Specialized Care Resources for Diagnosis and Management of Patients Who Have Suffered Falls: Results of a National Survey in Geriatric Units.

INTRODUCTION: Clinical guidelines recommend comprehensive multifactorial assessment and intervention to prevent falls and fractures in older populations. METHODS: A descriptive study was conducted by the Falls Study Group of the Spanish Geriatric Medicine Society (SEMEG) to outline which types of healthcare-specific resources were assigned for fall assessment in Spanish geriatric departments. A self-reported seven-item questionnaire was delivered from February 2019 to February 2020. Where geriatric medicine departments were not available, we tried to contact geriatricians working in those areas. RESULTS: Information was obtained regarding 91 participant centers from 15 autonomous communities, 35.1% being from Catalonia and 20.8% from Madrid. A total of 21.6% reported a multidisciplinary falls unit, half of them in geriatric day hospitals. Half of them reported fall assessment as part of a general geriatric assessment in general geriatric outpatient clinics (49.5%) and, in 74.7% of cases, the assessment was based on functional tests. A total of 18.7% reported the use of biomechanical tools, such as posturography, gait-rides or accelerometers, for gait and balance analysis, and 5.5% used dual X-ray absorptiometry. A total of 34% reported research activity focused on falls or related areas. Regarding intervention strategies, 59% reported in-hospital exercise programs focused on gait and balance improvement and 79% were aware of community programs or the pathways to refer patients to these resources. CONCLUSIONS: This study provides a necessary starting point for a future deep analysis. Although this study was carried out in Spain, it highlights the need to improve public health in the field of fall prevention, as well as the need, when implementing public health measures, to verify that these measures are implemented homogeneously throughout the territory. Therefore, although this analysis was at the local level, it could be useful for other countries to reproduce the model.

Paraneoplastic or treatment-associated dermatomyositis: a diagnostic challenge.

Dermatomyositis (DM) is a systemic autoimmune disorder characterized by proximal myopathy and dermatological findings. Approximately 15-30% of DM cases emerge as a paraneoplastic syndrome caused by a concomitant malignancy. Although more rare, in cancer patients DM has also been reported as a possible result of toxicity of some antineoplastic agents, such as taxanes and monoclonal antibodies. Herein, we report a 35-year-old woman with metastatic breast cancer who presented with skin lesions after initiation of paclitaxel and anti-HER2 agents. Clinical, laboratory, and histological findings were consistent with the diagnosis of DM.

Systematic Review and Meta-Analyses of Aminopeptidases as Prognostic Biomarkers in Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease characterized by the progressive loss of motor neurons in the spinal cord, brain stem, and cerebral cortex. Biomarkers for ALS are essential for disease detection and to provide information on potential therapeutic targets. Aminopeptidases catalyze the cleavage of amino acids from the amino terminus of protein or substrates such as neuropeptides. Since certain aminopeptidases are known to increase the risk of neurodegeneration, such mechanisms may reveal new targets to determine their association with ALS risk and their interest as a diagnostic biomarker. The authors performed a systematic review and meta-analyses of genome-wide association studies (GWASs) to identify reported aminopeptidases genetic loci associated with the risk of ALS. PubMed, Scopus, CINAHL, ISI Web of Science, ProQuest, LILACS, and Cochrane databases were searched to retrieve eligible studies in English or Spanish, published up to 27 January 2023. A total of 16 studies were included in this systematic review, where a series of aminopeptidases could be related to ALS and could be promising biomarkers (DPP1, DPP2, DPP4, LeuAP, pGluAP, and PSA/NPEPPS). The literature reported the association of single-nucleotide polymorphisms (SNPs: rs10260404 and rs17174381) with the risk of ALS. The genetic variation rs10260404 in the DPP6 gene was identified to be highly associated with ALS susceptibility, but meta-analyses of genotypes in five studies in a matched cohort of different ancestry (1873 cases and 1861 control subjects) showed no ALS risk association. Meta-analyses of eight studies for minor allele frequency (MAF) also found no ALS association for the "C" allele. The systematic review identified aminopeptidases as possible biomarkers. However, the meta-analyses for rs1060404 of DPP6 do not show a risk associated with ALS.

