control policies. This study describes the context and the process in which Law 28/2005 was passed in Spain with a synthesis of its substance. It provides the background of the events leading up to Spain's current smoking control law in addition to an analysis of the role played by the different social actors in the process and the arguments and strategies employed in opposition by the tobacco industry. A review is also provided of the political agents, highlighting that decentralized countries have further problems in enforcing regulations. This case offers lessons for the future.

Alternative construction and demolition (C&D) waste characterization method proposal / Proposta de método alternativo para identificação da composição de resíduos de construção civil (RCC)

ABSTRACT Construction and demolition waste generally represents the majority of solid waste generated in Brazilian cities, and characterization of this waste stream is still incipient. Therefore, to support managers in the process in the diagnostic phase, this study consisted in a proposal qualitative characterization method in field, that use of construction and demolition (C&D) waste generation indicators. For this, a survey which have been divided in two stages: quantitative characterization based on a three-indicator-analysis of C&D waste generation and qualitative characterization consists of an image analysis procedure on C&D waste samples. The qualitative characterization method has proved to be efficient for samples with high-volume parts. However, this method is limited to represent characterizations that contain residues which might cover the other C&D waste types, for example, plastic sheeting, cardboard and packaging. This method of image analysis is suitable for use in early diagnostics, which require fast results about C&D waste composition.

RESUMO Os resíduos da construção civil podem representar a maior parte dos resíduos sólidos gerados nos municípios, e o conhecimento de sua composição ainda é limitado. Para apoiar gestores na fase de diagnóstico desses resíduos, este estudo propõe um método de campo que forneça a sua caracterização qualitativa apoiado em indicadores de geração. Para tanto, a pesquisa foi dividida em duas etapas: caracterização quantitativa baseada na análise de três indicadores de geração de resíduos da construção civil; e caracterização qualitativa, que consistiu em um procedimento de análise de imagem de amostras de resíduos da construção civil. O método de caracterização qualitativa provou ser eficiente para amostras volumosas. No entanto, esse método foi considerado limitado para representar caracterizações que contêm resíduos que podem abranger outros tipos de resíduos de construção civil, a exemplo de plásticos, papelão e embalagens. O método de análise de imagem mostrou-se adequado para uso em diagnósticos preliminares, os quais exigem resultados rápidos sobre a composição dos resíduos da construção civil.

[Impact of the new smoke-free legislation (law 42/2010) on levels of second-hand smoke in hospitality venues]. / Impacto de la nueva legislación sobre tabaquismo (Ley 42/2010) en los niveles de humo ambiental de tabaco en locales de hostelería.

OBJECTIVE: To evaluate pollution by second-hand smoke in a sample of hospitality venues before and after the implementation of smoke-free legislation. METHODS: A cross sectional, before-after study was conducted in 2008 and 2011 after the total ban. A SidePack Aerosol monitor was used both inside and outside the hospitality venues to measure fine breathable particles (PM2.5). A total of 43 places with pre- and post-legislation measurements were included. RESULTS: The median indoor pollution in hospitality venues was 204.2µg/m(3) in 2008 and 18.82µg/m(3) in 2011; the average outdoor PM2.5 concentration was 47.04µg/m(3) in 2008 and 18.82µg/m(3) in 2011. Pollution was higher in bars and cafeterias, followed by pubs and discos. Before the law was implemented, pollution was 4.34 times higher indoors than outdoors; in 2011 the average indoor PM2.5 concentration decreased by 90.88%. CONCLUSIONS: Only a complete ban is able to protect workers and customers against the health risks of second-hand smoke exposure.

A randomized, double-blind, placebo-controlled trial to assess prevention of mood episodes with risperidone long-acting injectable in patients with bipolar I disorder.

The efficacy and safety of risperidone long-acting injectable (LAI) for preventing recurrence of mood episodes in patients with bipolar I disorder was evaluated in a randomized, placebo-controlled study. After a 12-week open-label period with risperidone LAI (n=560), patients who did not experience a recurrence entered an 18-month randomized, double-blind period with risperidone LAI (n=132) or placebo (n=135); a third treatment arm (n=131) was randomized to oral olanzapine (10 mg/day) for reference and exploratory comparisons. The primary efficacy endpoint was time to recurrence of any mood episode for risperidone LAI versus placebo in the double-blind period (Kaplan-Meier analysis). Additional efficacy endpoints included Young Mania Rating Scale, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression. During the double-blind period, dosing was fixed at patients' final open-label dose (25 mg, 66% of patients; 37.5 mg, 31%; 50 mg, 4%). The primary outcome demonstrated a median time to mood episode recurrence of 198 day in the placebo arm, whereas the median was not reached in the risperidone LAI arm (p=0.057). Time to recurrence of any mood episode was significantly longer with risperidone LAI versus placebo (log-rank test stratified by region only, p=0.031); the difference was significant for time to recurrence of elevated mood episodes (p=0.005) but not depressive episodes (p=0.655). Significant improvement of manic symptoms and global condition versus placebo were observed for risperidone LAI, with no evidence of worsening of depression. In conclusion, risperidone LAI significantly delayed time to recurrence of elevated mood episodes, with a safety profile consistent with previous studies.

[Study of Flexible Doses of Paliperidone ER in Pacients with Schizophrenia who Have Undergone Inefficient Treatment with other Antipsychotics]. / Estudio de dosis flexibles de paliperidona ER en pacientes con esquizofrenia previamente tratados sin efectividad con otros antipsicóticos.

BACKGROUND: Extended-release (ER) paliperidone is an innovative atypical antipsychotic that allows minimal peak-to-through fluctuations with once-daily dosing. OBJECTIVE: To evaluate effectiveness, safety and tolerability of flexible, once-daily doses of paliperidone ER (3-12 mg/day) in patients with schizophrenia from Argentina and Colombia who had previously failed treatment with other antipsychotic agents. METHODS: The authors conducted a 6-month, open-label, prospective and multicentric study. Effectiveness was assessed with Positive and Negative Syndrome Scale (PANSS) and Personal and Social Performance scale (PSP). Other measures of effectiveness, safety and tolerability, were also conducted. RESULTS: Paliperidone ER 3-12 mg/day improved Positive and Negative Syndrome Scale (PANSS) total scores (primary endpoint) from baseline to study end (p < 0,001). In the PANSS total score, the mean change from baseline (83, 9 units) to end point (53,7 units) was significant (p < 0,001). Flexible doses of paliperidone ER demonstrated a ≥20% reduction in the PANSS total score (p<0.001) in almost two-thirds of patients. PSP mean change from baseline (52 units) to end point (85 units) was significant (p < 0,001). Secondary effectiveness assessments, as well as safety and tolerability measures, demonstrated favourable results throughout the study. CONCLUSIONS: Flexible doses of paliperidone ER over 6 months were effective, safe and well tolerated in patients with schizophrenia from Argentina and Colombia.