Partial-AZFc deletions in Chilean men with primary spermatogenic impairment: gene dosage and Y-chromosome haplogroups.

PURPOSE: To investigate the association of partial-AZFc deletions in Chilean men with primary spermatogenic failure and their testicular histopathological phenotypes, analyzing the contribution of DAZ dosage, CDY1 copies, and Y-chromosome haplogroups. SUBJECTS AND METHODS: We studied 479 Chilean men: 334 infertile patients with histological examination (233 cases with spermatogenic defects and 101 normal spermatogenesis, obstructive controls, OC), and 145 normozoospermic controls (NC). AZFc subdeletions were detected by single-tagged sequences and single nucleotide variants analysis. DAZ-copy number was quantified by real-time qPCR. Y-chromosome haplogroups (Y-hg) were hierarchically genotyped through 16 biallelic-markers. RESULTS: The prevalence of AZFc-partial deletions was increased in cases (6%) compared with NC (1.4%) (P = 0.035). There was no difference between 143 Sertoli-cell only syndrome, 35 maturation arrest, or 35 mix atrophy patients and controls. However, gr/gr deletions were more frequent in 16 subjects with hypospermatogenesis compared with NC (P = 0.003) and OC (P = 0.013). Y-hg R was the most prevalent (~ 50%), but decreased among gr/gr deletions (21%, P = 0.03). The prevalence of Y-hg M increased in cases versus controls, both in total and non-deleted men (3.9 and 3.7% versus 0.4%, P = 0.009 and P = 0.016, respectively). Among gr/gr deletions, Y-hg H increased compared with non-deleted men (14.3% versus 0.4%, P = 0.0047). CONCLUSION: Partial-AZFc deletions in a Chilean admixed population are associated with secretory azo/oligozoospermia and might have a role in the development of hypospermatogenesis. Low represented haplogroups, Y-hg M and Y-hg H, show an association with the occurrence of spermatogenic failure and gr/gr deletions respectively; however, additional studies are required.

A DILEMMA-FOCUSED INTERVENTION FOR DEPRESSION: A MULTICENTER, RANDOMIZED CONTROLLED TRIAL WITH A 3-MONTH FOLLOW-UP.

BACKGROUND: Since long ago it has been asserted that internal conflicts are relevant to the understanding and treatment of mental disorders, but little research has been conducted to support the claim. The aim of this study was to test the differential efficacy of group cognitive behavioral therapy (CBT) plus an intervention focused on the dilemma(s) detected for each patient versus group individual CBT plus individual CBT for treating depression. A comparative controlled trial with a 3-month follow-up was conducted. METHODS: One hundred twenty-eight adults meeting criteria for MDD and/or dysthymia, presenting at least one cognitive conflict (implicative dilemma or dilemmatic construct, assessed by the repertory grid technique) and who had completed seven sessions of group CBT were randomly assigned to eight sessions of individual manualized CBT or dilemma-focused therapy (DFT). The Beck Depression Inventory-II was administered at baseline, at the end of therapy and after 3 months' follow-up. RESULTS: Multilevel mixed effects modeling yielded no significant differences between CBT and DFT with the intention-to-treat sample. Equivalent effect sizes, remission, and response rates were found with completers as well. In combination with group CBT, both individual CBT and DFT significantly reduced depressive symptoms. CONCLUSIONS: Both conditions obtained comparable results to those in the literature. Thus, the superiority of the adjunctive DFT was not demonstrated. Working with dilemmas can be seen as a promising additional target in the psychotherapy of depression, but further research is still required.

A continuing HIV epidemic and differential patterns of HIV-STI risk among MSM in Quito, Ecuador: an urgent need to scale up HIV testing and prevention.

This study characterized the HIV epidemic among men who have sex with men (MSM) in Quito, Ecuador and contrasted risk patterns with other STI's. 416 MSM ages 15 years and older were recruited using respondent-driven sampling in 2010-2011. Biological testing and a self-interview survey assessed HIV and STI infections and risk behaviors. Analysis incorporated recruiter-level variables and clustering adjustments to control for recruitment patterns. We identify high levels of HIV (11 %), HSV-2 (14 %) and active syphilis (5.5 %) infections, low levels of lifetime HIV testing (57 %), limited knowledge of HIV and STI's (<48 %) and limited consistent condom use independent of partner type (<40 %). Sex work was associated with all infections while associations with residential location, how casual partners are met and other variables, varied. Scale-up of behavioral prevention and HIV testing is urgently needed. Interventions should target male sex workers and exploit differential patterns of HIV-STI risk to stay ahead of the epidemic.

CAG and GGN repeat polymorphisms in the androgen receptor gene of a Chilean pediatric cohort with idiopathic inguinal cryptorchidism.