Artificial neural networks model: Neuropsychological variables and their relationship with body fat percentage in adults / Modelo de redes neuronales artificiales: Variables neuropsicológicas y su relación con el porcentaje de grasa corporal en adultos

Abstract There is a growing interest to understand the neural functions and substrates of complex cognitive processes related to Obesity (OB). Artificial Intelligence (AI) is being applied, specifically the perceptron model of Artificial Neural Networks (ANN) in non-communicable chronic diseases, to identify with greater certainty the connective factors (synaptic networks) between the input variables and the output variables associated. Objective Identify the synaptic weights of the ANN whose input variables are the executive functions (EF) and healthy lifestyles as predictors of Body Fat Percentage (BFP) in a group of adult subjects with different levels of BFP. Methods It was an exploratory, quantitative, cross-sectional, comparative, convenience, and explanatory research. The Neuropsychological Battery (BANFE-2) and the Overeating Questionnaire (OQ) were administered to 40 participants aged between 18-38 years. BFP was measured using a RENPHO ES-24M Smart Body Composition Scale. The perceptron ANN model with ten trials was applied with a multilayer-perceptron. Results The ANN showed that the sensory variables with greater synaptic weight for BFP were Stroop A and B Errors and Successes of BANFE-2, and OQ scales Rationalizations and Healthy Habits. Conclusions ANN proved to be important in the simultaneous analysis of neuropsychological and healthy lifestyle data for the analysis of OB prevention and treatment by identifying the variables that are closely related. These findings open the door for the use of non-linear analysis models, which allow the identification of relationships of different weights, between input and output variables, to more effectively direct interventions to modify obesity habits.

Resumen Existe un interés creciente por comprender las funciones neuronales y sustratos cognitivos complejos relacionados con la obesidad. Se está aplicando Inteligencia Artificial, en concreto el modelo perceptrón de Redes Neuronales Artificiales en enfermedades crónicas no transmisibles, para identificar con mayor certeza los factores de conexión (redes sinápticas) entre las variables de entrada y las variables de salida. Objetivo Identificar pesos sinápticos de la RNA cuyas variables de entrada fueron las funciones ejecutivas y los estilos de vida saludable, como predictores del Porcentaje de Grasa Corporal en un grupo de sujetos adultos con diferentes niveles del Porcentaje de Grasa. Métodos se trató de una investigación exploratoria, cuantitativa, transversal, comparativa, de conveniencia y explicativa. Se administró la Batería Neuropsicológica (BANFE-2) y el Cuestionario de Sobreingesta (OQ), a 40 participantes con edades comprendidas entre los 18-38 años. El porcentaje de grasa se midió con una báscula de composición corporal (RENPHO ES-24M). El modelo redes neuronales de perceptrón, se ejecutó con diez ensayos. Resultados El modelo de Red Neuronal mostró que las variables sensoriales con mayor peso sináptico para el porcentaje de grasa, fueron Errores Stroop A y B y Aciertos de BANFE-2, y Racionalizaciones de las escalas OQ y Hábitos Saludables. Conclusiones las redes neuronales artificiales demostró ser importante en el análisis simultáneo de datos neuropsicológicos y de estilo de vida saludable para el análisis de prevención y tratamiento de la obesidad, al identificar las variables que están estrechamente relacionadas. Estos hallazgos abren la puerta al uso de modelos de análisis no lineales, que permiten identificar relaciones de diferente peso, entre variables de entrada y salida, más eficientes que los modelos lineales.

Toxic erythema of chemotherapy induced by liposomal doxorubicin, a clinical case.

