Systematic review and meta-analysis of intraventricular antibiotics for neonatal meningitis and ventriculitis.

PURPOSE: We aimed to determine the safety and effectiveness of intraventricular antibiotics in neonates with meningitis and/or ventriculitis and analyze the quality of available evidence. METHODS: DESIGN: Systematic review and meta-analysis. DATA SOURCES: PubMed, EMBASE, LILACS, and SCOPUS up to 17 February 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomized experimental and observational studies were included. The Cochrane methodology was used for systematic reviews. RESULTS: Twenty-six observational studies and one randomized clinical trial involving 272 patients were included. The risk of bias in both pediatric and neurosurgical studies was high, and the quality of evidence was low (evidence level C). In the pediatric studies, no significant differences in mortality were found between intraventricular antibiotics and only systemic antibiotic [25.4% vs 16.1%, OR = 0.96 (0.42-2.24), P = 0.93]. However, when analyzing the minimum administered doses, we found a lower mortality when a minimum duration of 3 days for intraventricular antibiotics was used compared to only systemic antibiotic [4.3% vs 17%, OR = 0.22 (0.07-0.72), P = 0.01]. In the neurosurgical studies, the use of intraventricular antibiotics in ventriculitis generally results in a mortality of 5% and a morbidity of 25%, which is lower than that in cases where intraventricular antibiotics were not used, with an average mortality of 37.3% and a morbidity of 50%. CONCLUSION: Considering the low quality of evidence in pediatric and neurosurgical studies, we can conclude with a low level of certainty that intraventricular antibiotics may not significantly impact mortality in neonatal meningitis and ventriculitis. However, reduced mortality was observed in cases treated with a minimum duration of 3 days of intraventricular antibiotic, particularly the multidrug-resistant or treatment-refractory infections. Higher-quality studies are needed to improve the quality of evidence and certainty regarding the use of intraventricular antibiotics for treating neonatal meningitis and ventriculitis.

[Edge effect on lichen's distribution and chlorophyll content, in fragments of Polylepis quadrijuga (Rosaceae) in Páramo de la Rusia (Boyacá-Colombia)].

The ecosystems fragmentation is one of the anthropic phenomena with highest impact at global level and the edge effect causes that only the fragments interior conserve their original biotic and abiotic characteristics. Lichens are organisms especially susceptible to environmental variability, what could be useful for bio-indication of edge effect. In this work, we evaluated the edge effect in two fragments of Polylepis quadrijuga in the Páramo de la Rusia (Boyacá-Colombia) to determine if there is an edge effect on distribution of lichens associated to P. quadrijuga and their chlorophyll content. We used three transects of 70 m across the matrix-edge-interior gradient in each fragment. We chose nine phorophytes per transect to measure the environmental variables: photosynthetically active radiation, relative humidity and air temperature, and the biological variables: richness and cover per species. Besides, we employed the species that were present in all the three zones of the gradient to quantify the content of chlorophylls a and b, and determine if there are changes in the ratio of chlorophylls a/b that could suggest physiological plasticity as a response to the edge effect. Our results showed that fragment 2 had a higher edge exposition because of its high relation perimeter/area, allowing to an environmental homogenization and lose of biodiversity in relation with fragment 1. Overall, we found 55 differentially distributed species in relation with the fragments and the matrix-edge-interior gradient. The interior of fragment 1 was the most conserved zone, harboring a composition different in more than 40 % to the composition of any other zone. We classified the lichens according with their habits: gelatinous, fruticose, crusty or foliose, but we did not find any relationship between the habit distribution and the edge effect. Six species of wide distribution showed changes in the chlorophyll content along the matrix-edge-interior gradient, what is an evidence of physiological plasticity to edge effect. It was also possible to distinguish between species with preference to warmer environment and species with preference to more humid and sufficiently irradiated places. We concluded that some species of lichens could have an important potential as bio-indicators of fragmentation in the páramo.

A new tool for evaluating health equity in academic journals; the Diversity Factor.