BACKGROUND: Cryptorchidism is one of the most common congenital disorders in boys and it is associated with a higher risk of sub-fertility and testicular cancer. Testicular descent occurs during embryo-fetal development in two phases, transabdominal and inguino-scrotal. In the latter process, androgens play a leading role. The androgen receptor has in its N-terminal domain, two aminoacidic repeats encoded by polymorphic nucleotide repetitions: (CAG)nCAA and GGN. The number of repetitions of these trinucleotides has been associated with different transactivation capacities and sensitivities of the androgen receptor response. OBJECTIVE: To determine whether pediatric Chilean individuals with idiopathic inguinal cryptorchidism have a different number of CAG and/or GGN repeats polymorphisms compared with controls. MATERIALS AND METHODS: A total of 109 cases with idiopathic inguinal cryptorchidism (26 bilateral and 83 unilateral) were studied by polymerase chain reaction amplification from DNA extracted from peripheral blood, followed by fragment size analysis by capillary electrophoresis, which were compared with 140 controls. RESULTS: The CAG26 repeats allele was increased in the total cases (8.3% vs. 1.4%; p = 0.012; odds ratio = 6.21, 95% confidence interval 1.31-29.4), and in bilateral cases compared to controls (11.5% vs. 1.4%; p = 0.028; odds ratio = 9 CI 95% 1.43-56.8). Similarly, CAG > 22 alleles were increased in the total cases (62.4% vs. 49.3%, p = 0.041), and more significantly in bilateral cases (73.1% vs. 49.3%; p = 0.032; odds ratio = 2.79, 95% confidence interval 1.1-7.1). In addition, CAG < 18 alleles were not observed among cases, but were present in 5.7% of controls (p = 0.01). Regarding the GGN repeats, no differences were observed between cases and controls either when analyzing separately unilateral and bilateral cryptorchidism. The joint analysis of the distribution of CAG and GGN alleles showed that the CAG26 allele was present with GGN23, hence the combination CAG26/GGN23 alleles was equally increased in bilateral cases compared with controls (11.5% vs. 1.4%). In contrast, CAG < 18 was preferably observed in the combination CAG < 18/GGN≠23 and was absent in the total cases (4.3% vs. 0%; p = 0.037). DISCUSSION: These results suggest that greater lengths of CAG alleles may contribute to a diminished androgen receptor function. The CAG26 allele alone or in combination with GGN23 was associated with a higher risk of bilateral cryptorchidism. On the other hand, CAG < 18 and the CAG < 18/GGN≠23 allele combination may reduce the probability of cryptorchidism.

Differential Effect of 2 Hormonal Contraceptives on the Relative Telomere Length of Youth With Type 1 Diabetes.

Context: Adolescents and young women (AYA) with type 1 diabetes (T1D) may require hormonal contraception for an extended period. However, it is unclear what effect hormonal contraception has on telomere length, a marker of the risk for complications. Objective: To investigate the relative telomere length (RTL) in AYA with T1D (AYA-T1D) and healthy young women (AYA-C) after 18 months of combined oral contraception use (COC) with ethinyl estradiol/desogestrel, or a subdermal etonogestrel implant (IM). Methods: A nonrandomized prospective study was performed in which 39 AYA-T1D and 40 AYA-C chose the COC or the IM. RTL was measured by monochrome multiplex-quantitative PCR in DNA from peripheral blood mononuclear cells (PBMC). The impact of contraceptives and clinical variables on RTL was assessed using lineal regression analysis. Results: Longer RTL compared to baseline was observed in AYA-T1D (P < .05) and AYA-C (P  < .01) after using the IM. However, the total of AYA and the AYA-C group treated with COC decreased RTL after 18 months of treatment compared to baseline (P < .05). The type of contraceptive used was determinant for the changes in RTL compared to baseline in all subjects and controls (P ≤ .006). For AYA-T1D, HbA1c levels were not associated with RTL, but the high-sensitivity C-reactive protein was negatively related with the changes in RTL at 18 months compared to baseline (standardized R2 : 0.230, P  = .003). Conclusion: IM was associated with longer RTL in AYA-T1D and AYA-C. In contrast, a shortening of telomere length in PBMC was observed after using COC.

Testicular steroid sulfatase overexpression is associated with Leydig cell dysfunction in primary spermatogenic failure.

BACKGROUND: Decreased testosterone (T) to LH ratio and increased 17ß-estradiol (E2) serum concentrations represent a common finding among patients with severe spermatogenic failure, suggesting a concurrent Leydig cell steroidogenic dysfunction. Aromatase overexpression has been associated with increased serum and intratesticular E2 in these patients. However, it is unknown whether the sulfatase pathway contributes to the increased availability of active estrogens in patients with primary spermatogenic failure. OBJECTIVES: To assess estrogen sulfotransferase (SULT1E1) and steroid sulfatase (STS) mRNA abundance in testicular tissue of patients with Sertoli cell-only syndrome (SCOS) and normal tissues, its association with serum and intratesticular hormone levels, and to explore the mRNA and protein testicular localization of both enzymes. MATERIALS AND METHODS: Testicular tissues of 23 subjects with SCOS (cases) and 22 patients with obstructive azoospermia and normal spermatogenesis (controls) were obtained after biopsy. SULT1E1 and STS transcripts accumulation was quantified by RT-qPCR. For mRNA and protein localization, we performed RT-qPCR in Leydig cell clusters and seminiferous tubules isolated by laser-capture microdissection and immunofluorescence in testicular tissues. Serum and intratesticular hormones were measured by immunoradiometric assays. RESULTS: SULT1E1 mRNA accumulation was similar in both groups. The amount of STS mRNA was higher in cases (p = 0.007) and inversely correlated with T/LH ratio (r = -0.402; p = 0.02). Also, a near significant correlation was observed with intratesticular E2 (r = 0.329, p = 0.057), in agreement with higher intratesticular E2 in cases (p < 0.001). Strong STS immunoreaction was localized in the wall of small blood vessels but not in Leydig cells. Both SULT1E1 and STS mRNA abundance was similar in Leydig cell clusters and the tubular compartment, except for lower SUTL1E1 mRNA in the seminiferous tubules of SCOS patients (p = 0.001). CONCLUSIONS: Our results suggest that an unbalance of the STS/SULT1E1 pathway contributes to the testicular hyperestrogenic microenvironment in patients with primary spermatogenic failure and Leydig cell dysfunction.

