Pollination services to crops of watermelon (Citrullus lanatus) and green tomato (Physalis ixocarpa) in the coastal region of Jalisco, Mexico.

Bees play a pivotal role as pollinators in crops essential for human consumption. However, the global decline in bee populations poses a significant threat to pollination services and food security worldwide. The loss and degradation of habitats due to land use change are primary factors contributing to bee declines, particularly in tropical forests facing high deforestation rates. Here, we evaluate the pollination services provided to crops of watermelon (Citrullus lanatus) and green tomato (Physalis ixocarpa) in three municipalities in the state of Jalisco, Mexico, a place with Tropical Dry Forest, during years 2008, and 2014 to 2017. Both crops are cultivated in the dry season, approximately during the months of November to March. We describe the composition of the pollinator community and their visitation frequency (measured through the number of visits per flower per hour), and we assess the impact of pollinators on plant reproductive success and the level of pollinator dependence for each crop species (measured through the number of flowers that developed into fruits). We also evaluate how the landscape configuration (through the percentage of forest cover and distance to the forest) influences richness and abundance of pollinators (measured as number of species and individuals of pollinators per line of 50 m), and we use the model Integrated Valuation of Ecosystem Services and Tradeoffs (InVEST) to map and value the pollination service in both crops. InVEST Crop pollination model is a simulation focuses on wild pollinators providing the pollinator ecosystem service. Our findings indicate that Apis mellifera was the primary pollinator of both crops, one of the few abundant pollinators in the study region during the dry season. In experiments where pollinators were excluded from flowers, watermelon yielded no fruits, while green tomato experienced a 65% reduction in production. In the case of green tomato, fruit set showed a positive correlation with pollinator abundance. A positive association between forest cover and total pollinator abundance was observed in green tomato in 2008, but not in watermelon. Additionally, a positive relationship was observed between the abundance of bees predicted by the InVEST model and the abundance of bees observed in green tomato flowers in 2008. In the study region, green tomato and watermelon rely on pollinators for fruit production, with honeybees (from feral and managed colonies) acting as the primary provider of pollination services for these crops. Consequently, the conservation of natural areas is crucial to provide food and nesting resources for pollinators. By doing so, we can ensure the diversity and abundance of pollinators, which in turn will help secure food security. The findings of this study underscore the critical need for the conservation of natural areas to support pollinator populations. Policymakers should prioritize the protection and restoration of habitats, particularly tropical forests, which are essential for maintaining the diversity and abundance of pollinators.

Emerging concepts in heart failure management and treatment: focus on current guideline-directed medical therapy for heart failure with reduced ejection fraction.

One of the most relevant and differentiating aspects provided by the 2021 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure is the retraction of the historical stepped and vertical pharmacological treatment scheme for heart failure with reduced ejection fraction (HFrEF). Subsequently, it was replaced by an updated algorithm that places four therapeutic families in the same initial horizontal step with an equally high degree of recommendation (class I). In this context, these four pillars, which have demonstrated a significant reduction in mortality and hospitalizations in patients with HFrEF, include (1) angiotensin-converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB)/angiotensin II receptor-neprilysin inhibitors (ARNi), (2) beta blockers, (3) mineralocorticoid receptor antagonists (MRA) and (4) sodium-glucose cotransporter 2 inhibitors (SGLT2is) as the main novelty. This manuscript reviews the current therapeutic algorithm with a special focus on the therapeutic value of adding an MRA (still underused in both clinical trials and real world), changing an ACEi/ARB for an ARNi and incorporating an SGLT2i in patients with HFrEF. This article is part of the Emerging concepts in heart failure management and treatment Special Issue: https://www.drugsincontext.com/special_issues/emerging-concepts-in-heart-failure-management-and-treatment.

Spatial patterns and determinants of avocado frontier dynamics in Mexico.

