One-year outcomes of two community-based mental health interventions for Afro-Colombian survivors of the armed conflict and displacement.

The objective of the study is to assess the middle-term effects (1 year after intervention) of two community-based mental health interventions, Common Elements Treatment Approach intervention, CETA, and Narrative Community Group Therapy intervention, NCGT, in two cities of the Colombian Pacific region (Buenaventura and Quibdó). A follow-up study was conducted on a cohort of trial participants. In this trial, the positive effects of two mental health interventions were evaluated; assessment was carried out in separate groups (CETA arm, NCGT arm and a control group) of the reduction of symptoms of anxiety, depression, post-traumatic stress and function impaired mentality. The participants were Afro-Colombian survivors of the armed conflict and displacement living in Buenaventura and Quibdó. They were surveyed using the same instrument used in the original trial. Intent-to-treat analyses were performed, and longitudinal mixed-effects regression models with random effects were used to analyse the middle-term effects of the interventions. At 1-year post-intervention, participants in Buenaventura who received the CETA intervention experienced a decrease in depression (-0.23; p = 0.02), post-traumatic stress symptoms (-0.23; p = 0.02) and total mental health symptoms (-0.14; p = 0.048). In Quibdó, the NCGT intervention significantly improved function impairment (-0.30; p = 0.005). CETA and NCGT interventions have the potential to maintain a reduction of mental health symptoms in participants from the Colombian Pacific region.

Mental health Narrative Community-Based Group Therapy in violence-displaced Afro-Colombians: a randomized controlled trial.

This study aims to evaluate the effect of a mental health Narrative Community-Based Group Therapy (NCGT) in Afro-Colombian violence survivors. A randomized controlled trial was conducted in Buenaventura and Quibdó, Colombia. Afro-Colombian adults (n=521) were randomly allocated to a NCGT (n1=175), a wait-control group (n2=171) or a Common Elements Treatment Approach (CETA, n3=175). The CETA was described separately given conceptual/methodological differences. Lay psychosocial community workers delivered the NCGT. Symptoms were assessed before and after intervention/wait with culturally adapted mental health symptoms and gender-specific functionality scales. Intent to treat analysis and mean difference of differences were used for comparisons. In Buenaventura, a significant reduction in functional impairment (mean difference: -0.30, 95% Confidence Interval [95% CI]: -0.55, -0.05) and depression (mean difference: -0.24, 95% CI: -0.42, -0.07) were found, with small and moderate effect size, respectively. In Quibdó, functionality improved significantly (mean difference: -0.29, 95% CI: -0.54, -0.04, small effect size). Even though differences in depression and anxiety were not significant, there were reductions in symptoms. The NCGT is effective in improving daily functioning among violence victims in the Colombian Pacific and has the potential to reduce symptoms of depression. Further exploration is required to understand the effects of a narrative group therapy for mental health in Afro-Colombian populations.Trial Registration: ClinicalTrials.gov number: NCT01856673 (https://clinicaltrials.gov/ct2/show/NCT01856673).

Trichostrongylus colubriformis infection damages intestine brush board cells and could negatively impact postabsorptive parameters of Santa Ines lambs.

This study aimed to evaluate histological, digestive and postabsorptive physiological parameters in Santa Ines lambs infected with Trichostrongylus colubriformis and fed different levels of phosphorus. Therefore, eighteen Santa Ines, castrated male, six-month old, healthy lambs (initial body weight 22.4 ± 2.7 kg) were distributed in one of four treatments arranged in a 2 × 2 split-plot arrangement: Sufficient dietary P level and uninfected (SPui; n = 4), Sufficient dietary P level and infected (SPi; n = 5), Deficient dietary P level and uninfected (DPui; n = 4), Deficient dietary P level and infected (DPi; n = 5). Infected lambs received, orally, a single pulse dose of 40.000 T. colubriformis infective larval stage (L3). Animals were fed Tifton 85 hay (Cynodon ssp.; 60%), and cassava meal and maize gluten meal (40%). Measurement of nutrient apparent digestibility and nitrogen metabolism were performed in individual metabolic stalls. To achieve the trial results, it was measured methane emissions in respiratory chambers, urine purine derivatives, ruminal short-chain fatty acids (SCFA), histological cuts of duodenal mucosal tissues and passage rates fluxes, analyzed by external (Yb, Cr, and Co) and internal (iNDF) markers. Statistical procedures were performed in R studio. The fixed main effects of treatment and the interactions were tested by ANOVA, and means compared by Duncan's test at 5% significance. Apparent digestibility was not affected by treatments, however, nitrogen retained decreased (P < 0.01) and urinary nitrogen losses increased (P < 0.01) in infected animals. Small intestine digesta content, empty segment weight, and length were higher in infected animals (P < 0.05). Passage rate was not majorly affected by infection or dietary P levels. Methane emissions, SCFA concentrations, and purine derivative excretion were also not affected by treatments. Regarding the histology, the vilosity weight (P < 0.05), and crypt depth (P < 0.01) decreased in infected animals. In conclusion, T. colubriformis infection can damage intestinal mucosa and affect nitrogen metabolism, but did not affect the digesta transit, and nutrient digestibility. The P dietary levels did not promote any modification in GIT physiological parameters tested in this study.