Prevalence of anti-DFS70 autoantibodies in a Latin American cohort of patients with systemic lupus erythematosus and without autoimmune diseases.

INTRODUCTION/OBJECTIVES: Anti-dense fine speckled 70 (DFS70) autoantibodies were reported to be more prevalent in healthy individuals than those with autoimmune diseases such as systemic lupus erythematosus (SLE). We determined anti-DFS70 autoantibody prevalence in a Latin American cohort of patients with SLE and healthy individuals. METHODS: This study included 127 individuals with anti-nuclear antibodies (ANAs; > 1:160) suggesting the presence of anti-DFS70, including 64 patients with SLE and 63 healthy controls. The anti-DFS70 autoantibodies were determined by immunoadsorption using NOVA Lite® HEp-2 Select kit with DAPI. Negative fluorescence after adsorption with the DFS70 antigen indicated anti-DFS70 autoantibody positivity. RESULTS: The presence of anti-DFS70 autoantibodies was confirmed by indirect immunofluorescence in 21 (33.3%) healthy controls and 8 (12.5%) patients with SLE (p = 0.005). Among the anti-DFS70-positive patients with SLE, the most frequent compromise was renal involvement in six cases (75%), 4 patients (37.5%) were positive for anti-Sm, which was the most frequently associated antibody, and one patient (12.5%) was positive for anti-DNA. CONCLUSIONS: Anti-DFS70 autoantibodies might be considered a biomarker to differentiate patients with SLE from ANA-positive individuals without autoimmune diseases. KEY POINTS: • In a Latin American cohort, the anti-DFS70 was higher in individuals without autoimmune diseases compared with that in patients with SLE.• The anti-DFS70 might have utility as a biomarker of exclusion in patients with non-specific clinical signs of AARDs.

Role of the Androgen Receptor Gene CAG Repeat Polymorphism on the Sequence of Pubertal Events and Adiposity in Girls with High Dehydroepiandrosterone Sulfate Level.

STUDY OBJECTIVE: The androgen receptor (AR) harbors a variable repeat number of glutamine residues codified by (CAG)n, which seems to inversely affect AR transcriptional activity. We assessed whether (CAG)n affects the sequence of the androgen-sensitive pubertal events and body composition in prepubertal girls. DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS: Nested case-control study within the Growth and Obesity Cohort Study of 1196 low-middle income children (approximately 50% girls) from a university clinic in Santiago, Chile. Cases were girls with high dehydroepiandrosterone sulfate (DHEAS; >42 µg/dL; HD) at age 7.0 (±0.4) years (n = 58). On follow-up, 32 of them had thelarche (TB2) before the age of pubarche (PH2) and 26 had PH2 before the age of TB2. As controls, 107 age-matched girls with normal DHEAS (≤42 µg/dL; ND) were selected. MAIN OUTCOME MEASURES: Methylation-weighted mean (CAG)n (mw[CAG]n) was calculated through X-chromosome methylation-sensitive enzyme restriction and polymerase chain reaction followed by automated capillary electrophoresis in peripheral blood DNA. RESULTS: Girls with HD and PH2 before the age of TB2 showed a trend to higher frequency (7/26, 26.9%) of mw(CAG)n <20 compared with ND girls (12/107; 11.2%; P = .087). Accordingly, a direct correlation between age of PH2 and mw(CAG)n was observed in HD (r = 0.352; P = .007) and in ND girls (r = 0.207; P = .033). Moreover, HD girls with mw(CAG)n less than 20 had lower waist circumference and waist/height ratio than HD girls with mw(CAG)n from 20 to less than 25 (P = .027 and P = .012, respectively) at age of DHEAS determination. CONCLUSION: Our results suggest that a greater transcriptional activity of the AR, given by short number of CAG repeats, might favor the onset of pubarche and reduce central adiposity in prepubertal girls with HD.