The surging demand for commodity crops has led to rapid and severe agricultural frontier expansion globally and has put producing regions increasingly under pressure. However, knowledge about spatial patterns of agricultural frontier dynamics, their leading spatial determinants, and socio-ecological trade-offs is often lacking, hindering contextualized decision making towards more sustainable food systems. Here, we used inventory data to map frontier dynamics of avocado production, a cash crop of increasing importance in global diets, for Michoacán, Mexico, before and after the implementation of the North American Free Trade Agreement (NAFTA). We compiled a set of environmental, accessibility and social variables and identified the leading determinants of avocado frontier expansion and their interactions using extreme gradient boosting. We predicted potential expansion patterns and assessed their impacts on areas important for biodiversity conservation. Avocado frontiers expanded more than tenfold from 12,909 ha (1974) to 152,493 ha (2011), particularly after NAFTA. Annual precipitation, distance to settlements, and land tenure were key factors explaining avocado expansion. Under favorable climatic and accessibility conditions, most avocado expansion occurred on private lands. Contrary, under suboptimal conditions, most avocado expansion occurred on communal lands. Large areas suitable for further avocado expansion overlapped with priority sites for restoration, highlighting an imminent conflict between conservation and economic revenues. This is the first analysis of avocado frontier dynamics and their spatial determinants across a major production region and our results provide entry points to implement government-based strategies to support small-scale farmers, mostly those on communal lands, while trying to minimize the socio-environmental impacts of avocado production. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s10113-022-01883-6.

Discounting, Cognitive Inflexibility, and Antisocial Traits as Predictors of Adolescent Drug Involvement.

Cognitive impairments, such as steep delay discounting, have been correlated with substance-related disorders. However, antisocial traits, cognitive inflexibility, and loss discounting have been barely considered despite having a high relationship with problematic consumption. This study aims to identify the predictive power of these variables in four types of drug use. Fifty-two adolescents (age range of 13 to 19 years) were assessed with a substance involvement test, four discounting tasks using $3,000, a card sorting test, and antisocial screening. Discriminant analysis with simultaneous estimation and varimax rotation was carried out. Function one included discounting of both losses, function two AT and CI, and function three probabilistic gains. The three functions explained 60.1% of the variance. The results show that preference for small and soon punishments and larger and unlikely punishments distinguished non-use and experimental use of moderate consumption and problematic consumption. High antisocial traits and low cognitive inflexibility distinguished experimental use groups of non-use. Risk-taking did not discriminate effectively between moderate consumption and problematic consumption. A replication of this study with a larger sample size is recommended to verify the results.

Decision-Making Under Risk and Uncertainty by Substance Abusers and Healthy Controls.

Cognitive impairment characterized by high impulsivity and risk-taking has been correlated with substance-related disorders. However, it is unclear if the decision-making process is well known upon consideration of factors such as uncertainty environments, risk, and time manipulation in different decision-making procedures. The main objective of this study was to identify behavioral differences between substance abusers and healthy control participants in a behavioral test battery, including (1) two uncertainty decision-making tasks, the Balloon Analog Risk Task (BART) and the Iowa Gambling Task (IGT, trial 1-40); (2) three risk-taking tasks, the Columbia Card Task Hot version (CCT-hot), Columbia Card Task Cold version (CCT-cold), and the IGT (trial 41-100); and (3) an impulsivity task, the Delay Discounting task (DD). The second objective looked at how the six behavioral tests correlate. We worked with a sample of 54 adult participants (Substance abusers: n = 28; Healthy controls: n = 26). An anonymous survey website was created to execute all the cognitive tasks. The results showed no statistically significant differences between the groups in any of the tasks. However, the results showed an upward trend of impulsive (i.e., steeply discounting curve) and risk-taking behaviors (i.e., a low learning curve in IGT) in substance abuse participants. The factor analysis results showed four different main factors: (1) risk-taking task in the IGT (trial 40-100), (2) uncertainty task in BART, (3) impulsivity in DD, IGT (trial 1-40), and (4) deliberate process in the Columbia card task (cold and hot). We conclude that factors such as the uncertainty tasks in the BART and the first block of IGT trials, the risk cues in the CCT tasks (i.e., number of loss, number of gains, and loss cards), and the time to delivery in the DD task, can affect the complex decision-making process in both clinical and healthy groups.

Training and Practice Patterns in Cancer Rehabilitation: A Survey of Physiatrists Specializing in Oncology Care.