Current methods to evaluate a journal's impact rely on the downstream citation mapping used to generate the Impact Factor. This approach is a fragile metric prone to being skewed by outlier values and does not speak to a researcher's contribution to furthering health outcomes for all populations. Therefore, we propose the implementation of a Diversity Factor to fulfill this need and supplement the current metrics. It is composed of four key elements: dataset properties, author country, author gender and departmental affiliation. Due to the significance of each individual element, they should be assessed independently of each other as opposed to being combined into a simplified score to be optimized. Herein, we discuss the necessity of such metrics, provide a framework to build upon, evaluate the current landscape through the lens of each key element and publish the findings on a freely available website that enables further evaluation. The OpenAlex database was used to extract the metadata of all papers published from 2000 until August 2022, and Natural language processing was used to identify individual elements. Features were then displayed individually on a static dashboard developed using TableauPublic, which is available at www.equitablescience.com. In total, 130,721 papers were identified from 7,462 journals where significant underrepresentation of LMIC and Female authors was demonstrated. These findings are pervasive and show no positive correlation with the Journal's Impact Factor. The systematic collection of the Diversity Factor concept would allow for more detailed analysis, highlight gaps in knowledge, and reflect confidence in the translation of related research. Conversion of this metric to an active pipeline would account for the fact that how we define those most at risk will change over time and quantify responses to particular initiatives. Therefore, continuous measurement of outcomes across groups and those investigating those outcomes will never lose importance. Moving forward, we encourage further revision and improvement by diverse author groups in order to better refine this concept.

Global healthcare fairness: We should be sharing more, not less, data.

The availability of large, deidentified health datasets has enabled significant innovation in using machine learning (ML) to better understand patients and their diseases. However, questions remain regarding the true privacy of this data, patient control over their data, and how we regulate data sharing in a way that that does not encumber progress or further potentiate biases for underrepresented populations. After reviewing the literature on potential reidentifications of patients in publicly available datasets, we argue that the cost-measured in terms of access to future medical innovations and clinical software-of slowing ML progress is too great to limit sharing data through large publicly available databases for concerns of imperfect data anonymization. This cost is especially great for developing countries where the barriers preventing inclusion in such databases will continue to rise, further excluding these populations and increasing existing biases that favor high-income countries. Preventing artificial intelligence's progress towards precision medicine and sliding back to clinical practice dogma may pose a larger threat than concerns of potential patient reidentification within publicly available datasets. While the risk to patient privacy should be minimized, we believe this risk will never be zero, and society has to determine an acceptable risk threshold below which data sharing can occur-for the benefit of a global medical knowledge system.

BASAN index (Body mass index, Age, Sex, Arterial hypertension and Neck circumference) predicts severe apnoea in adults living at high altitude.

OBJECTIVES: Obstructive sleep apnoea (OSA)/hypopnoea syndrome is associated with serious and major multiorgan morbidities, particularly in its most severe forms. However, no severe OSA screening instruments are available for high altitude residents that enable adequate identification and clinical prioritisation of such patients. We aimed at developing a severe OSA prediction tool based on the clinical characteristics and anthropometric measurements of a clinical referral cohort living at 2640 m.a.s.l. DESIGN: Cohort-nested cross-sectional study. SETTING: Sleep laboratory for standard polysomnography (PSG) in Colombia. PARTICIPANTS: A predictive model was generated from 8718 participants referred to the PSG laboratory. Results were subsequently validated in a second cohort of 1898 participants. PRIMARY OUTCOME: To identify clinical and anthropometric variables associated with severe OSA (>30 events/hour) and to include them in a binary logistic regression model. RESULTS: The significant variables that were retained with the presence of severe OSA included Body mass index (BMI), Age, Sex, Arterial hypertension and Neck circumference (BASAN). The area under the receiver operating characteristic curvefor the BASAN index was 0.69 (95% CI: 0.68 to 0.70) in the derivation cohort and 0.67 (95% CI: 0.65 to 0.69) in the validation cohort, whereby a BASAN index ≥2 had a sensitivity of 95% and a specificity of 17% to detect severe OSA. CONCLUSION: An objectively based approach to screen for the presence of severe OSA, the BASAN index, exhibits favourable sensitivity characteristics that should enable its operational use as a screening tool in a Hispanic population with a clinical suspicion of OSA and living at high altitude.

Moderate prenatal alcohol exposure increases total length of L1-expressing axons in E15.5 mice.