Exposición a violencia de género en una población de mujeres consultantes a un servicio de psiquiatría comunitaria en Cali, Colombia / Exposure to gender violence in a population of women consulting a Community Psychiatry service in Cali, Colombia

RESUMEN Objetivo Conocer las características sociales, sintomatología mental y exposiciones a hechos de violencia de mujeres consultantes a un servicio de salud mental comunitaria en una Institución de Atención Primaria. Metodología Se realizó un estudio de corte trasversal descriptivo en el programa de Psiquiatría Comunitaria de dos centros asistenciales de la Red de Salud de Ladera E. S. E. en Cali, Colombia. Se analizó el contenido de 157 registros del año 2018, usando estadística descriptiva para las variables sociodemográficas, clínicas y relacionadas con su historial psiquiátrico. Resultados El 43,59% del total de las mujeres consultó por trastornos afectivos, ninguna enunció situaciones relacionadas con violencia en el motivo de consulta. Sin embargo, cerca del 16% enunció situaciones de violencia en el apartado de "enfermedad actual", mientras que el 39,49% lo señaló como parte de los "antecedentes personales", y el 15,29% lo relacionó con los "antecedentes familiares". tras comparar este grupo de mujeres expuestas a violencia con las no expuestas, se encontró que los trastornos depresivos eran más frecuentes en el grupo expuesto (58,53%; p=0,035). El manejo farmacológico fue más frecuente en mujeres no expuestas y de tipo psicosocial en mujeres expuestas (p<0,05). Conclusiones Aunque se hubiese enunciado alguna forma de violencia dentro del contenido de las historias clínicas, menos del 2% de los reportes incluyó diagnósticos relacionados con violencia de género.

ABSTRACT Objective This study aims to know the social characteristics, mental health symptoms, and exposure of violence of women who are patients of the community psychiatry service in a Primary Care Institution. Methodology An observational and descriptive study was conducted. Patients were women who have been treated in the Community Mental Health Program in two healthcare centers of the Ladera Health Network: E.S.E in Cali, Colombia. 157 records from 2018 was analyzed using descriptive statistics for sociodemographic and clinical variables and those related to their psychiatric history. Results 43.59% of all women consulted for affective disorders. None reported any situation related to violence as the reason for consultation. However, violent situations were enunciated by 15.92% of the women in the "current illness" box, while 39.49% pointed it out as part of "personal history," and 15.29% related it to the "family history". Comparing this group of women exposed to violence with those not exposed, it was found that depressive disorders were more frequent in the exposed group (58.53%; p=0.035). Pharmacological management was more frequent in unexposed women and psychosocial in exposed women (p<0.05). Conclusions Although some form of violence had been stated within the medical record content, less than 2% of the reports included diagnoses related to gender violence.

Single serine on TSC2 exerts biased control over mTORC1 activation mediated by ERK1/2 but not Akt.

Tuberous sclerosis complex-2 (TSC2) negatively regulates mammalian target of rapamycin complex 1 (mTORC1), and its activity is reduced by protein kinase B (Akt) and extracellular response kinase (ERK1/2) phosphorylation to activate mTORC1. Serine 1364 (human) on TSC2 bidirectionally modifies mTORC1 activation by pathological growth factors or hemodynamic stress but has no impact on resting activity. We now show this modification biases to ERK1/2 but not Akt-dependent TSC2-mTORC1 activation. Endothelin-1-stimulated mTORC1 requires ERK1/2 activation and is bidirectionally modified by phospho-mimetic (S1364E) or phospho-silenced (S1364A) mutations. However, mTORC1 activation by Akt-dependent stimuli (insulin or PDGF) is unaltered by S1364 modification. Thrombin stimulates both pathways, yet only the ERK1/2 component is modulated by S1364. S1364 also has negligible impact on mTORC1 regulation by energy or nutrient status. In vivo, diet-induced obesity, diabetes, and fatty liver couple to Akt activation and are also unaltered by TSC2 S1364 mutations. This contrasts to prior reports showing a marked impact of both on pathological pressure-stress. Thus, S1364 provides ERK1/2-selective mTORC1 control and a genetic means to modify pathological versus physiological mTOR stimuli.