BACKGROUND: Cancer rehabilitation is an integral part of the continuum of care for survivors. Due to the increasing number of survivors, physiatrists commonly see cancer patients in their general practices. Essential to guiding the field is to understand the current training and practice patterns of cancer rehabilitation physicians. OBJECTIVES: To assess current trends in training and practice for cancer rehabilitation physicians, including the level of burnout among providers in this field. DESIGN: Cross-sectional descriptive survey study. SETTING: Online survey. PARTICIPANTS: American physicians who are affiliated with the Cancer Rehabilitation Physician Consortium (CRPC) of the American Academy of Physical Medicine and Rehabilitation (AAPM&R). The CRPC is a group of cancer rehabilitation providers (both fellowship-trained and not fellowship-trained) with the mission of furthering cancer rehabilitation medicine through education, research, and networking. METHODS: All CRPC physicians were invited to complete a voluntary and anonymous 43-question online survey. The survey was conceived by a group of eight experts interested in providing additional information to the current literature regarding the training and practice in the cancer rehabilitation field. MAIN OUTCOME MEASUREMENTS: Training, practice, opioid prescribing, and professional support. RESULTS: Thirty-seven of 50 physicians participated (response rate = 74%). Respondents were from various states, the three most common being New York (16%, n = 6), Texas (16%, n = 6), and Massachusetts (11%, n = 4). About 57% (n = 21) of the respondents were employed in an academic medical center and 73% (n = 27) reported their primary departmental affiliation was Physical Medicine and Rehabilitation (PM&R). Approximately 78% (n = 29) credited mentorship early in training for their interest in the field. More than half (54%, n = 20) either strongly agreed or agreed that cancer rehabilitation fellowship training is necessary for graduating physiatrists who plan to treat oncology patients/survivors. National PM&R meetings were the primary source of continuing education for 86% (n = 31). Sixty-five percent (n = 24), strongly agreed or agreed that cancer rehabilitation physiatrists should know how to prescribe opioids, and 35% (n = 13) reported prescribing them when appropriate. About 54% (n = 20) rated their level of burnout as low or very low, and more than half (51%, n = 19) believed their burnout level was lower than physiatrists treating other rehabilitation populations. CONCLUSIONS: Cancer rehabilitation is a growing subspecialty in PM&R, and most physiatrists in general practice will treat many survivors-often for neurologic or musculoskeletal impairments related to cancer or its treatment. Cancer rehabilitation physicians perceive that they have relatively low levels of burnout, and early mentorship and fellowship training is beneficial. Professional conferences and mentorship are a primary source for continuing education. LEVEL OF EVIDENCE: IV.

Substance use and antisocial behavior: criterion-related validity of the Antisocial Process Screening Device in Mexican adolescents / Uso de sustancias y comportamiento antisocial: validez de criterio del Test de Tamizaje del Proceso Antisocial en adolescentes mexicanos

Abstract Introduction Adolescents who use drugs present several health problems, including criminal behavior. The Antisocial Process Screening Device (APSD) is a test that evaluates current conduct disorders in adolescents. Objective This research carried out a cross-cultural adaptation of the APSD on Mexican population. Method The original version of the APSD was translated into Mexican Spanish. The final version was administered to 1 070 adolescents (958 students, 72 with minor faults, and 40 with criminal behavior) who completed the APSD and the ENCODE, the National survey on drug use. We computed correlations and regression models between APSD and ENCODE. We carried out a multivariate analysis to compare samples and quantity of drugs. Finally, we fitted the two-and three-factor models of the APSD with a CFA. Results The APSD scores correlated significantly with all of the ENCODE variables. In the multivariate analysis, the variable quantity of drugs was significant to rise the APSD score (F [3 847] = 7.53, p = .000). The CFA with three factors had the best fit. Reliability analysis suggests acceptable internal consistency (α = .79). Discussion and conclusion Our results confirmed that the Mexican Spanish version of the APSD has good psychometric properties to be used in future research.

Resumen Introducción Los adolescentes que consumen drogas presentan varios problemas de salud, incluida la conducta delictiva. El Test de Tamizaje de Proceso Antisocial (APSD, por sus siglas en inglés) es una prueba que evalúa los trastornos de conducta actual en adolescentes. Objetivo Esta investigación realizó una adaptación intercultural de la APSD en población mexicana. Método La versión original del APSD fue traducida al español de México. La versión final se administró a 1 070 adolescentes (958 estudiantes, 72 con delitos menores y 40 con conducta delictiva) que completaron el APSD y la Encuesta Nacional de Consumo de Drogas en Estudiantes (ENCODE). Calculamos correlaciones y modelos de regresión entre APSD y ENCODE. Realizamos un análisis multivariado para comparar muestras y cantidad de drogas consumidas. Finalmente, ajustamos los modelos de dos y tres factores del APSD con un CFA. Resultados Las puntuaciones APSD se correlacionaron significativamente con todas las variables ENCODE. En el análisis multivariado, la variable cantidad de drogas consumida fue significativa para incrementar el puntaje en APSD (F [3 847] = 7.53, p = .000). El CFA con tres factores tuvo el mejor ajuste. El análisis de confiabilidad sugiere una consistencia interna aceptable (α = .79). Discusión y conclusión Nuestros resultados confirmaron que la versión mexicana en español del APSD tiene adecuadas propiedades psicométricas para su utilización en futuras investigaciones.