Public health campaigns broadcast the link between heavy alcohol consumption during pregnancy and physical, cognitive, and behavioral birth defects; however, they appear less effective in deterring moderate consumption prevalent in women who are pregnant or of childbearing age. The incidence of mild Fetal Alcohol Spectrum Disorders (FASD) is likely underestimated because the affected individuals lack physical signs such as retarded growth and facial dysmorphology and cognitive/behavioral deficits are not commonly detected until late childhood. Sensory information processing is distorted in FASD, but alcohol's effects on the development of axons that mediate these functions are not widely investigated. We hypothesize that alcohol exposure alters axon growth and guidance contributing to the aberrant connectivity that is a hallmark of FASD. To test this, we administered alcohol to pregnant dams from embryonic day (E) 7.5 to 14.5, during the time that axons which form the major forebrain tracts are growing. We found that moderate alcohol exposure had no effect on body weight of E15.5 embryos, but significantly increased the length of L1+ axons. To investigate a possible cause of increased L1+ axon length, we investigated the number and distribution of corridor cells, one of multiple guidance cues for thalamocortical axons which are involved in sensory processing. Alcohol did not affect corridor cell number or distribution at the time when thalamocortical axons are migrating. Future studies will investigate the function of other guidance cues for thalamocortical axons, as well as lasting consequences of axon misguidance with prenatal alcohol exposure.

Frecuencia de defectos del esmalte y factores asociados en niños de 3 a 5 años

Los defectos de esmalte son un conjunto de alteraciones clínicamente visibles en él esmalte, debidos a desórdenes ocurridos durante la biomineralización o en la secreción de la matriz del esmalte. Los dientes primarios comienzan a formarse en la etapa intrauterina y completan su desarrollo meses después del nacimiento del niño. Durante el desarrollo dental, se presenta una serie de factores los cuales pueden afectar la función ameloblástica y conducir al desarrollo de defectos del esmalte. Objetivo: Determinar la frecuencia de defectos del esmalte y sus factores asociados en niños de 3 a 5 años del Colegio Enrique Nerini (Lima) y Colegio María Inmaculada (Iquitos). Material y métodos: Estudio observacional, descriptivo de corte transversal, prospectivo. El método fue la encuesta y la observación estructurada. Se presentaron los resultados en tablas de medidas de resumen descriptivas, para las variables cualitativas. Para el análisis bivariado, se utilizó la prueba chi cuadrado. Resultados: Se evaluaron 340 niños en dentición primaria que cumplieron los criterios inclusión, 170 niños de cada colegio. La frecuencia total de defectos del esmalte fue de 3,6% (6), en el colegio Enrique Nerini (Lima). Al evaluarse la frecuencia de defectos del esmalte en el Colegio María Inmaculada (Iquitos) se encontró una frecuencia de defectos del esmalte del 20.6% (35). Conclusión: Las poblaciones estudiadas en ambos colegios presentaron una baja frecuencia de defectos del esmalte, siendo mayor la frecuencia en el Colegio María Inmaculada.

Prevalence of central sleep apnea during continous positive airway pressure (CPAP) titration in subjects with obstructive sleep apnea syndrome at an altitude of 2640 m.

BACKGROUND: The occurrence of central apneas when applying positive pressure (CPAP) to patients with obstructive sleep apnea syndrome (OSAS) is called complex sleep apnea (CompSA). This causes poor adherence to CPAP and persistence of symptoms. In Bogota, a city located at an altitude of 2640 m above sea level, chronic hypoxemia can generate certain instability of the respiratory system during sleep which could increase the presence of central apnea. The aim was to establish the prevalence of central apnea (central apnea index >5/h) in adults with moderate or severe OSAS during CPAP titration, and the factors associated with this. METHOD: Patients over 18 years old with OSAS were referred to the Fundacion Neumologica Colombiana Sleep Center, from January 2008 to June 2010. Polysomnogram (PSG) for CPAP titration was performed according to the American Academy of Sleep Medicine criteria. The prevalence was calculated and the clinical and baseline PSG factors associated with the CompSA were analyzed. RESULTS: We included 988 patients, 58% men. CompSA prevalence was 11.6%. Factors associated with CompSA were: central apneas in the baseline PSG (OR: 5.34 [3.49-8.16]), history of heart failure (OR: 2.53 [1.58-4.07]), and male sex (OR: 1.68 [1.06-2.69]). CONCLUSION: The prevalence of complex sleep apnea in Bogota (11.6%) was intermediate compared to the reported in lower altitudes. The factors associated with the development of CompSA were male sex, heart failure, and the presence of central apnea in the baseline PSG.