A 76-year-old woman presented to the medical oncology outpatient clinic with painful, burning, pruritic erythematous plaques involving both palms and axillae that had suddenly appeared five days before. Examination revealed no additional relevant findings and laboratory studies did not show any alteration. The patient had been recently diagnosed with a high-grade angiosarcoma of the breast (probably radiation induced) and after frequent local recurrences, was being treated with liposomal doxorubicin (three cycles were administered, the last of which was seven days before the appearance of the mentioned lesions). Oral corticosteroids were started, treatment with liposomal doxorubicin was stopped, and cutaneous biopsies performed that revealed features compatible with toxic erythema of chemotherapy induced by liposomal doxorubicin. Complete resolution of the cutaneous lesions was verified one month after. No signs of recurrence of angiosarcoma were documented at follow-up three months later.

Poor Perception and Knowledge of Electronic Cigarettes Among Adolescents and Their Parents.

OBJECTIVES: Electronic cigarettes (e-cigs) and vaping are a popular form of substance abuse among adolescents. Studies have shown that adolescents have a poor understanding of e-cigs but little is known about parental understanding. The primary objective was to assess if a discrepancy in perception and knowledge regarding the content and safety profile of e-cigs between adolescents and their parents exists. METHODS: Single-site prospective questionnaire analysis of adolescents (12-21 years) and their parents between November 2018 and March 2019 was performed. Each participant pair received an anonymous, confidential, electronic questionnaire. Data were collected via Research Electronic Data Capture. χ2 and independent t tests were used for comparative analysis. RESULTS: A total of 300 adolescent/parent pairs were included for analysis. The mean age of adolescents was 15.1 years (SD, 2.1), and that of parents was 43.9 years (SD, 8.7). Overall knowledge of e-cigs was inadequate in both adolescents and parents: 93.7% and 88.3%, respectively (P < 0.0001). Less adolescents (49.0%) compared with parents (71.0%) perceived any health risks to smoking e-cigs (P < 0.0001). Among adolescents, 17% admitted to smoking e-cigs compared with 5.4% smoking conventional tobacco cigarettes (P < 0.0001), and they reported using e-cigs (17.0%) more often than any other substance except alcohol (27.3%). Only 49.7% of adolescents reported receiving formal education at school regarding e-cigs. Parents reported discussing e-cigs risks/benefits with adolescents less often than other topics (71.3% vs 79.0% to 84.3%; P < 0.0007). CONCLUSIONS: This analysis suggests that perception and knowledge regarding the content and safety profile of e-cigs are poor among both adolescents and parents. These findings support the need for tighter federal regulation and an increase in public health awareness programs.

[An opportunity to identify and prevent frailty through falls intervention.] / Oportunidad para la detección y manejo precoz de la fragilidad a través del abordaje de las caídas.

Falls are one of the classic giant geriatric syndromes with a multifactorial etiopathogenesis and closely related to frailty, being this relationship bidirectional. The Consensus Document on the Prevention of Frailty and Falls approved by the Interterritorial Council of the National Health System in 2014 provides recommendations for the screening of frailty and falls in all older adults in order to develop a management plan in high risk older adults so to prevent disability. This review describes the intrinsic relationship between frailty and falls, falls assessment and screening instruments to use and detect frailty and finally gives evidence-based recommendations to reduce falls impact.

Las caídas son uno de los grandes síndromes geriátricos, con una etiopatogenia multifactorial y con una estrecha relación con la fragilidad, siendo esta relación bidireccional. El Documento de Consenso sobre Prevención de Fragilidad y Caídas aprobado por el Consejo Interterritorial del Sistema Nacional de Salud en 2014, propone un cribado universal de fragilidad y riesgo de caídas, con el objetivo de intervenir en aquellos ancianos de alto riesgo y por tanto prevenir discapacidad. Esta revisión evalúa la relación intrínseca entre caídas y fragilidad, describe las herramientas de valoración del paciente que presenta caídas, incidiendo en aquellos aspectos que detectan fragilidad y finalmente propone intervenciones que han demostrado reducir su impacto.

Prostate Ewing Sarcoma/PNET: A case of long survival in a highly aggressive malignancy.