Nail unit ultrasound: a complete guide of the nail diseases.

INTRODUCTION: The nails have a functional and esthetic importance for patients. Almost always, the nail disorders are diagnosed on the basis of clinical findings, but imaging methods may be required for a better assessment. These imaging methods, such as ultrasound and magnetic resonance, may help to establish an accurate diagnosis. Magnetic resonance imaging is not widely available and sometimes may be very expensive; that is why, ultrasound is an excellent imaging modality. Our objective is to expose the nail unit anatomy, the nail unit anatomy in ultrasound, and some of the frequent pathologies found in our daily practice. METHODS: A review of the literature was done to review the anatomy, technical aspects, and different findings in normal and abnormal nail unit ultrasound. RESULTS: Ultrasound offers an appropriate alternative for the evaluation of the nail unit, allows a real-time evaluation of each one of the components of the nail unit with an optimal visualization of these structures, and allows the evaluation of the thickness of the components, the vascularity, and blood flow by Doppler application. In addition, the nail unit disorder, such as infectious diseases, inflammatory and rheumatologic conditions, nail tumors, among others, may be assessed, not only in the diagnosis but also in the follow-up. Pre-surgical evaluation, surgical follow-up, and some procedures, such as biopsies, may be done by this technique. CONCLUSIONS: Ultrasound is an excellent technique for evaluation of normal anatomy, diagnosis, and follow-up of patients with nail unit diseases. This is an alternative for other imaging methods and may be used for an accurate diagnosis approach.

Postoperative Cyst Associated with Bone Morphogenetic Protein Use in Posterior and Transforaminal Lumbar Interbody Fusion Managed Conservatively: Report of Two Cases.

Bone morphogenetic protein use in spinal surgery for off-label indications continues to remain popular. One area where its use has known associated radicular complications is posterior or transforaminal lumbar interbody fusion. These complications include radiculitis, cyst development, and heterotopic ossification, amongst others. Typically, cyst development has been treated surgically. We present two cases of bone morphogenetic protein-related cysts treated medically and thus, present medical treatment as an alternative treatment option.

Síndrome de apnea hipoapnea obstructiva del sueño en paciente con accidente cerebrovascular isqueémico / Obstructive sleep apnea hypoapnea syndrome in patients with ischemic cerebrovascular accident

El síndrome de apnea hipoapnea obstructiva del sueño es considerado factor de riesgo para accidente cerebrovascular, que es a nivel mundial la segunda causa de muerte y primera de discapacidad. Objetivo: describir la prevalencia de sospecha de SAHOS por escala Epwhort y aumento de circunferencia cervical en pacientes con ACV isquémico en los hospitales de San José e Infantil Universitario de San José, de Bogotá DC, de octubre 2013 a septiembre 30 de 2014. Metodología: estudio descriptivo de corte transversal con población elegida con diagnóstico de ACV isquémico. Resultados: 125 pacientes con edad promedio de 69 años (DE 15.0) y relación hombre/mujer 1:1. Antecedente de SAHOS 1.6% (n: 2). Por Epworth 57% (n: 63/109) tenian sospecha de SAHOS, hombres 60,3%(n: 35). La mediana para Epworth fue 10 (RIQ 7-12). Circunferencia cervical >43 cm en hombres 8,6% (n:5) y en mujeres >40 cm en 28% (n:14). El 30% (19/62) de ACV tenía sospecha de SAHOS por Epworth y circunferencia cervical. Los hombres con Epworth (8-15), tenían circunferencia cervical aumentada 14% (5/35) y las mujeres 51,9% (14/27). La mortalidad intrahospitalaria fue 9,7% (n:12). Conclusión: se encontró que más de la mitad tenía sospecha de SAHOS leve por Epworth. Hubo mayor prevalencia de obesidad cervical en mujeres y una tercera parte tenían sospecha de SAHOS por ambos criterios, lo cual confirma la importancia de explorar de rutina estos indicadores...