Impact of funding harm reduction programs for people who inject drugs in Mexico / Impacto del financiamiento de programas de reducción del daño para personas que se inyectan drogas en México

Abstract Introduction Despite evidence from harm reduction programs, there are limited data on their impact in Mexico. The Mexican National HIV Program has supported harm reduction programs implemented by community-based organizations both financially and technically. Objective To obtain an estimate of HIV infections averted from 2015 to 2018. Method A deterministic model was developed to estimate the number of infections, with harm reduction projects financed by CENSIDA and implemented by Community-Based Organizations, using data reported from the period 2015 to 2018. The benefit was obtained by estimating the costs of providing prevention programs and comparing the latter to the costs of providing care. Results An analysis of 66,973 people included in harm reduction programs showed that an estimated 869 HIV infections were averted between 2015 and 2018. Potential savings obtained by providing these harm reduction services exceeded over $600,000 Mexican pesos for every infection averted. Discussion and conclusion Harm reduction services play a key role in reducing the incidence of HIV in Mexico. Ensuring their financing is necessary since, combined with other services, they are a cost-effective tool for reducing the economic and public health burden of HIV/AIDS.

Resumen Introducción A pesar de la evidencia que aportan los programas de reducción de daños, hay pocos datos sobre el impacto que tienen en México. El Programa Nacional de VIH en México ha apoyado técnica y financieramente la implementación de proyectos de reducción de daños operados por la sociedad civil. Objetivo Estimar el número de infecciones de VIH evitadas en el periodo de 2015 a 2018. Método Se desarrolló un modelo determinista para estimar el número de infecciones evitadas con los proyectos de reducción de daños financiados por CENSIDA e implementados por organizaciones de la sociedad civil a partir de los datos reportados durante el periodo 2015-2018. El beneficio se obtuvo al estimar el costo de proveer programas de prevención comparado con el costo de proveer tratamiento. Resultados Del análisis de 66,973 personas contactadas con los programas, se estimaron 869 infecciones de VIH evitadas entre 2015 y 2018. El ahorro potencial de proveer estos servicios de reducción de daños fue de más de $600 mil pesos por infección evitada. Discusión y conclusión Los servicios de reducción de daños cumplen un papel importante en la reducción de la incidencia de VIH en México. Asegurar su financiamiento es necesario ya que es una herramienta costo-efectiva si se le combina con otras estrategias para reducir la carga económica y de salud pública del VIH/sida.

Development of an evidence-based model of rapid testing, counseling and referral patients with HIV, HVC and other STDs in Mexican addiction treatment centers / Desarrollo de un modelo basado en evidencia de pruebas rápidas, orientación y derivación de pacientes con VIH, VHC y otras ITS en centros mexicanos de tratamiento de adicciones

Abstract Introduction Efforts to identify new cases of HIV, HVC and other STIs, through the application of quick tests, focus on people who inject drugs, without taking into account the fact that the use of alcohol and other drugs of abuse inhibits decision making, increasing the transmission of STIs through risky sexual practices. Accordingly, it is necessary to have detection algorithms that consider people who use multiple drugs to improve the identification of new cases and their subsequent linkage with health services. Objective This paper describes the development process of the OPB-APR model for the detection, counseling and referral of people with HIV and other STIs at addiction treatment centers. Method The procedure is divided into three phases: 1. A literature review to identify the basic concepts of HIV and other STIs, substance use, risky sexual behaviors, quick tests, and specialized psychological counseling; 2. A feasibility study in which a health professional is trained to implement the OPB-APR model; 3. Drafting of the final version. Results The final version of the OPB-APR model was obtained, which describes standardized procedures for detection, counseling and referral to health services. Discussion and conclusions The OPB-APR model aims to strengthen the public health system by increasing the coverage of services for the detection of HIV, HCV and other STIs. The above through the implementation of standardized procedures among specialized and non-specialized health professionals of addiction care centers.