Autologous gastrointestinal reconstruction surgery for short bowel syndrome: the cornerstone for intestinal rehabilitation.

PURPOSE OF REVIEW: Intestinal failure (IF) evolved from being the last recognized organ failure, to become one of the most progressive fields in terms of therapeutic alternatives and results. Short bowel syndrome (SBS) is the main cause of IF in adults and children. The use of surgery allowed patients with unfavorable anatomy type and length to be wean off parenteral nutrition. We aim to evaluate its current impact on intestinal rehabilitation. RECENT FINDINGS: Autologous gastro-intestinal reconstructive surgery (AGIRS), including bowel lengthening contributes by converting patient's anatomy to a more favorable one, improving quality of life, and modifying the natural history of the disease, allowing to recover intestinal autonomy in approximately 70% of the adults and 50% of the children's with SBS-IF. The current use of postsurgical medical rehabilitation strategies including the use of enterohormones complement the path to sufficiency, increasing the chances of success in both age group of patients. SUMMARY: The development of AGIRS has changed the outcome of SBS-IF patients, becoming the main surgical procedure prescribed in multidisciplinary units, allowing to enhance the number of patients achieving intestinal autonomy throughout rehabilitation, leaving transplantation as the last surgical alternative.

Carcinoma del cístico, a propósito de un caso.

El carcinoma primario en el conducto cístico es un tumor raro y abarca del 0.1% al 0.2% de los carcinomas del tracto gastrointestinal. Presentamos el caso de un varón con pérdida de peso e ictericia, en el que se demuestra por imagen una dilatación de vías intrahepática y extrahepática condicionada por una compresión extrínseca del colédoco. Se realiza colangiografía pancreática retrógrada endoscópica que confirma la compresión, por lo que se lleva a cabo una exploración quirúrgica que evidencia una tumoración del conducto cístico. Se realiza colecistectomía con resección de ganglios linfáticos, además de anastomosis hepatoyeyunal. La tumoración se reporta como carcinoma del conducto cístico sin involucro ganglionar.Primary cystic duct carcinoma is a rare tumor and comprises 0.1% to 0.2% of carcinomas of the gastrointestinal tract. We present a case of a male with weight loss and jaundice. Evidence is shown by imaging of intrahepatic and extrahepatic duct dilatation conditioned by extrinsic bile duct compression. An endoscopic retrograde pancreatic cholangiography was performed confirming the compression, so a surgical exploration was preformed showing a tumor of the cystic duct, a cholecystectomy with resection of regional lymph nodes, as well as a hepatic-jejunal anastomosis. The tumor is reported as cystic duct carcinoma without lymph node involvement.

Impacts of violence on the mental health of Afro-descendant survivors in Colombia.

The Colombian armed conflict has disproportionately affected minorities, especially afro-Colombian communities. However, there is a lack of evidence about mental health of victims. This study aims to describe the prevalence of mental illness and its associated factors in Afro-descendant violence survivors in Buenaventura and Quibdó, Colombia. A cross-sectional study was carried out using data from a previous trial which aimed to reduce mental health symptoms (ClinicalTrials.gov: NCT01856673). Data of 710 adults identified through a snowball sampling technique was analysed. Diagnoses of depression, anxiety, post-traumatic stress disorder (PTSD), and dysfunction were established using adapted versions of the Hopkins Symptoms Checklist and the Harvard Trauma Questionnaire, plus variables identified in a qualitative study. Multivariate regressions were used to identify associated factors with these diagnoses. The prevalence of depression, anxiety and PTSD in both cities was 26.62% (95% confidence interval [95%CI]: 20.30;23.89), 36.53% (95%CI: 30.63;42.36), and 39.15% (95%CI: 33.36;44.83), respectively. Being married and having registered with the government as victim of the conflict were found to be protective factors for depression and PTSD, respectively. Psychological trauma, unemployment, and traumatic experiences, amongst others, were found as risk factors. The Colombian armed conflict, plus disparities and social exclusion, may be associated with mental health morbidity.

The Potential Link between Episodes of Diverticulitis or Hemorrhoidal Proctitis and Diets with Selected Plant Foods: A Case-Control Study.