Riesgo de afectación en salud mental asociado al malestar psicológico en un grupo de adultos jóvenes durante el aislamiento por COVID-19 / Risk of Mental Health Impairment Associated with Psychological Distress in a Group of Young Adults During Isolation by COVID-19

Resumen La pandemia por COVID-19 ha generado diversos problemas de salud mental en la población, puesto que las rutinas fueron afectadas abruptamente y la población se vio obligada a aislarse de sus familiares y amigos, y a cambiar la modalidad de sus trabajos, especialmente durante el tiempo en el cual las medidas fueron más restrictivas. Todo ello ha derivado en problemas de ansiedad, depresión, estrés y riesgo de suicidio, entre otros. El objetivo de este estudio fue conocer el riesgo de afectación en salud mental entre personas que reportaron malestar psicológico durante el aislamiento por COVID-19 en una muestra de 396 adultos jóvenes en Colombia. Este es un estudio retrospectivo, que siguió un diseño caso-control, para identificar la influencia del malestar psicológico percibido, el cual se evaluó a través de autorreporte. Los instrumentos utilizados fueron: a) un cuestionario de datos sociodemográficos, b) Depression, Anxiety and Stress Scale (DASS-21), (c) Overall Depression Severity and Impairment Scale (ODSIS), d) Overall Anxiety Severity and Impairment Scale (OASIS), e) Escala de Zung para Ansiedad, f) Escala de Riesgo Suicida de Plutchik. Los resultados muestran que el riesgo de padecer afectación en salud mental es al menos dos veces mayor en quienes percibieron malestar psicológico durante el aislamiento restrictivo en comparación con aquellos que reportaron no tener el mismo malestar (OR(estres) = 2.04; OR(riesgo suicidio) = 2.61; OR(ansiedad) = 2.85; OR(depres¡ón) = 3,37). La depresión es la variable de salud mental de mayor impacto, pues el riesgo de tener sintomatología depresiva es tres veces mayor; sin embargo, en la triada depresión-ansiedad-estrés es aún más alto el riesgo de afectación en quienes estuvieron expuestos al malestar psicológico (OR = 3.71). Estos hallazgos evidencian la necesidad de intervención en salud mental, especialmente en quienes tienen más de una afectación.

Abstract The COVID-19 pandemic has led to various mental health problems in the population, as routines were abruptly affected, forcing people to isolate themselves from their family and friends and change the modality of their jobs, especially during the most restrictive measures. All of this has resulted in problems such as anxiety, depression, stress, and the risk of suicide, among others. This study aims to determine the risk of mental health impairment in people who reported psychological distress during isolation due to COVID-19 in a sample of 396 young adults in Colombia. This is a retrospective study that followed a case-control design to identify the influence of perceived psychological distress measured by self-report. The instruments used were: (a) a sociodemographic data questionnaire, (b) Depression, Anxiety and Stress Scale (DASS-21), (c) Overall Depression and Impairment Scale (ODSIS), (d) Overall Anxiety and Impairment Scale (OASIS), (e) Zung Anxiety Scale, and (f) Plutchik's Risk of Suicide Scale. The results show that the risk of suffering from mental health problems is at least twice as high in those who perceived psychological distress during restrictive isolation compared to those who reported not having the same (OR(estres) = 2.04; OR(riesgo suicidio) = 2.61; OR(ansiedad) = 2.85; OR(depresión) = 3.37). Depression is the mental health variable with the greatest impact, as the risk of having depressive symptoms is even three times greater; however, in the depression, anxiety, and stress triad, the risk of involvement is even higher for those who were exposed to psychological distress (OR=3.71). These findings underscore the need for mental health intervention, especially in those who have more than one affectation.

A systematic review and meta-analysis of trans-diagnostic third-wave online psychological interventions / Revisión sistemática y metaanálisis de intervenciones transdiagnósticas en línea de tercera generación

Abstract Existing meta-analyses on the effect of online psychological interventions (OPIs) have found small to medium effect sizes for the treatment of anxiety and depression. On the other hand, third-generation trans-diagnostic OPIs are very rare and, due to the large variability among disorders, symptoms or target populations, it is difficult to assess their overall effect. Other systematic reviews and meta-analyses have overly broad inclusion criteria that make the understanding of the findings more difficult. The current study aims to analyze the empirical evidence for third-wave trans-diagnostic OPIs designed to decrease symptoms and promote psychological flexibility, including studies that compare a OPI to some control condition (e. g., waiting list, treatment as usual or other that should not have any effect) and include a general symptomatology scale as dependent variable. A search without filters or timeframe was performed on Scopus and 1 408 articles were found, among which 21 were reviewed in depth and 6 were included for meta-analysis. Risk of bias was assessed by a quality and heterogeneity assessment. Separate meta-analyses were performed for general distress and psychological flexibility at post-treatment and last follow-up. Risk of bias analysis suggest low risk of threats to validity and attribute heterogeneity to between-study attrition rates. Additionally, meta-regression models for duration, attrition rate, and mean age are proposed for each time point. The results show significantly large effect sizes for both variables at both time points. According to the meta-regression models attrition rates are a mediating variable for the effect on general distress both at completion and at the last follow-up. On the other hand, duration, age and attrition rate are all mediating variables for the effect on psychological flexibility at the end of treatment. The findings suggest that the high attrition rates observed on tele-psychology need to be mitigated; if this is not possible, intention-to-treat approaches should be adopted for data analysis.