Prostate Ewing sarcoma/peripheral primitive neuroectodermal tumor (ES/PNET) is extremely rare. Currently, a multimodal approach is recommended, although there is no standard treatment. Nevertheless, this tumor has a very poor prognosis, with the longest reported survival of 24 months. We present a case of locally advanced prostate ES/PNET in a 29-year-old male who was treated with a multimodal approach. The patient is alive and disease free, with a seven year follow-up, with very good quality of life. This exceptionally long survival may be the result of the very aggressive multimodal treatment chosen and described herein.

Association Between Pulmonary Embolism and COVID-19 in Emergency Department Patients Undergoing Computed Tomography Pulmonary Angiogram: The PEPCOV International Retrospective Study.

BACKGROUND: There have been reports of procoagulant activity in patients with COVID-19. Whether there is an association between pulmonary embolism (PE) and COVID-19 in the emergency department (ED) is unknown. The aim of this study was to assess whether COVID-19 is associated with PE in ED patients who underwent a computed tomographic pulmonary angiogram (CTPA). METHODS: A retrospective study in 26 EDs from six countries. ED patients in whom a CTPA was performed for suspected PE during a 2-month period covering the pandemic peak. The primary endpoint was the occurrence of a PE on CTPA. COVID-19 was diagnosed in the ED either on CT or reverse transcriptase-polymerase chain reaction. A multivariable binary logistic regression was built to adjust with other variables known to be associated with PE. A sensitivity analysis was performed in patients included during the pandemic period. RESULTS: A total of 3,358 patients were included, of whom 105 were excluded because COVID-19 status was unknown, leaving 3,253 for analysis. Among them, 974 (30%) were diagnosed with COVID-19. Mean (±SD) age was 61 (±19) years and 52% were women. A PE was diagnosed on CTPA in 500 patients (15%). The risk of PE was similar between COVID-19 patients and others (15% in both groups). In the multivariable binary logistic regression model, COVID-19 was not associated with higher risk of PE (adjusted odds ratio = 0.98, 95% confidence interval = 0.76 to 1.26). There was no association when limited to patients in the pandemic period. CONCLUSION: In ED patients who underwent CTPA for suspected PE, COVID-19 was not associated with an increased probability of PE diagnosis. These results were also valid when limited to the pandemic period. However, these results may not apply to patients with suspected COVID-19 in general.

Intense craving for appetizing foods: validation and standardization of the Food Cravings Questionnaire-Trait in Mexico.

INTRODUCTION: Food craving is a motivational and physiological response for eating specific foods, mainly with high caloric content. To assess food craving, self-reports, inventories and questionnaires are used. The Food Cravings Questionnaire-Trait is multi-dimensionally structured and has been validated in several countries, since it is sensitive and adaptable to contextual-cultural changes. OBJECTIVES: To validate and standardize the Food Cravings Questionnaire-Trait in adults of Mexico City. METHOD: Non-experimental, cross-sectional, randomized study of 1059 subjects of both genders, between 18 and 84 years of age; 71.86 % of the female gender. Psychometric properties were examined with exploratory and confirmatory factor analyses. RESULTS: The domains of the questionnaire were reduced and the items were reorganized differently from the original version. The confirmatory factor analysis showed an adequate fit and acceptable standardization of factors. High internal consistency was found for the global questionnaire (a = 0.973 and rho = 0.975) for each one of the domains. CONCLUSION: This study determines the viability of the Food Cravings Questionnaire for the population of Mexico City.

INTRODUCCIÓN: El food craving o "ansia por comer" es una respuesta motivacional y fisiológica por comer alimentos específicos, principalmente con alto contenido calórico. Para evaluarlo se usa, entre otros, el Food Craving Questionnaire Trait, estructurado multidimensionalmente y validado en diversos países, el cual ha mostrado ser sensible y adaptable a los cambios contextuales-culturales. OBJETIVOS: Validar y estandarizar el Food Craving Questionnaire-Trait en adultos de la Ciudad de México. MÉTODO: Estudio no experimental, transversal y aleatorizado de 1059 sujetos de uno y otro sexo, entre 18 y 84 años; 71.86 % del sexo femenino. Se examinaron propiedades psicométricas con análisis factoriales exploratorios y confirmatorios. RESULTADOS: Se redujeron los factores del cuestionario y los ítems se reorganizaron de forma diferente al original. El análisis factorial confirmatorio mostró ajuste adecuado y estandarización aceptable de los factores. Se encontró alta consistencia interna para el cuestionario global (a = 0.973 y rho = 0.975) para cada uno de los factores. CONCLUSIÓN: Este estudio determina la viabilidad del Food Craving Questionnaire para población de la Ciudad de México.