Diverticulitis and hemorrhoidal proctitis in the population are significant public health problems. We studied the potential association between the intake of certain plant foods and diverticulitis or hemorrhoidal episodes through a case-control study including 410 cases and 401 controls. We used a semiquantitative food frequency questionnaire. The intake was additionally quantified according to a 24 h recall. The plant foods or derived food products were categorized by their main chemical components into ethanol, caffeine/theine/theobromine, capsaicin, alliin, acids, eugenol, and miscellaneous foods such as curcumin. The mean score for overall intake of plant foods under consideration was 6.3 points, and this was significantly higher in cases (8.5) than in controls (4.1). Overall intake was similar in cases presenting with diverticulitis or hemorrhoidal proctitis. Cases had 13 times the odds of being in the upper quartile for overall intake (>7 points), compared to controls. Explanatory logistic regression models showed that the strongest association with diverticulitis and hemorrhoidal proctitis was shown by the chemical food group of capsaicin, followed by ethanol, eugenol, caffeine/theine/theobromine, and acids. Neither alliin nor miscellaneous food groups showed any association. High, frequent consumption of capsaicin, followed by ethanol, eugenol, caffeine/theine/theobromine, and acids increase the risk of diverticulitis and hemorrhoidal proctitis.

Homicide Epidemic in Cali, Colombia: A Surveillance System Data Analysis, 1993‒2018.

Objectives. To examine homicide rates in Cali, Colombia, during the 1993-2018 period, using information derived from an interagency surveillance system. Methods. We used homicide data from Cali's Epidemiological Surveillance System to examine homicide trends by victim's age and sex, time, and type of method used. We estimated trend changes and the annual percentage changes using joinpoint regression analyses. Results. Homicide rates per 100 000 inhabitants dropped from 102 in 1993 to 47.8 in 2018. We observed reductions in homicide rates across age and sex groups. Most homicide victims were men aged 20 to 39 years from poor, marginalized areas. Firearms were used in 84.9% of all cases. The average annual percentage change for the entire period was -3.6 (95% confidence interval = -6.7, -0.4). Conclusions. Fluctuations in homicide rates in Cali show a clear epidemic pattern, occurring concurrently with the "crack epidemic" in different countries. Reliable and timely information provided by an Epidemiological Surveillance System allowed opportune formulation of public policies to reduce the impact of violence in Cali.

Endoscopic retrograde cholangiopancreatography for treatment biliopleural fistulas.

BACKGROUND: Biliopleural fistula is a rare communication between the biliary system and the pleural space secondary to ruptured hydatid cysts, hepatobiliary surgeries or penetrating wounds. There is not so much of the subject in the literature, so there is no standardized protocol for its management. OBJECTIVE: The objective of this work is to determine advantages and disadvantages of the use of ERCP as a conservative initial treatment for biliopleural fistulas. METHOD: Our retrospective study included patients with a diagnosis of biliopleural fistula who underwent ERCP as initial treatment, older than 18 years in a period from August 2016 to August 2019. RESULTS: Eight patients with a diagnosis of biliopleural fistula were included, 75% men and 25% women with a mean age of 24.5 years; the traumatic etiology was predominant in our group (89%), the diagnosis was made between days 3 and 14 after chest tube placement and we were successful in treating the fistula with ERCP in 87.5% of our patients. CONCLUSIONS: The use of ERCP as initial treatment for biliopleural fistula should be considered as the initial tool in the algorithm of management of this entity.

ANTECEDENTES: La fístula biliopleural es una comunicación poco frecuente entre el sistema biliar y el espacio pleural secundario a ruptura de quistes hidatídicos, cirugías hepatobiliares o heridas penetrantes Existe poco sobre el tema en la literatura por lo que no existe un protocolo estandarizado para su manejo. OBJETIVO: El objetivo de este trabajo es determinar ventajas y desventajas del uso de CPRE como tratamiento inicial conservador para fístulas biliopleurales. MÉTODO: Nuestro estudio retrospectivo incluyó pacientes con diagnóstico de fístula biliopleural quienes fueron sometidos a CPRE como tratamiento inicial, mayores de 18 años en un período de Agosto de 2016 a Agosto de 2019. RESULTADOS: Se incluyeron 8 pacientes con diagnístico de fístula biliopleural, 75% hombres y 25% mujeres con una media de edad de 24.5 años; la etiología traumática fue a predominante en nuestro grupo (89%), el diagnóstico se realizó entre los días 3 y 14 post colocación de sonda torácica y obtuvimos éxito en el tratamiento de la fístula con CPRE en el 87.5% de nuestros pacientes. CONCLUSIONES: El uso de CPRE como tratamiento inicial para fístula biliopleural debe ser considerada como la herramienta inicial en el algoritmo de manejo de esta entidad.