Resumen Los metaanálisis existentes sobre el efecto de las intervenciones psicológicas en línea (OPIs, por sus siglas en inglés) han encontrado tamaños de efecto pequeños o medianos para el tratamiento de la ansiedad y la depresión. Por otra parte, las OPIs transdiagnósticas de tercera generación son muy escasas y, debido a la gran variabilidad entre los trastornos, los síntomas o las poblaciones objetivo, es difícil evaluar su efecto global. Otras revisiones sistemáticas y metaanálisis tienen criterios de inclusión demasiado amplios que dificultan la comprensión de los hallazgos. El presente estudio tiene como objetivo analizar la evidencia empírica actual para las OPIs transdiagnósticas de tercera generación diseñadas para disminuir los síntomas y promover la flexibilidad psicológica, incluyendo estudios que comparen una OPI con alguna condición de control (por ejemplo lista de espera, tratamiento habitual u otro que no debería tener efecto) y que incluyan una escala de sintomatología general como variable dependiente. Se excluyeron estudios basados en otras terapias y/o diseñados para prevenir o tratar una población, un trastorno o un conjunto de síntomas específicos. También se excluyeron los protocolos de estudio, los diseños pretest-postest y otros en los que era imposible calcular el tamaño del efecto. Se realizó una búsqueda sin filtros ni marco temporal en Scopus y se encontraron 1 408 artículos entre los cuales 21 fueron revisados en profundidad y 6 fueron incluidos en el presente estudio. El riesgo de sesgo se evaluó mediante una evaluación de calidad y heterogeneidad; no fue posible realizar análisis de sesgo de publicación. Se realizaron metaanálisis separados para el malestar general y la flexibilidad psicológica en postratamiento y último seguimiento. El análisis del riesgo de sesgo sugiere un bajo riesgo de amenazas a la validez y atribuye la heterogeneidad principalmente a las tasas de deserción entre los estudios. Además, se proponen modelos de metarregresión para la duración, la tasa de deserción y la edad promedio en cada punto temporal. Los resultados muestran tamaños de efecto significativamente grandes para ambas variables en ambos puntos temporales y se evalúa su heterogeneidad, que se atribuye en gran medida a las tasas de deserción de los estudios incluidos. Según los modelos de metarregresión, las tasas de deserción son una variable mediadora del efecto sobre el malestar general tanto en el momento de la finalización como en el último seguimiento. Por otra parte, la duración, la edad y la tasa de abandono son variables mediadoras del efecto sobre la flexibilidad psicológica al final del tratamiento. Los resultados sugieren que es necesario mitigar las altas tasas de deserción observadas en la telepsicología y, cuando no sea posible, adoptar enfoques de intención de tratar para el análisis de los datos.

Favorecedores y limitantes en procesos de entrega de saberes para la continuidad de memorias territoriales: una experiencia desde las mujeres rurales en Granada, Antioquia

Cuando se habla de memoria se lleva la idea del acto de recordar, no olvidar y construir identidad política; materializada en dispositivos como libros, archivos, exposiciones, informes y conmemoraciones (el producto), poco se habla de los medios que permiten su construcción desde actos dialógicos que posibilitan el encuentro y el compartir con otros(as). Se exponen los resultados de investigación, frente a aquellas condiciones dialógico/conversacionales que favorecen el intercambio para la entrega de saberes que dan continuidad a las memorias territoriales, y los elementos que llegan a limitar el circulo dialógico de la palabra y la acción concreta.

When we talk about memory, the idea of the act of remembering, not forgetting and building political identity is carried; materialized in devices, such as books, archives, exhibitions, reports, and commemorations (the product); little is said about the means that allow its construction from dialogic acts that enable the encounter and sharing with others. The research results are presented in relation to those dialogic/conversational conditions that favor the exchange for the delivery of knowledge that gives con tinuity to territorial memories, and the elements that limit the dialogic circle of the word and concrete action.

One-year follow-up of a randomized trial with a dilemma-focused intervention for depression: Exploring an alternative to problem-oriented strategies.