Deseo intenso por alimentos apetecibles: validación y estandarización del Food Craving Questionnaire-Trait en México / Intense craving for appetizing foods: validation and standardization of the Food Cravings Questionnaire-Trait in Mexico

Resumen Introducción: El food craving o “ansia por comer” es una respuesta motivacional y fisiológica por comer alimentos específicos, principalmente con alto contenido calórico. Para evaluarlo se usa, entre otros, el Food Craving Questionnaire Trait, estructurado multidimensionalmente y validado en diversos países, el cual ha mostrado ser sensible y adaptable a los cambios contextuales-culturales. Objetivos: Validar y estandarizar el Food Craving Questionnaire-Trait en adultos de la Ciudad de México. Método: Estudio no experimental, transversal y aleatorizado de 1059 sujetos de uno y otro sexo, entre 18 y 84 años; 71.86 % del sexo femenino. Se examinaron propiedades psicométricas con análisis factoriales exploratorios y confirmatorios. Resultados: Se redujeron los factores del cuestionario y los ítems se reorganizaron de forma diferente al original. El análisis factorial confirmatorio mostró ajuste adecuado y estandarización aceptable de los factores. Se encontró alta consistencia interna para el cuestionario global (a = 0.973 y rho = 0.975) para cada uno de los factores. Conclusión: Este estudio determina la viabilidad del Food Craving Questionnaire para población de la Ciudad de México.

Abstract Introduction: Food craving is a motivational and physiological response for eating specific foods, mainly with high caloric content. To assess food craving, self-reports, inventories and questionnaires are used. The Food Cravings Questionnaire-Trait is multi-dimensionally structured and has been validated in several countries, since it is sensitive and adaptable to contextual-cultural changes. Objectives: To validate and standardize the Food Cravings Questionnaire-Trait in adults of Mexico City. Method: Non-experimental, cross-sectional, randomized study of 1059 subjects of both genders, between 18 and 84 years of age; 71.86 % of the female gender. Psychometric properties were examined with exploratory and confirmatory factor analyses. Results: The domains of the questionnaire were reduced and the items were reorganized differently from the original version. The confirmatory factor analysis showed an adequate fit and acceptable standardization of factors. High internal consistency was found for the global questionnaire (a = 0.973 and rho = 0.975) for each one of the domains. Conclusion: This study determines the viability of the Food Cravings Questionnaire for the population of Mexico City.

Efficacy of Cognitive Behavioral Therapy for Habit Modification and Drug Adherence in Obesity / Eficacia de la Terapia Cognitivo Conductual para Modificación de Hábitos y Adherencia Farmacológica en Obesidad

Abstract The obesity is a global health problem, also it is increasing in adults and pediatric population, reducing life quality. Treatment must be interdisciplinary with elements of behavior modification on self-control, habit modifications, support networks and highlighting to adherence. Cognitive behavioral therapy, specifically on problem solving model, is efficient in treatment of anthropometric control, metabolic and behavioral indicators. Methods: Quasi-experimental, comparative, clinical and randomized study, n=100 adults of both sexes with an exogenous obesity diagnostic. The intervention was performed with an interdisciplinary treatment of cognitive behavioral therapy on problem solving model and 3mg. (0-0-1) of melatonin (50 subjects), comparing it with a group that only received the treatment by melatonin 3mg. (0-0-1) (50 subjects) per 8 months; the anthropometry and blood biochemical values (glucose, triglycerides, HDL and LDL) was evaluated after and before; dropout rate and adherence to the drug was evaluated every month. A bioimpedance machine was used. Results: The analysis demonstrated in eight months that the problem solving model with melatonin group got an adherence average of 80% (p= .05); in comparison with melatonin group that showed an average of 48% (p= .05). Relating to anthropometry and blood biochemical values, problem solving model and melatonin group got better effectiveness (p= .05). Conclusions Cognitive behavioral therapy combined with melatonin, was more effective in anthropometric indicators, blood chemistry and mainly in adherence, confirming the importance of the incursion of effective psychological techniques that contribute to the management of obesity.