Resumen Introducción Los esfuerzos para la identificación de nuevos casos de VIH, VHC y otras ITS, mediante la aplicación de pruebas rápidas, se centra en personas que se inyectan drogas, sin considerar que el consumo de alcohol y otras drogas de abuso inhiben la toma de decisiones incrementando el riesgo de contagio de ITS durante prácticas sexuales de riesgo. Por este motivo, es necesario contar con algoritmos de detección que consideren a personas con múltiples consumos para incrementar la identificación de nuevos casos y su posterior vinculación a servicios de salud. Objetivo Describir el proceso de desarrollo del modelo OPB-APR para la detección, orientación y referencia de personas con VIH y otras ITS en centros de tratamiento de adicciones. Método El procedimiento se dividió en tres fases: 1. Revisión de literatura para identificar conceptos básicos sobre el VIH y otras ITS, consumo de sustancias, conductas sexuales de riesgo, pruebas rápidas, y orientación psicológica especializada; 2. Estudio de factibilidad en el que se entrenó a profesionales de la saludpara implementar el modelo OPB-APR; 3. Integración de la versión final. Resultados Se obtuvo la versión final del modelo OPB-APR el cual describe procedimientos estandarizados para la detección, orientación y referencia a servicios de salud. Discusión y conclusión El modelo OPB-APR pretende fortalecer al sistema público de salud al incrementar la cobertura de servicios para la detección del VIH, VHC y otras ITS. Lo anterior mediante la implementación de procedimientos estandarizados entre los profesionales de la salud especializados y no especializados de centros para la atención de adicciones.

Efecto de borde en la distribución de líquenes y el contenido de clorofilas en fragmentos de Polylepis quadrijuga (Rosaceae) en el páramo de La Rusia (Boyacá-Colombia) / Edge effect on lichen's distribution and chlorophyll content, in fragments of Polylepis quadrijuga (Rosaceae) in Páramo de la Rusia (Boyacá-Colombia)

Resumen:La fragmentación de los ecosistemas es uno de los fenómenos antrópicos de mayor impacto global, y el efecto borde provoca que solo el interior de los fragmentos conserve sus características bióticas y abióticas originales. Los líquenes son organismos especialmente susceptibles a la variabilidad ambiental, lo que podría ser útil para la bio-indicación del efecto borde. En este trabajo se evaluó el efecto borde en dos fragmentos de Polylepis quadrijuga en el Páramo de la Rusia (Boyacá-Colombia), para determinar si existe un efecto borde sobre la distribución de los líquenes asociados a P. quadrijuga y su contenido de clorofilas. Se utilizaron tres transectos de 70 m a través del gradiente matriz-borde-interior en cada fragmento. Se escogieron nueve forofitos por transecto para medir variables ambientales: radiación fotosintéticamente activa, humedad relativa y temperatura del aire, y variables biológicas: riqueza y cobertura de cada especie. Además, fueron elegidas las especies que estaban presentes en las tres zonas del gradiente para cuantificar el contenido de clorofilas a y b, y determinar si hay cambios en la relación de clorofilas a/b que podrían sugerir plasticidad fisiológica como respuesta al efecto borde. Nuestros resultados mostraron que el fragmento 2 tenía una mayor exposición al borde debido a su alta relación perímetro/área, lo que causa una homogenización ambiental y pérdida de biodiversidad con relación con el fragmento 1. En general, se encontraron 55 especies que se distribuyen diferencialmente en relación con los fragmentos y el gradiente matriz-borde-interior. El interior del fragmento 1 fue la zona más conservada, que alberga una composición diferente en más de un 40 % a la composición de cualquier otra zona. Se clasificaron los líquenes de acuerdo con sus hábitos: gelatinosos, fruticosos, costrosos o foliosos, pero no se encontró ninguna relación entre la distribución por hábito y el efecto borde. Seis especies de amplia distribución mostraron cambios en el contenido de clorofila a lo largo del gradiente matriz-borde-interior, lo que es una evidencia de la plasticidad fisiológica al efecto borde. También fue posible diferenciar entre especies con preferencia por ambientes de alta temperatura y especies con preferencia a lugares más húmedos y suficientemente irradiados. Se concluye que algunas especies podrían tener un importante potencial como bio-indicadores de la fragmentación en ambientes de páramo.