BACKGROUND: Cognitive behavioural therapy (CBT) is aimed to counteract cognitions and behaviours that are considered as dysfunctional. The aim of the study is to test whether the inclusion of a non-counteractive approach (dilemma-focused intervention, DFI) in combination with CBT group therapy will yield better short- and long-term outcomes than an intervention conducted entirely using CBT. METHOD: A total of 128 patients with depression and at least one cognitive conflict, of six health community centres in Barcelona, participated from November of 2011 to December of 2014 in seven weekly group CBT sessions and were then randomly allocated to either DFI or CBT (eight individual sessions each) by an independent researcher. Depressive symptoms were assessed with the Beck Depression Inventory-II at baseline, at the end of therapy and three- and twelve-month follow-ups. Therapists did not participate in any of the assessments nor in the randomisation of patients and evaluators were masked to group assignment. Both intention to treat and complete case analyses were performed using linear mixed models with random effects. FINDINGS: According to intention-to-treat analysis (F2, 179 = 0.69) and complete case analysis (F2, 146 = 0.88), both conditions similarly reduced the severity of symptoms across posttreatment assessments. For the 77 participants (CBTgroup +CBTindividual = 40; CBTgroup+DFIindividual = 37) that completed allocated treatment and one-year follow-up assessment, response and remission rates were relative higher for the DFI condition, however no significant differences were found between treatment conditions. The relapse rates were similar between treatment conditions (CBTgroup +CBTindividual = 7/20; CBTgroup+DFIindividual = 8/22). INTERPRETATION: Although using a counteractive approach across all the treatment sessions is quite effective, it does not seem to be necessary to produce significant improvement. DFI may be considered as an alternative, which could be included in a wider treatment for depression. TRIAL REGISTRATION: ClinicalTrials.gov; ID: NCT01542957.

Sentido de vida y su asociación con la ansiedad y la depresión en jóvenes / Meaning in life and its association with anxiety and depression in young people

Resumen El sentido de vida se ha convertido en una importante variable salutogénica en las poblaciones más jóvenes. La investigación ha evidenciado que el sentido de vida está relacionado con la disminución de comportamientos de riesgo, como el consumo de sustancias psicoactivas, y es un factor protector frente a diferentes problemáticas de salud, que van desde los eventos cardiovasculares hasta la disminución de la aparición de sintomatología ansiosa y depresiva. El objetivo de este estudio fue identificar cómo esta variable se asocia con la ansiedad y la depresión en un grupo de adolescentes y jóvenes. Se analizaron los datos de 596 participantes colombianos cuyas edades oscilaron entre 18 y 24 años (M = 21; DE = 1.74; 68 % mujeres y 32 % hombres). Se utilizaron la Escala Dimensional de Sentido de Vida y la Escala para la Depresión, la Ansiedad y el Estrés (DASS-21). En primer lugar, se encontraron diferencias significativas en las puntuaciones de sentido de vida en las siguientes variables: los participantes que reportaron algún diagnóstico de enfermedad, consumo de sustancias psicoactivas y estrato socioeconómico. Se presenta un modelo resultante de un análisis de ecuaciones estructurales basado en cuadrados mínimos parciales. El modelo tuvo índices de ajuste adecuado (NFI = .84; SRMR = .06). El sentido de vida se asoció negativa y significativamente con la ansiedad y la depresión. Los resultados encontrados presentan implicaciones para la investigación al tiempo que se constituyen en sustento empírico para incluir la variable en programas de intervención y prevención, de tal forma que puedan evaluarse objetivamente y consigan disminuir las puntuaciones de ansiedad y depresión en jóvenes.

Abstract Around 300 million people in the world suffer from depression and anxiety. Both have become, according to the main organizations, one of the first causes of disability and lost work years on the planet. Not to mention that depression is one of the main antecedents of deaths by suicide. Both have a special impact on young populations and adolescents. In Colombia the data is not more encouraging, around 53 % of the young people has at least one symptom of anxiety and 80 % have at least one symptom of depression. Given this data, anxiety and depression constitute important health problems that require sufficient attention. On the other hand, the meaning in life has become an important salutogenic variable in younger populations. Recent research has shown that the meaning in life is related to the reduction of risk behaviors, such as the consumption of psychoactive substances, and is a protective factor against different health problems, ranging from cardiovascular events to the reduction of the appearance of anxious and depressive symptoms. Based on the above, the objective of this study was to identify how the meaning in life is associated with anxiety and depression in adolescents and young people. The data of 596 Colombian participants whose ages ranged between 18 and 24 years (M = 21; SD = 1.74; 68 % women and 32 % men) were analyzed, the only condition to participate was knowing how to read and write. The Dimensional Meaning Life Scale and the Scale for Depression, Anxiety and Stress (DASS-21) were used. Firstly, significant differences were found in the meaning in life scores in the participants who reported a diagnosis of disease, consumption of psychoactive substances and socioeconomic condition. The highest meaning scores were obtained by people who did not have a diagnosis of medical or psychological illness, who did not consume any psychoactive substances, and people in the highest socioeconomic status. Likewise, there were differences for anxiety and depression, people with a diagnosis of disease and who consume psychoactive substances had higher scores for both anxiety and depression. Women had higher anxiety scores, and people from the lowest socioeconomic conditions had the highest scores for depression. A model resulting from an analysis of structural equations based on partial least squares is presented. The model had adequate fit indices (NFI = .84; SRMR = .06). The meaning in life was negatively and significantly associated with anxiety and depression. The path coefficients of the latent variable meaning in life show an impact of -.49 on anxiety and -.71 on depression. According to the R squared values, the meaning of life explains 24 % of the presence of anxiety symptoms and around 51 % of depression. Regarding the measurement model, both the Dimensional Meaning in Life Scale and the Scale for Depression, Anxiety and Stress (DASS-21) showed excellent adjustments in the measurement and operationalization of the latent variables. The results found present implications for research, and they also constitute empirical support to include the variable in intervention and prevention programs that can be objectively evaluated and reduce anxiety and depression scores in adolescents and young people, which would also allow to reduce all the negative consequences associated with both pathologies. Other projections and limitations associated with what was found in this research are discussed.