Resumen La obesidad es un problema de salud que aumenta en la población, reduciendo la calidad de vida. El tratamiento debe de ser interdisciplinario, que incluya autocontrol de ingesta alimentaria, modificación de hábitos, redes de apoyo y manejo de adherencia. La terapia cognitiva conductual específicamente el modelo en solución de problemas es eficaz en el manejo de antropometría, indicadores metabólicos y conductuales, sin embargo no hay evidencia de su impacto en adherencia farmacológica. Método: estudio cuasiexperimental, comparativo, aleatorio simple y clínico. Participaron 100 adultos de ambos sexos con diagnóstico de obesidad exógena. Se aplicó intervención basada en el modelo en solución de problemas combinado con 3 mg. (0-0-1) de melatonina (50 sujetos), comparándola con un grupo que solo recibió melatonina 3 mg. (0-0-1) (50 sujetos) durante 8 meses; se evaluó antropometría (IMC y porcentaje de grasa), química sanguínea (glucosa, triglicéridos, HDL y LDL), tasa de abandono y adherencia al fármaco mensualmente. Se utilizó báscula de bioimpedancia. Resultados. El grupo de terapia y melatonina obtuvo un promedio de adherencia del 80% (p = .05); en comparación con el grupo de melatonina que mostró un promedio de 48% (p = .05). En la antropometría y química sanguínea, este grupo mostró mayor eficacia (p = .05). Conclusiones. La terapia cognitivo conductual combinada con melatonina, fue más efectiva en indicadores antropométricos, de química sanguínea y principalmente en adherencia, lo que confirma la importancia de la incursión de técnicas psicológicas efectivas que coadyuven en el manejo de obesidad.

A desinstitucionalização no contexto da reforma psiquiátrica e seus desdobramentos: um relato sobre práticas em um caps / Deinstitutionalization in the context of psychiatric reform and its consequences: a story about practices in a caps / La desinstitucionalización en el contexto de la reforma psiquiátrica y sus consecuencias: un relato sobre las prácticas en un caps

A história da atenção à saúde mental é marcada pela presença das instituições totais e existência de práticas que cerceavam direitos e reduziam a autonomia dos sujeitos. O advento da reforma psiquiátrica brasileira e da Luta Antimanicomial trouxeram várias mudanças no cenário de trabalho com o sujeito psicótico. À vista disso, o presente trabalho tem por objetivo discutir como têm ocorrido os processos de desinstitucionalização na atualidade, assim como investigar de que maneira os novos modelos de atenção adotados nos Centros de Atenção Psicossocial (CAPS) contrastam com as formas de tratamento que eram oferecidas nas instituições totais. Trata-se de um relato de experiência de caráter qualitativo- descritivo realizado dentro de um CAPS localizado em uma cidade do interior de Minas Gerais. Elaborou-se um panorama histórico e teórico que embasou as observações realizadas durante as visitas técnicas. Como resultado, foram estabelecidos quatro eixos temáticos. Esses visaram articular o usuário do CAPS com: (1) os profissionais; (2) as oficinas terapêuticas; (3) a sociedade e (4) a instituição. As análises realizadas apontaram que o CAPS aqui relatado tem caminhado em direção ao resgate do sujeito, considerando em sua atuação a promoção de autonomia e a retomada da subjetivação e socialização do mesmo.