Abstract:The ecosystems fragmentation is one of the anthropic phenomena with highest impact at global level and the edge effect causes that only the interior of fragments conserves their original biotic and abiotic characteristics. Lichens are organisms especially susceptible to environmental variability, what could be useful for bio-indication of edge effect. In this work, we evaluated the edge effect in two fragments of Polylepis quadrijuga in the Páramo de la Rusia (Boyacá-Colombia) to determine if there is an edge effect on distribution of lichens associated to P. quadrijuga and their chlorophyll content. We used three transects of 70 m across the matrix-edge-interior gradient in each fragment. We chose nine phorophytes per transect to measure the environmental variables: photosynthetically active radiation, relative humidity and air temperature, and the biological variables: richness and cover per species. Besides, we employed the species that were present in all the three zones of the gradient to quantify the content of chlorophylls a and b, and determine if there are changes in the ratio of chlorophylls a/b that could suggest physiological plasticity as a response to the edge effect. Our results showed that fragment 2 had a higher edge exposition because of its high relation perimeter/area, allowing to an environmental homogenization and lose of biodiversity in relation with fragment 1. Overall, we found 55 differentially distributed species in relation with the fragments and the matrix-edge-interior gradient. The interior of fragment 1 was the most conserved zone, harboring a composition different in more than 40 % to the composition of any other zone. We classified the lichens according with their habits: gelatinous, fruticose, crusty or foliose, but we did not find any relationship between the habit distribution and the edge effect. Six species of wide distribution showed changes in the chlorophyll content along the matrix- edge-interior gradient, what is an evidence of physiological plasticity to edge effect. It was also possible to distinguish between species with preference to warmer environment and species with preference to more humid and sufficiently irradiated places. We concluded that some species of lichens could have an important potential as bio-indicators of fragmentation in the páramo. Rev. Biol. Trop. 64 (4): 1683-1697. Epub 2016 December 01.

Factores subjetivos asociados a la no adherencia a la CPAP en pacientes con síndrome de apnea hipopnea de sueño / Subjective factors associated with cpap non-adherence in patients with sleep apnea hypopnea syndrome

Introducción: los beneficios de la CPAP dependen del número de horas que el paciente la use. El objetivo del estudio fue establecer, en pacientes con apnea del sueño (SAHS), si hay adecuada adherencia a la CPAP y determinar qué factores referidos por el paciente se relacionan a la no adherencia. Métodos: estudio observacional analítico transversal en pacientes tratados con CPAP. Se definió buena adherencia como uso mínimo de cuatro horas al menos el 70% de los días (registro del dispositivo). Análisis de regresión logística para evaluar los factores relacionados a la no adherencia: presión, resequedad de la vía aérea, problemas con la máscara y falta de educación en el uso de CPAP. Resultados: de 160 pacientes, 88 (55%) tuvieron mala adherencia. La edad, peso, talla, cuello e índice de apneas fueron similares en los grupos con buena y mala adherencia. El Epworth y la presión de CPAP fueron significativamente mayores en el grupo de mala adherencia (p<0.05). El promedio de horas de uso de CPAP en el grupo con buena adherencia fue de 5.1 ± 1.7 horas y en el grupo con mala adherencia fue de 1.9 ± 1.5 horas. Los pacientes sobreestimaron el uso de la CPAP en 2.0 horas: reportadas por el paciente 5.3 horas frente a 3.3 horas según la tarjeta del equipo (p<0.001). El único factor referido por el paciente que se relacionó con la mala adherencia fue la presión de CPAP (OR ajustado: 3,34 [1,34 a 8,30]). Conclusiones: la adherencia al tratamiento con CPAP en pacientes con SAHS es subóptima (mala adherencia en 55% de los pacientes). La principal causa relacionada con la no adherencia según los pacientes fue la intolerancia a la presión del dispositivo. Los pacientes sobreestiman las horas reales de uso del CPAP.

Introduction: the benefits of CPAP depend on the number of hours being used by the patient. The aim of the study was to establish, in patients with sleep apnea (SAHS), if there is adequate adherence to CPAP and to determine what factors reported by the patient are related to non-adherence. Methods: an analytical observational cross-sectional study in patients treated with CPAP. Good adherence was defined as a minimum of 4 hours use at least 70% of days (device score). Logistic regression analysis to assess factors related to non-adherence: pressure, airway dryness, mask problems and lack of education in the use of CPAP. Results: of 160 patients, 88 (55%) had poor adherence. Age, weight, height, neck and apnea index were similar in the groups with good and poor adherence. The Epworth and CPAP pressure were significantly higher in the group of poor adherence (p <.05). The average hours of use of CPAP in the group with good adherence was 5.1 ± 1.7 hours and the poor adherence group was 1.9 ± 1.5 hours. The patients overestimated the use of CPAP in 2.0 hours: 5.3 hours reported by the patient versus 3.3 hours according to the device card (p <0.001). The only factor reported by the patient that was associated with poor adherence was CPAP pressure (adjusted OR: 3.34 [1.34 to 8.30]). Conclusions: adherence to CPAP in patients with SAHS is suboptimal (poor adherence in 55% of patients). The main cause related to non-adherence according to patients was intolerance to the pressure device. Patients overestimate the real hours of CPAP use.