Neurophysiological findings of auditory evoked potentials in infants with a history of prematurity.

Background: Auditory evoked potentials (AEPS) constitutes the most commonly used neurophysiological test to assess the functional development of the auditory brainstem in infants and allows the evaluation of hearing for high frequencies. Methods: An observational, descriptive, cross-sectional and retrospective study was conducted. The AEPS results for 186 infants (372 ears) with a history of prematurity were examined. The bioelectrical response, morphology, amplitude, latencies I, III and V, and intervals I-III, III-V and I-V were compared, as well as auditory thresholds between two groups of premature infants < 32 and ≥ 32 weeks of gestational age (WGA). Results: The bioelectrical response, latencies I, III and V, and intervals I-III and III-V were similar between the two groups of premature infants according to their corrected age; no statistically significant differences were found (p > 0.05) for these variables. The amplitude, morphology, and the I-V interval were more affected in the group of premature infants < 32 WGA (p < 0.05). Of the 372 ears evaluated, 275 showed normal hearing and 97 showed some degree of hearing loss for high frequencies, which was more frequent in patients < 32 WGA (p < 0.05). Conclusions: The functional development of the auditory brainstem was similar between the groups of premature infants and within the normal range for the respective corrected age. Prematurity produced a directly proportional and statistically significant increase in the frequency of hearing loss for high frequencies.

Introducción: Los potenciales evocados auditivos (PEA) son la prueba neurofisiológica más utilizada para evaluar el desarrollo funcional del tronco encefálico auditivo en lactantes; además, permiten evaluar la audición para las frecuencias altas. Métodos: Se llevó a cabo un estudio observacional, descriptivo, transversal y retrospectivo. Se evaluaron los resultados de PEA de 186 lactantes (372 oídos) con antecedente de prematuridad. Se compararon la respuesta bioeléctrica, la morfología, la amplitud, las latencias I, III y V, los intervalos I-III, III-V y I-V y los umbrales auditivos en dos grupos de prematuros < 32 y ≥ 32 semanas de edad gestacional (SEG). Resultados: La respuesta bioeléctrica, las latencias I, III y V y los intervalos I-III y III-V fueron similares en los dos grupos de prematuros de acuerdo con su edad corregida; al compararse, no se encontraron diferencias estadísticamente significativas (p > 0.05) para estas variables. La amplitud, la morfología y el intervalo I-V estuvieron más afectados en el grupo de prematuros < 32 SEG (p < 0.05). De los 372 oídos evaluados, se encontraron 275 con audición normal y 97 con algún grado de hipoacusia para las frecuencias altas, más frecuente en los pacientes < 32 SEG (p < 0.05). Conclusiones: El desarrollo funcional del tronco cerebral auditivo fue similar entre los grupos de prematuros y dentro del rango normal para la edad corregida respectiva. La prematuridad produjo un incremento directamente proporcional y estadísticamente significativo en la frecuencia de hipoacusia para las frecuencias altas.

Hallazgos neurofisiológicos de potenciales evocados auditivos en lactantes con antecedente de prematuridad / Neurophysiological findings of auditory evoked potentials in infants with a history of prematurity

Resumen Introducción: Los potenciales evocados auditivos (PEA) son la prueba neurofisiológica más utilizada para evaluar el desarrollo funcional del tronco encefálico auditivo en lactantes; además, permiten evaluar la audición para las frecuencias altas. Métodos: Se llevó a cabo un estudio observacional, descriptivo, transversal y retrospectivo. Se evaluaron los resultados de PEA de 186 lactantes (372 oídos) con antecedente de prematuridad. Se compararon la respuesta bioeléctrica, la morfología, la amplitud, las latencias I, III y V, los intervalos I-III, III-V y I-V y los umbrales auditivos en dos grupos de prematuros < 32 y ≥ 32 semanas de edad gestacional (SEG). Resultados: La respuesta bioeléctrica, las latencias I, III y V y los intervalos I-III y III-V fueron similares en los dos grupos de prematuros de acuerdo con su edad corregida; al compararse, no se encontraron diferencias estadísticamente significativas (p > 0.05) para estas variables. La amplitud, la morfología y el intervalo I-V estuvieron más afectados en el grupo de prematuros < 32 SEG (p < 0.05). De los 372 oídos evaluados, se encontraron 275 con audición normal y 97 con algún grado de hipoacusia para las frecuencias altas, más frecuente en los pacientes < 32 SEG (p < 0.05). Conclusiones: El desarrollo funcional del tronco cerebral auditivo fue similar entre los grupos de prematuros y dentro del rango normal para la edad corregida respectiva. La prematuridad produjo un incremento directamente proporcional y estadísticamente significativo en la frecuencia de hipoacusia para las frecuencias altas.