Obstructive sleep apnea hypoapnea syndrome is considered a risk factor for cerebrovascular accident which is the second cause of death and leading cause of disability worldwide. Objective: to describe suspicion prevalence of OSAHS estimated by the Epworth score and increase of neck circumference in patients with ischemic CVA at San José and Infantil Universitario de San José hospitals, Bogotá DC, from October 2013 and September 30 2014. Methodology: cross sectional descriptive study including a population diagnosed with ischemic CVA. Results: 125 patients with mean age 69 years (SD 15.0) and male/female ratio of 1:1. History of OSAHS in 1.6% (n: 2). By Epworth score, 57% (n: 63/109) had suspicion of OSAHS, 60.3% (n: 35) corresponded to men. The media for Epworth score was 10 (RIQ 7-12). Neck circumference, >43 cm in men 8.6% (n: 5) and women >40 cm in 28% (n: 14). OSAHS was suspected in 30% of CVAs (19/62) by Epworth score and neck circumference. Men with Epworth score (8-15), had an increased neck circumference 14% (5/35) and women 51.9% (14/27). In-hospital mortality was 9.7% (n: 12). Conclusion: we found that mild SOAHS estimated by Epworth score was suspected in more than half the patients. There was a higher prevalence of neck obesity in women and OSAHS was suspected in one third of them by both criteria, which confirms the importance of routinely exploring these indicators...

Miktoarm star polymer based multifunctional traceable nanocarriers for efficient delivery of poorly water soluble pharmacological agents.

A versatile methodology to develop an inherently fluorescent and thus traceable multifunctional nanodelivery platform based on miktoarm polymers is reported. Miktoarm stars containing covalently linked tetraiodofluorescein dye, polyethylene glycol, and polycaprolactone self-assemble into micelles, and integrate multiple functions including fluorescent tags for imaging, a hydrophobic core for drug incorporation, and a hydrophilic corona for micelle stabilization. Curcumin, a pleiotropic but very poorly water-soluble drug, is loaded into these micelles with an efficiency of 25-60 wt%. It leads to a 25 000-fold increase in its aqueous solubility, and a sustained release over a period of 7 d. These micelles are rapidly internalized into murine J774A.1 macrophages, and accumulated into discrete cellular compartments, whereas the free and physically encapsulated dye is diffused in the cytoplasm. Curcumin-loaded micelles reduce lipopolysaccharide-induced nitric oxide release. The studies establish miktoarm star based nanocarriers as highly efficient in tracking their fate and expanding the scope of pharmacological agents with limited utility in experimental medicine.

Genes similar to the Vibrio parahaemolyticus virulence-related genes tdh, tlh, and vscC2 occur in other vibrionaceae species isolated from a pristine estuary.

Detection of the human pathogen Vibrio parahaemolyticus often relies on molecular biological analysis of species-specific virulence factor genes. These genes have been employed in determinations of V. parahaemolyticus population numbers and the prevalence of pathogenic V. parahaemolyticus strains. Strains of the Vibrionaceae species Photobacterium damselae, Vibrio diabolicus, Vibrio harveyi, and Vibrio natriegens, as well as strains similar to Vibrio tubiashii, were isolated from a pristine salt marsh estuary. These strains were examined for the V. parahaemolyticus hemolysin genes tdh, trh, and tlh and for the V. parahaemolyticus type III secretion system 2α gene vscC2 using established PCR primers and protocols. Virulence-related genes occurred at high frequencies in non-V. parahaemolyticus Vibrionaceae species. V. diabolicus was of particular interest, as several strains were recovered, and the large majority (>83%) contained virulence-related genes. It is clear that detection of these genes does not ensure correct identification of virulent V. parahaemolyticus. Further, the occurrence of V. parahaemolyticus-like virulence factors in other vibrios potentially complicates tracking of outbreaks of V. parahaemolyticus infections.

Combined A3 Coupling and Click Chemistry Approach for the Synthesis of Dendrimer-Based Biological Tools.