Características psicodinámicas de duelo en pacientes con insuficiencia renal terminal / Psychodynamic characteristics of mourning in patients with ESRD

La presente investigación fundamenta en la clínica psicoanalítica el estudio de dos casos de tres personas diagnosticadas con IRT que reciben tratamiento de hemodiálisis, en razón a que dadas las características y el aumento de los reportes que se presentan, ya esto se considera un problema de salud pública. El objetivo principal es describir las características dinámicas del proceso de duelo en pacientes con IRT en un centro de terapia renal de la ciudad de Cartagena. El procedimiento metodológico empleó un diseño de tipo cualitativo; la investigación se desarrolló con un diseño clínico mediante el estudio de casos, y fundamentada en la hermenéutica psicoanalítica. Todo esto respaldado en la historia clínica, la entrevista semiestructurada individual y familiar, los test proyectivos, test del dibujo de la figura humana Machover y TAT de Murray, para la debida integración de los análisis. Se concluye que predominan funciones fallidas de los progenitores y que son individuos provenientes de familias psicosomáticas, que utilizan la enfermedad para obtener un beneficio secundario.

The present investigation, is based on psychoanalytic Clinic, through the study of two cases of three patients diagnosed with TRI receiving hemodyalisis treatment, having into account the increase of the cases and the characteristics of its presentation it is now considered a public health problem. The main aim is to describe the dynamic characteristics of the process of mourning in patients with TRI in renal therapy center of the city of Cartagena (Colombia). The methodology used for this research was through a qualitative type design. This research was developed with a clinical design through case studies, based on psychoanalytic hermeneutics, all this backed in the clinical history, the semi-structured individual and familiar interviews, The projective test of the drawing of the human figure Machover and TPT of Murray, analyzing their integration. We conclude the dominance of failed functions of parents, and that they are individuals from psychosomatic families, that use their illness to obtain secondary profits.

Sensibilidad y especificidad de la citología obtenida mediante aspiración con aguja fina en el diagnóstico de las neoplasias foliculares de la glándula tiroides: un estudio prospectivo / Sensitivity and specificity of fine-needle aspiration cytology in the diagnosis of follicular neoplasms of thyroid gland: a prospective study

Introducción. La citología obtenida mediante aspiración con aguja fina posee un rendimiento cuestionable en el diagnóstico de las neoplasias foliculares de la glándula tiroides, grupo de neoplasias conformado por el adenoma folicular, el carcinoma folicular y las neoplasias de células de Hürthle. Métodos. Se realizó un estudio prospectivo en el cual se evaluaron las citologías realizadas en el Servicio de Cirugía de Cuello de la E.S.E. Hospital Universitario del Caribe durante el periodo de tiempo comprendido entre mayo de 2014 y mayo de 2015. Un patólogo con entrenamiento en citopatología de tiroides realizó el diagnóstico citológico e histopatológico de cada uno de los extendidos y especímenes quirúrgicos. Los resultados del estudio citológico se dicotomizaron como «citología con sospecha de neoplasia folicular» y «citología sin sospecha de neoplasia folicular». Los resultados del estudio histopatológico se dicotomizaron como «positivos para neoplasia folicular» y «negativos para neoplasia folicular». El diagnóstico citológico se correlacionó con el estudio histopatológico con el objetivo de determinar los parámetros de rendimiento diagnóstico. Resultados. La población de estudio estuvo conformada por 95 pacientes, 89 (93,7%) mujeres y 6 (6,3%) hombres, con una edad promedio de 46,1 ± 14,9 años. Se obtuvo una sensibilidad del 30,8% y una especificidad del 92,7% en el diagnóstico de las neoplasias foliculares. La frecuencia de falsos positivos fue de 6,3% y la frecuencia de falsos negativos fue de 9,5%. Conclusión. La citología obtenida mediante aspiración con aguja fina posee una baja sensibilidad en el diagnóstico de las neoplasias foliculares de la glándula tiroides (AU)