Abstract Background: Auditory evoked potentials (AEPS) constitutes the most commonly used neurophysiological test to assess the functional development of the auditory brainstem in infants and allows the evaluation of hearing for high frequencies. Methods: An observational, descriptive, cross-sectional and retrospective study was conducted. The AEPS results for 186 infants (372 ears) with a history of prematurity were examined. The bioelectrical response, morphology, amplitude, latencies I, III and V, and intervals I-III, III-V and I-V were compared, as well as auditory thresholds between two groups of premature infants < 32 and ≥ 32 weeks of gestational age (WGA). Results: The bioelectrical response, latencies I, III and V, and intervals I-III and III-V were similar between the two groups of premature infants according to their corrected age; no statistically significant differences were found (p > 0.05) for these variables. The amplitude, morphology, and the I-V interval were more affected in the group of premature infants < 32 WGA (p < 0.05). Of the 372 ears evaluated, 275 showed normal hearing and 97 showed some degree of hearing loss for high frequencies, which was more frequent in patients < 32 WGA (p < 0.05). Conclusions: The functional development of the auditory brainstem was similar between the groups of premature infants and within the normal range for the respective corrected age. Prematurity produced a directly proportional and statistically significant increase in the frequency of hearing loss for high frequencies.

Long-term chromium picolinate supplementation improves colostrum profile of Santa Ines ewe.

Chromium (Cr) is a micromineral that is involved in the metabolism of carbohydrates, lipids, ammonia, and nucleic acids; thus, its supplementation can influence the nutritional status of ruminants, and consequently, colostrum profile, since this secretion depends on products secreted by the mammary gland and elements of the maternal bloodstream. The present study investigated the influence of supplementation with Cr bound to organic molecule on the nutritional, immune, and antioxidant quality of ewe colostrum. Thirty-two multiparous Santa Ines ewes (55.3 ± 8.00 kg body weight) were randomly assigned into four groups: T1 (0.0 mg of chromium picolinate (CrPic) supplementation per ewe, n = 8), T2 (0.15 mg of CrPic per ewe, n = 9), T3 (0.30 mg of CrPic per ewe, n = 7), and T4 (0.45 mg of CrPic per ewe, n = 8). Supplementation was supplied during the breeding season, pregnancy, and lactation. Shortly after calving, the first milking colostrum was collected to determine its chemical composition, activity of lysozyme, lactoperoxidase, ceruloplasmin, catalase, glutathione peroxidase, and oxygen radical absorbance capacity. The results show that lactoperoxidase activity decreased with CrPic supplementation (P < 0.01), revealing that this micromineral reduces an important component of defense mechanism in the body. Therefore, the results of this work show that supplementation with chromium picolinate influences colostrum quality.

Neurotransmitters and Behavioral Alterations Induced by Nickel Exposure.

BACKGROUND: Nickel ions (Ni2+) are a heavy metal with wide industrial uses. Environmental and occupational exposures to Ni are potential risk factors for brain dysfunction and behavioral and neurological symptoms in humans. METHODS: We reviewed the current evidence about neurochemical and behavioral alterations associated with Ni exposure in laboratory animals and humans. RESULTS: Ni2+ exposure can alter (both inhibition and stimulation) dopamine release and inhibit glutamate NMDA receptors. Few reports claim an effect of Ni2+ at the level of GBA and serotonin neurotransmission. At behavioral levels, exposure to Ni2+ in rodents alters motor activity, learning and memory as well as anxiety and depressive-like symptoms. However, no analysis of the dose-dependent relationship has been carried out regarding these effects and the levels of the Ni2+ in the brain, in blood or urine. CONCLUSION: Further research is needed to correlate the concentration of Ni2+ in biological fluids with specific symptoms/deficits. Future studies addressing the impact of Ni2+ under environmental or occupational exposure should consider the administration protocols to find Ni2+ levels similar in the general population or occupationally exposed workers.

A randomized controlled trial of a transdiagnostic cognitive-behavioral intervention for Afro-descendants' survivors of systemic violence in Colombia.