Interpretación de los autoanticuerpos en enfermedades reumatológicas / Interpretation of autoantibodies in rheumatological diseases

RESUMEN Las enfermedades autoinmunes son un grupo de patologías crónicas en las que factores genéticos, ambientales y hormonales contribuyen a su aparición. Además de tener un amplio espectro clínico, la interpretación de los diversos autoanticuerpos y técnicas utilizadas en el laboratorio también son un reto clínico. Dada la complejidad de estas enfermedades, es muy importante apoyarse en las pruebas de laboratorio para establecer un correcto diagnóstico, seguimiento y, en algunos casos inclusive, establecer pronósticos o predicción de la posible aparición de autoinmunidad. Con todo esto se pretende mejorar la calidad de vida de los pacientes disminuyendo la gran morbimortalidad de este grupo de enfermedades, especialmente al diagnosticarlas en etapas tempranas. La mayoría de las enfermedades reumatológicas se caracterizan por la alta producción de autoanticuerpos y reactantes de fase aguda, los cuales están implicados en su fisiopatología produciendo daño directo a nivel sistémico. Entre estas, el lupus eritematoso sistémico, la artritis reumatoide y el síndrome de Sjögren son las más reconocidas. Portales motivos, el objetivo de este trabajo es hacer una revisión que permita guiar tanto a médicos como a personal de laboratorio en la interpretación de los diferentes autoanticuerpos en enfermedades autoinmunes.

ABSTRACT Autoimmune diseases are a group of chronic diseases in which genetic, environmental, and hormonal factors contribute to their appearance. In addition to having a broad clinical spectrum, the interpretation of the various autoantibodies and techniques used in the laboratory is also a clinical challenge. Given the complexity of these diseases, it is very important to rely on the results of laboratory tests to establish a correct diagnosis and follow-up and, in some cases even to establish a prognosis or prediction of autoimmunity. Taking all this into account, it is intended to improve the quality of life of patients by decreasing the increased morbidity and mortality in this group of diseases, especially by early diagnosis. Most rheumatological diseases are characterised by the high production of auto-antibodies and acute phase reactants, which are involved in their pathophysiology, leading to systemic involvement. Among these, the most recognised are, systemic lupus erythematosus, rheumatoid arthritis, and Sjögren's syndrome. For these reasons, the objective of this project is to present a review that will help both physicians and laboratory personnel in the interpretation of the different autoantibodies in autoimmune diseases.

Anticuerpos anti-DFS70: un nuevo autoanticuerpo útil en la exclusión de patologías autoinmunes / Anti-DFS70 antibodies: A new useful antibody in the exclusion of auto-immune diseases

RESUMEN Los anticuerpos anti-DFS70 (Dense Fine Speckle, peso molecular de 70 kd) son un subgrupo de anticuerpos antinucleares (ANA) de tipo natural, los cuales se manifiestan por un patrón moteado denso fino (DFS) por inmunofluorescencia indirecta. Este se caracteriza por la fluorescencia granular distribuida irregularmente en la interface de los núcleos y de la cromatina. Inicialmente, este anticuerpo fue descrito en pacientes con cistitis intersticial, dermatitis atópica y algunas neoplasias como el cáncer de próstata. Se ha encontrado que sus antígenos actúan directamente contra co-activadores de la transcripción nuclear (LEDGF/p75), codificada por el gen PSP1 y localizado en la región C terminal entre los a.a. 349 y 435. Adicionalmente, se documenta asociación con algunas funciones fisiológicas como la protección contra la apoptosis inducida por estrés, promover la supervivencia de las células epiteliales del cristalino y actuar como cofactor de replicación del virus VIH a través de su interacción con la integrasa viral. En el campo de la autoinmunidad se ha evidenciado recientemente la importancia de este anticuerpo como marcador biológico útil en la discriminación de personas con ANA positivos que no evolucionan a enfermedad autoinmune sistémica (EAI). Lo anterior se ha basado en la observación de que estos anticuerpos son más frecuentes en individuos sanos que en los pacientes con EAI y que los individuos sanos con anti-DFS70 positivo no desarrollaron EAI después de un seguimiento clínico por 4 arios o más. Este artículo revisa la descripción de los anti-DFS70 y su utilidad en la práctica clínica.