The history of mental health care is marked by the presence of total institutions and the existence of practices that curtail rights and reduce the autonomy of the subjects. The advent of the Brazilian psychiatric reform and of the anti-asylum movement brought several changes in the work scenario with the psychotic subject. In view of this, the present work aims to discuss how the deinstitutionalization processes have taken place in the present day, as well as to investigate how the new models of attention adopted in the Psychosocial Care Centers (CAPS) contrast with the forms of treatment that were offered in the total institutions. This is a qualitative-descriptive experience report carried out within a CAPS located in a city in the interior of Minas Gerais. A historical and theoretical panorama was elaborated that based the observations realized during the technical visits. As a result, four thematic axes have been established. These aimed at articulating the CAPS user with: (1) the professionals; (2) the therapeutic workshops; (3) society and (4) the institution. The analyzes carried out indicated that the CAPS reported here has been moving towards the rescue of the subject, considering in its action the promotion of autonomy and the resumption of subjectivation and socialization of the same.

La historia de la atención a la salud mental está marcada por la presencia de las instituciones totales y la existencia de prácticas que cercaban derechos y reducían la autonomía de los sujetos. El advenimiento de la Reforma Psiquiátrica brasileña y antimanicomial trajo varios cambios en el trabajo de ajuste con el sujeto psicótico. A la vista de ello, el presente trabajo tiene por objetivo discutir cómo han ocurrido los procesos de desinstitucionalización en la actualidad, así como investigar de qué manera los nuevos modelos de atención adoptados en los Centros de Atención Psicosocial (CAPS) contrastan con las formas de tratamiento que se ofrecían en las instituciones totales. Se trata de un relato de experiencia de carácter cualitativo-descriptivo realizado dentro de un CAPS ubicado en una ciudad del interior de Minas Gerais. Se elaboró un panorama histórico y teórico que basó las observaciones realizadas durante las visitas técnicas. Como resultado, se establecieron cuatro ejes temáticos. Estos destinado para articular el usuario CAPS con: (1) los profesionales; (2) los talleres terapéuticos; (3) la sociedad y (4) la institución. Los análisis realizados apuntaron que el CAPS aquí relatado ha caminado hacia el rescate del sujeto, considerando en su actuación la promoción de autonomía y la retomada de la subjetivación y socialización del mismo.

The Ras-related gene ERAS is involved in human and murine breast cancer.

Although Ras genes are frequently mutated in human tumors, these mutations are uncommon in breast cancer. However, many breast tumors show evidences of Ras pathway activation. In this manuscript, we have analyzed and characterized mouse mammary tumors generated by random Sleeping Beauty transposon mutagenesis and identify ERAS -a member of the RAS family silenced in adult tissues- as a new gene involved in progression and malignancy of breast cancer. Forced expression of ERAS in human non-transformed mammary gland cells induces a process of epithelial-to-mesenchymal transition and an increase in stem cells markers; these changes are mediated by miR-200c downregulation. ERAS expression in human tumorigenic mammary cells leads to the generation of larger and less differentiated tumors in xenotransplant experiments. Immunohistochemical, RT-qPCR and bioinformatics analysis of human samples show that ERAS is aberrantly expressed in 8-10% of breast tumors and this expression is associated with distant metastasis and reduced metastasis-free survival. In summary, our results reveal that inappropriate activation of ERAS may be important in the development of a subset of breast tumors. These findings open the possibility of new specific treatments for this subset of ERAS-expressing tumors.

Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study.