BACKGROUND: Exposure to violence has negative consequences on mental health. Armed-conflict in Colombia has widely affected Afro-descendants in the Pacific region. Evidence regarding effectiveness of mental health interventions is lacking in low-income settings, especially in areas with active conflict. The objective of this study is to evaluate an individualized Common Elements Treatment Approach (CETA), a transdiagnostic psychotherapy model based on Cognitive-Behavioral Therapy, for adult trauma survivors. METHODS AND FINDINGS: A referred sample of 521 adult Afro-descendants from Buenaventura and Quibdó, Colombia, experiencing significant sadness, suffering or fear (score>0.77 in Total Mental Health Symptoms), with history of traumatic experiences, and with associated functional impairment were randomly allocated to CETA intervention, standby group without intervention, but under monthly monitoring, or a Narrative Community-Based Group Therapy. CETA was provided by trained Lay Psychosocial Community Workers without previous mental health experience, supervised by psychologists, during 12-14 weekly, 1.5-hour sessions. Symptoms were assessed with a locally validated survey built based on the Hopkins Symptom Checklist, the Harvard Trauma Questionnaire, the PTSD CheckList-Civilian Version, a qualitative study for additional general symptoms and a gender-specific functional impairment scale. CETA was compared with the control group and the intervention effects were calculated with mixed models using intention to treat analysis. Participant completion of follow-up was 75.1% and 13.2% voluntarily withdrew. Reduction in post-traumatic stress symptoms was significant in both municipalities when comparing intervention and control groups (mean difference), with a with a moderate effect size in Buenaventura (Cohen's d  =  0.70) and a small effect size in Quibdó (d = 0.31). In Buenaventura, the intervention also had significant effects on depression (large effect size d = 1.03), anxiety (large effect size d = 0.80) and functional impairment (moderate effect size d = 0.70). In Quibdó, it had no significant effect on these outcomes. Changes in Total Mental Health Symptoms were not significant in neither city. CONCLUSIONS: This trial suggests that CETA, can be effective in improving depression, anxiety, post-traumatic stress and function among victims of systematized violence in low-income and active conflict settings. Nonetheless, the difference of effectiveness between the two cities of intervention may indicate that we cannot assume that a mental health intervention known to be effective in one setting will be effective in another, even in similar circumstances and population. This may have special importance when implementing and reproducing these types of intervention in non-controlled circumstances. Further research should address these concerns. Results can be of use by governmental decision-makers when defining mental health programs for survivors. TRIAL REGISTRATION: ClinicalTrials.gov NCT01856673 (https://clinicaltrials.gov/ct2/show/NCT01856673).

Mental Health and Psychosocial Problems and Needs of Violence Survivors in the Colombian Pacific Coast: A Qualitative Study in Buenaventura and Quibdó.

Introduction/ProblemFor more than 60 years, Colombia experienced an armed conflict involving government forces, guerrillas, and other illegal armed groups. Violence, including torture and massacres, has caused displacement of entire rural communities to urban areas. Lack of information on the problems displaced communities face and on their perceptions on potential solutions to these problems may prevent programs from delivering appropriate services to these communities. This study explores the problems of Afro-Colombian survivors from two major cities in Colombia; the activities they do to take care of themselves, their families, and their community; and possible solutions to these problems. METHODS: This was a qualitative, interview-based study conducted in Quibdó and Buenaventura (Colombia). Free-list interviews and focus groups explored the problems of survivors and the activities they do to take care of themselves, their families, and their community. Key-informant interviews explored details of the identified mental health problems and possible solutions. RESULTS: In Buenaventura, 24 free-list interviews, one focus group, and 17 key-informant interviews were completed. In Quibdó, 29 free-list interviews, one focus group, and 15 key-informant interviews were completed. Mental health problems identified included: (1) problems related to exposure to torture/violent events; (2) problems with adaptation to the new social context; and (3) problems related to current poverty, lack of employment, and ongoing violence. These problems were similar to trauma symptoms and features of depression and anxiety, as described in other populations. Solutions included psychological help, talking to friends/family, relying on God's help, and getting trained in different task or jobs. CONCLUSION: Afro-Colombian survivors of torture and violence described mental health problems similar to those of other trauma-affected populations. These results suggest that existing interventions that address trauma-related symptoms and current ongoing stressors may be appropriate for improving the mental health of survivors in this population. Santaella-TenorioJ, Bonilla-EscobarFJ, Nieto-GilL, Fandiño-LosadaA, Gutiérrez-MartínezMI, BassJ, BoltonP. Mental health and psychosocial problems and needs of violence survivors in the Colombian Pacific Coast: a qualitative study in Buenaventura and Quibdó. Prehosp Disaster Med. 2018;33(6):567-574.