ABSTRACT Anti-DFS70 antibodies (Dense Fine Speckled, 70 kd molecular weight) are a sub-group of anti-nuclear antibodies (ANA) that show a fine dense speckled pattern (DFS) by indirect immunofluorescence. This pattern is also recognized by irregularly distributed granular fluorescence at the interface of nuclei and chromatin. This antibody was initially described in patients with interstitial cystitis, atopic dermatitis, and malignancy, such as prostate cancer. These antigens have been found to act directly against co-activators of nuclear transcription (LEDGF/p75) encoded by the PSP1 gene and located in the C-terminal region between the a.a. 349 and 435. Additionally, associations with some physiological functions have been described, such as protection against stress-induced apoptosis, the survival of lens epithelial cells, and acting as a cofactor of HIV replication through its interaction with viral integrase. As regards autoimmunity, recent evidence has also shown the importance of this antibody as a useful biological marker in the discrimination of individuals with positive ANA that do not progress to systemic autoimmune disease (SID). This is based on the observation that these antibodies are more common in healthy individuals than in patients with SID, and that healthy individuals with positive anti-DFS70 did not develop SIDs after a clinical follow-up of four years or more. This article reviews the description of anti-DFS70 and its usefulness in clinical practice.

Análisis retrospectivo y transversal de la calidad microbiología y fisicoquímica de pollo crudo y procesado en santa Fe de Bogotá / Retrospective and cross-sectional analysis of the microbiological and physicochemical quality of raw and processed chicken in Santa Fe de Bogota

Antecedentes Las Enfermedades Transmitidas por Alimentos (ETA) son un problema de salud pública. La Secretaría de Salud de Bogotá busca mejorar el sistema de vigilancia epidemiológica para las ETA. Objetivos a) Analizar los resultados microbiológicos y fisicoquímicos de pollo crudo, procesado y preparado muestreados por los hospitales de la Secretaría (1997-1998); b) realizar un análisis de riesgos y puntos críticos de control en beneficiadoras y procesadoras de pollo seleccionadas por la Secretaría Distrital de Salud; c) seguimiento epidemiológico de muestras no aptas de pollo crudo y procesado tomadas por los hospitales de la Secretaría. Metodología Estudio de tres fases: a) observacional descriptivo de todas las muestras de pollo procesadas por el Laboratorio de Salud Pública, 1997-1998, evaluando proporción sobre muestras cárnicas y resultados físico-químicos y microbiológicos; b) estudio de casos de beneficiadoras de pollo en empresas escogidas por la Secretaría de Salud, con análisis de riesgos y puntos críticos; c) seguimiento epidemiológico de muestras no aptas, recolectadas por los hospitales de la Secretaría de Salud durante tres meses. Resultados a) Subrepresentación de las muestras de pollo en el total de las muestras cárnicas procesadas. Muestreo no probabilístico y no representativo del universo de carnes de pollo consumido; b) se identifican diversas debilidades en los procesos de producción y beneficio, y se hacen intervenciones en las empresas; c) pocos hospitales reportan investigación activa de muestras. El seguimiento epidemiológico no logra llegar hasta el productor. Conclusiones y Recomendaciones Implementar un programa sistemático y preferiblemente probabilístico de vigilancia de la calidad de los productos cárnicos de pollo. Incrementar la proporción de muestras de pollo examinadas, en concordancia con los niveles de consumo. El estudio de casos identifica varios puntos críticos en producción y beneficio de pollo, que deberían ser abordados por la Secretaría de Salud a través de programas de educación y vigilancia sistemática de la calidad.

Background Foodborne diseases (FBD) are a public health problem. The Secretariat of Health of Bogotá seeks to improve the epidemiological surveillance system for FBD. Objectives a) To analyze the microbiological and physicochemical results of raw, processed and prepared chicken sampled by the Secretariat's hospitals (1997-1998); b) to conduct an analysis of risks and critical control points in chicken processors and processors selected by the District Health Secretariat; c) epidemiological follow-up of ineligible samples of raw and processed chicken taken by the Secretariat's hospitals. Methodology Three-phase study: a) descriptive observational study of all chicken samples processed by the Public Health Laboratory, 1997-1998, evaluating the proportion of meat samples and physical-chemical and microbiological results; b) case study of chicken processors in companies selected by the Secretariat of Health, with analysis of risks and critical points; c) epidemiological follow-up of unfit samples collected by the hospitals of the Secretariat of Health during three months. Results a) Under-representation of chicken samples in the total number of meat samples processed. Non-probabilistic and non-representative sampling of the universe of chicken meat consumed; b) various weaknesses are identified in the production and processing processes, and interventions are made in the companies; c) few hospitals report active investigation of samples. Epidemiological follow-up does not reach the producer. Conclusions and Recommendations Implement a systematic and preferably probabilistic program for surveillance of the quality of chicken meat products. Increase the proportion of chicken samples examined, in accordance with consumption levels. The case study identifies several critical points in chicken production and processing that should be addressed by the Ministry of Health through education and systematic quality surveillance programs.

Intubación submandibular / Intubación submandibular

La ruta submandibular constituye una alternativa para la intubación endotraqueal segura y efectiva en el manejo de la vía aérea, diferente a la vía nasal, oral y a la traqueostomía, utilizadas convencionalmente en pacientes con injurias del complejo cráneomaxilofacial, cirugía ortognática o cirugía de malformaciones congénitas, que requieren fijación axilomandibular intraoperatoria. Presentamos en este artículo cinco casos clínicos de trauma maxilofacial intervenidos en el hospital El Tunal (Bogotá y Colombia), con indicaciones específicas para este tipo de tratamiento...