Introduction. The accuracy of fine-needle aspiration cytology in the diagnosis of follicular neoplasms of the thyroid gland, specifically follicular adenoma, follicular carcinoma and Hürthle cell neoplasms, is questionable. Methods. A prospective study was carried out. Fine-needle aspiration cytology performed at the E.S.E. Hospital Universitario del Caribe between May 2014 and May 2015 were evaluated. One pathologist with training in thyroid cytopathology performed cytological and histopathological examination of each smear and surgical specimen. The results of cytological examination were classified as "cytology suspicious for follicular neoplasm" or "cytology not suspicious for follicular neoplasm". The results of the histopathological examination were classified as "positive for follicular neoplasm" or "negative for follicular neoplasm". Cytological diagnosis and histopathological diagnosis were correlated in order to determine the sensitivity and specificity of fine-needle aspiration cytology in the diagnostic of follicular neoplasms. Results. The study population consisted of 95 patients, 89 (93.7%) females and 6 (6.3%) males, with a mean age of 46.1 ± 14.9 years. A sensitivity of 30.8% and a specificity of 92.7% in the diagnosis of follicular neoplasms was obtained. The false positive frequency was 6.3% and the frequency of false negatives was 9.5%. Conclusion. Fine-needle aspiration cytology has a low sensitivity in the diagnosis of follicular neoplasms of the thyroid gland (AU)

Minimum effective doses of haloperidol for the treatment of first psychotic episode: a comparative study with risperidone and olanzapine.

Minimum doses of haloperidol might show similar efficacy and side-effects compared to atypical antipsychotics. The objectives of this study were to compare the efficacy of minimum doses of haloperidol with standard doses of risperidone and olanzapine on a 6-month open trial in first psychotic episode patients and to examine the effect of compliance on their outcome. Forty-two patients were recruited and started on flexible doses of these drugs. Olanzapine was given with no cost to the patients. Efficacy and side-effects were monitored every 3 months using standardized assessments. Thirty patients completed the study. All treatment groups showed improvement in positive, negative and depressive symptoms. There were no differences in side-effects among them. The haloperidol group required higher doses of anticholinergics. The rate of treatment discontinuation was higher in the risperidone group due to the direct cost. Minimum doses of haloperidol might prove to be a good choice of treatment for patients with a first episode of psychosis.

Estudio micológico del aire en áreas ocupacionales y exteriores de la Facultad de Ciencias Químicas y Farmacia y otras áreas de la Universidad de San Carlos de Guatemala / Mycological study occupational air and outdoor areas of the faculty of chemistry and pharmacy and other areas of the USAC

Hay pocos estudios realizados sobre la aerobiología de los países tropicales y por tanto un vacío de información sobre el tema. El propósito de este estudio fue realizar un análisis de la distribución de hongos microscópicos aerotransportados en la atmósfera en los meses de febrero a agosto del 2008. Se mustrearon ocho locales, de los cuales siete se ubicaron dentro del campus de la Universidad de San Carlos de Guatemala, zona 12.

Variables clínicas, genéticas y de personalidad como predictores de respuesta al tratamiento antidepresivo: estudio paralelo de un ensayo clínico controlado de fluvocamina e imipramina / Clinical variables, molecural genotypes and personality as predictors antidepressant response. A paralels study of a clinical trial of fluvoxamine vs. impramide

En este trabajo se reportan los resultados de un estudio paralelo al proyecto de eficacia y seguridad de la fluvoxamina v.s. imipramina en el tratamiento de la depresión mayor. El estudio fue doble ciego, controlado y multicéntrico, y se analizaron variables clínicas, genotipos moleculares y depresión en la predicción de la respuesta antidepresiva. La muestra final quedó conformada por 40 sujetos, 14 (35 por ciento) hombres y 26 (65 por ciento) mujeres, con el diagnóstico de depresión mayor unipolar de acuerdo al DSMIV. Nuestros resultados indican que; el número de episodios previos e intentos suicidas correlacionaron con la severidad. Los pacientes deprimidos tuvieron una diferencia significativa en la escala de PE del ITC contra los controles. También, la escala del ITC-DR predijo la respuesta farmacológica. La presencia de efectos secundarios correlacionaron con un aumento en el puntaje de las escalas del ITC que están en relación directa con la presencia de trastornos de personalidad. Desde el punto de vista genético, ninguno de los genotipos moleculares estudiados predijo la respuesta farmacológica