[Implementation of intraoperative neurophysiologic monitoring in children and adults in secondary and tertiary health care facilities]. / Implementación del monitoreo neurofisiológico intraoperatorio en niños y adultos en el segundo y tercer nivel de atención.

INTRODUCTION: Intraoperative neurophysiological monitoring (IONM) is a procedure that uses neurophysiological techniques in order to evaluate the motor and sensitive systems during surgeries that endanger the nervous system. METHOD: The approach, scope, target population, and clinical questions to be answered were defined. A systematic search of the evidence was conducted step by step; during the first stage, clinical practice guidelines were collected, during the second stage systematic reviews were obtained, and during the third stage, clinical trials and observational studies were procured. The MeSH nomenclature and free related terminology were used, with no language restrictions and a 5-10 years frame. The quality of the evidence was graded using the CEPD and SIGN scales. RESULTS: Obtained using the search algorrhythms of 892 documents. Fifty-eight were chosen to be included in the qualitative synthesis. A meta-analysis was not possible due to the heterogeneity of the studies. CONCLUSIONS: Eighteen recommendations were issued and will support the adequate use of the IONM.

INTRODUCCIÓN: El monitoreo neurofisiológico intraoperatorio (MNIO) es un procedimiento que emplea técnicas neurofisiológicas con la finalidad de evaluar los sistemas motor y sensitivo durante cirugías que ponen en riesgo al sistema nervioso. MÉTODO: Se definieron el enfoque, los alcances, la población diana y las preguntas clínicas por resolver. Se realizó una búsqueda sistematizada de la evidencia por etapas. En la primera, se buscaron guías de práctica clínica; en la segunda, revisiones sistemáticas; y en la tercera, ensayos clínicos y estudios observacionales. Se utilizaron los términos MeSH y libres correspondientes, sin restricciones de lenguaje y con una temporalidad de 5 a 10 años. Se graduó la calidad de la evidencia utilizando las escalas CEPD y SIGN. RESULTADOS: Mediante los algoritmos de búsqueda se obtuvieron 892 documentos, y se seleccionaron 58 para la inclusión de la síntesis cualitativa. Debido a la heterogeneidad entre los estudios, no fue posible realizar metaanálisis. CONCLUSIONES: Se emitieron 18 recomendaciones, las cuales servirán como apoyo para la adecuada utilización del MNIO.

First motorcycle-exclusive lane (Motovia) in Colombia: perceptions of users in Cali, 2012-2013.

This study's goal was to evaluate the pilot exclusive lane for motorcycles (Motovía) in Cali, Colombia, from the perception of its users in 2012-2013. A cross-sectional study using roadside surveys plus a qualitative component of individual semi-structured interviews was carried out. Road users' perceptions were investigated before and after implementation of lane dividers (LD) and were compared with other roads in the city. Perceptions were compared using chi-square tests. In the study, 293 motorcyclists, 111 cyclists, and 115 automobile drivers were interviewed. Following the installation of the LD, the majority of motorcyclists and cyclists reported that LD made easier the driving maneuvers and decreased travel time, in contrast to perceptions of automobile drivers (p < 0.001). For most motorcyclists, the Motovia was considered as safe and effective, approving its continuity and replication. Half of automobile drivers and cyclists did not approve the installation of the Motovia due to travel time (drivers) and security issues (cyclists). Motovia is an option to enhance motorcyclists' safety on the road. It must, however, offer clear circulation alternatives for automobile drivers. According to users' perception, it is not safe for bicycles and other human-powered vehicles to share lanes with motorcycles. Further research about vulnerable road users' infrastructure is required.

Driving under the influence of alcohol in Cali, Colombia: prevalence and consumption patterns, 2013.

This study's goal was to establish the prevalence of driving under the influence of alcohol (DUI) and alcohol consumption patterns among drivers in Cali, Colombia, in 2013. A cross-sectional study based on a roadside survey using a stratified and multi-stage sampling design was developed. Thirty-two sites were chosen randomly for the selection of drivers who were then tested for blood alcohol concentration (BAC) and asked to participate in the survey. The prevalence of DUI was 0.88% (95% confidence intervals [95% CI] 0.26%-1.49%) with a lower prevalence when BAC was increasing. In addition, a higher prevalence was found during non-typical checkpoint hours (1.28, 95% CI -0.001%-0.03%). The overall prevalence is considered high, given the low alcohol consumption and vehicles per capita. Prevention measures are needed to reduce DUI during non-typical checkpoints and ongoing studies are required to monitor the trends and enable the assessment of interventions.