We report a versatile approach in which two highly efficient chemical reactions, multicomponent A3 coupling and alkyne-azide click chemistry, are combined to construct dendrimer-based tools for applications in biology. Using a convergent approach, dendrons with desired architecture and an alkyne at the focal point are first assembled and then stitched together via multicomponent A3 coupling reaction. The desired functional groups, including a stealth agent, imaging dye, and drug molecules, could be easily covalently linked to the surfaces of these hyperbranched macromolecules using alkyne-azide click chemistry. These A3-click dendrimers are noncytotoxic at concentrations as high as 1 µM and in fact reduce the toxicity of the drug. The dye-coated dendrimers specifically target and localize in lipid droplets. This unison methodology represents an attractive chemical strategy in exploiting the untapped potential of A3 coupling and facilitating the development of nanodevices for imaging and drug delivery.

A preliminary assessment of the effectiveness of the Mesoamerican Biological Corridor for protecting potential Baird's tapir (Tapirus bairdii) habitat in Southern Mexico.

Baird's tapir (Tapirus bairdii) is one of the most emblematic mammals of Mesoamerica, but like other large-bodied animals, it is facing an increasing risk of extinction due primarily to habitat loss. Mexico's 'ortion of the Mesoamerican Biological Corridor (MBC-M) is located in one of the main strongholds for Bairds tapir. To assess the MBC-M's effectiveness for tapir conservation, we estimated the distribution of the species' potential habitat by applying 2 modelling approaches (random forest and Maxent) to a set of uncorrelated environmental variables and a 157-point presence dataset. We calculated the extent of tapir habitat in within the MBC-M and modelled new corridors and conservation areas, which we compared to the MBC-M. Moreover, we assessed deforestation patterns in the region. Twenty-seven percent of highly suitable tapir habitat occurred in protected areas, 15% in corridors and 58.3% was outside the MBC-M and associated reserves. The spatial configuration of the MBC-M was partially concordant with the modelled set of conservation areas and corridors. The main dissimilarity was that the modelled corridors traversed forests in Belize and Guatemala to connect conservation areas. Analyses of deforestation since 1993 and human population density in the vicinity of the MBC-M indicated that future conservation efforts should give particular attention to the Montes Azules-El Triunfo Corridor due to greater habitat threat. The MBC-M has a great potential to play a prominent role in the conservation of tapir habitat but there is an urgent need to implement management plans that reinforce and complement this conservation initiative.

Apnea obstructiva del sueño y trastornos psiquiátricos / Obstructive sleep apnea and psychiatric disorders

Introduction: Obstructive sleep apnea is one of the most common sleep disorders, and is characterized by recurrent collapse of the upper airway during sleep caused suddenly, with a subsequent decrease in blood oxygen's saturation and has repercussions in the patient's general condition. Aim: To describe the characteristics of this association according to the available medical evidence. Report: The mechanisms of association of sleep apnea with psychiatric disorders are not well defined. However the coexistence of depressive symptoms with this condition has been documented and refractoriness in the treatment of psychiatric disorders when there is comorbidity. Although there is more evidence linking psychiatric disorders with obstructive sleep apnea, there is some evidence linking depressive disorders and anxiety symptoms, comorbid sleep apnea, which alerts the active search for both conditions in patients one of the diagnoses. Conclusions: Physicians should suspect obstructive sleep apnea in patients with refractory depression mainly chronic snoring, short and wide neck, a high body mass index and excessive daytime sleepiness.

Introducción: La apnea obstructiva del sueño es una de las alteraciones más comunes del dormir, se caracteriza por colapsos recurrentes de la vía aérea superior causados repentinamente durante el sueño, con posterior disminución de la saturación de oxígeno en sangre y repercusiones en el paciente en su estado general. Objetivo: Describir las características de esta asociación conforme a la evidencia médica disponible. Desarrollo: Los mecanismos de asociación de la apnea del sueño con trastornos psiquiátricos no están bien definidos. Sin embargo, se ha documentado la coexistencia de síntomas depresivos con esta patología, y la refractariedad en el tratamiento de los trastornos psiquiátricos cuando existe esta comorbilidad. Aunque no se encuentra mayor evidencia que relacione los trastornos psiquiátricos con la apnea obstructiva del sueño, existen algunos datos que relacionan los trastornos depresivos y síntomas ansiosos, con comorbilidad de apnea del sueño, lo que alerta sobre la búsqueda activa de ambas condiciones en los pacientes con uno de los diagnósticos. Conclusiones: El médico debe sospechar apnea obstructiva del sueño en pacientes con depresión refractaria principalmente, ronquido crónico, cuello corto y ancho, un elevado índice de masa corporal y somnolencia diurna excesiva.