OBJECTIVE: Determine whether the use of a metronome improves chest compression rate and depth during cardiopulmonary resuscitation (CPR) on a pediatric manikin. METHODS: A prospective, simulation-based, crossover, randomized controlled trial was conducted. Participants included pediatric residents, fellows, nurses, and medical students who were randomly assigned to perform chest compressions on a pediatric manikin with and without an audible metronome. Each participant performed 2 rounds of 2 minutes of chest compressions separated by a 15-minute break. RESULTS: A total of 155 participants performed 2 rounds of chest compressions (74 with the metronome on during the first round and 81 with the metronome on during the second round of CPR). There was a significant improvement in the mean percentage of compressions delivered within an adequate rate (90-100 compressions per minute) with the metronome on compared with off (72% vs 50%; mean difference [MD] 22%; 95% confidence interval [CI], 15% to 29%). No significant difference was noted in the mean percentage of compressions within acceptable depth (38-51 mm) (72% vs 70%; MD 2%; 95% CI, -2% to 6%). The metronome had a larger effect among medical students (73% vs 55%; MD 18%; 95% CI, 8% to 28%) and pediatric residents and fellows (84% vs 48%; MD 37%; 95% CI, 27% to 46%) but not among pediatric nurses (46% vs 48%; MD -3%; 95% CI, -19% to 14%). CONCLUSIONS: The rate of chest compressions during CPR can be optimized by the use of a metronome. These findings will help medical professionals comply with the American Heart Association guidelines.

Cervical Spine Motion During Airway Management Using Two Manual In-line Immobilization Techniques: A Human Simulator Model Study.

OBJECTIVE: The aim of this study is to evaluate cervical spine motion using 2 manual inline immobilization techniques with the use of a human simulator model. METHODS: Medical students, pediatric and family practice residents, and pediatric emergency medicine fellows were recruited to maintain cervical manual in line immobilization above the head of the bed and across the chest of a human simulator while orotracheal intubation was performed. Participants were then instructed on appropriate holding techniques after the initial session took place. Orotracheal intubation followed. A tilt sensor measured time to intubation and cervical extension and rotation angle. RESULTS: Seventy-one subjects participated in a total of 284 successful orotracheal intubations. No change in cervical spine movement or time to intubation was observed when using 2 different inline manual immobilization techniques with no training. However, a statistically significant difference with assistants above the head versus across the chest was observed after training in: extension 2.1° (95% confidence interval [95% CI], 1.15 to 3.00; P < 0.0001); rotation 0.7° (95% CI, 0.26 to 1.19; P = 0.003) and intubation time of -1.9 seconds (95% CI, -3.45 to -0.13; P = 0.035) after training. CONCLUSIONS: Cervical spine movement did not change when maintaining cervical spine immobilization from above the head versus across the chest before training. There was a statistically significant change in extension and rotation when assistants were above the head and in time to intubation when assistants were across the chest after training. The clinical significance of these results is unclear.

Accuracy of laceration length estimation in a pediatric emergency department and its impact on billing practices.

OBJECTIVES: This study aimed to determine the accuracy of laceration length estimation in a pediatric emergency department among health care providers of varying levels of training and its impact on billing practices. METHODS: This study involves a prospective case series. Children younger than 21 years with lacerations evaluated and repaired in the pediatric emergency department between January 1 and April 30, 2012, were eligible for enrollment. Each laceration was evaluated by a trainee/midlevel provider (frontline provider) and by an attending physician; each one offered an estimated laceration length. The true measurement was then documented by 1 of 6 pediatric emergency medicine fellows on shift. Data were analyzed using descriptive statistics. The mean error of estimation (the absolute differences between the estimated and the true laceration length) of attending physicians and frontline providers were determined and compared. The proportions of lacerations whose estimated length was in a different billing category were compared using χ(2). Cost analysis was documented. RESULTS: One hundred ninety patients were enrolled. The mean age was 5.9 years. A total of 119 patients (62.6%) were male, and 134 lacerations (70.5%) were located on the face. Most repairs were simple (79%). There was no difference between the estimated and measured length among attendings and frontline providers (P = 0.583). An average of 8.2% of lacerations were misclassified and billed incorrectly with 20% (4/20) of facial lacerations up-coded. The mean overcharge was $12.04. Of 11 lacerations elsewhere on the body, 3 (27%) were down-coded, with an average difference of $6.97 for simple and $38.51 for layered repairs. CONCLUSIONS: Pediatric emergency medicine practitioners are accurate estimators of laceration length. Eight percent of lacerations are misclassified and billed incorrectly. Physicians should be required to report measured lengths for billing.