Liver Transplantation for Acute Hepatic Failure Following Intentional Iron Overdose.

The majority of acute iron toxicity cases occur in young children from accidental ingestion. In adults, iron poisoning is rare and mostly due to intentional ingestion. Physicians, particularly those who do not routinely treat pediatric patients, are often unfamiliar with the clinical manifestation of iron poisoning, its management, and its potential for multiple organ failure, especially liver damage. Severe acute hepatotoxicity treated with liver transplantation is rare in adults, with very limited published literature. We report a case of a severe iron tablet overdose with suicidal intent that progressed to fulminant hepatic failure despite medical treatment, ultimately treated with liver transplantation.

Developing and validating a machine learning prognostic model for alerting to imminent deterioration of hospitalized patients with COVID-19.

Our study was aimed at developing and validating a new approach, embodied in a machine learning-based model, for sequentially monitoring hospitalized COVID-19 patients and directing professional attention to patients whose deterioration is imminent. Model development employed real-world patient data (598 prediction events for 210 patients), internal validation (315 prediction events for 97 patients), and external validation (1373 prediction events for 307 patients). Results show significant divergence in longitudinal values of eight routinely collected blood parameters appearing several days before deterioration. Our model uses these signals to predict the personal likelihood of transition from non-severe to severe status within well-specified short time windows. Internal validation of the model's prediction accuracy showed ROC AUC of 0.8 and 0.79 for prediction scopes of 48 or 96 h, respectively; external validation showed ROC AUC of 0.7 and 0.73 for the same prediction scopes. Results indicate the feasibility of predicting the forthcoming deterioration of non-severe COVID-19 patients by eight routinely collected blood parameters, including neutrophil, lymphocyte, monocyte, and platelets counts, neutrophil-to-lymphocyte ratio, CRP, LDH, and D-dimer. A prospective clinical study and an impact assessment will allow implementation of this model in the clinic to improve care, streamline resources and ease hospital burden by timely focusing the medical attention on potentially deteriorating patients.

Ciliated hepatic foregut cyst: A case report and review of literature.

INTRODUCTION: Ciliated hepatic foregut cyst (CHFC) is a rare cystic lesion that arises from the embryonic foregut with approximately 100 cases reported. Most commonly identified in segment IV of the liver, CHFC is typically asymptomatic and incidentally found on abdominal imaging. It is important to consider this entity in the differential diagnosis of atypical liver lesions since CHFC carries a risk of transformation into squamous cell carcinoma. A suspicion of CHFC is therefore an indication for surgical resection. CASE PRESENTATION: A 62-year-old male presented to surgery consultation for further evaluation of a hepatic cyst incidentally found on abdominal ultrasound. The patient was completely asymptomatic. Both abdominal computerized tomography and magnetic resonance imaging scan confirmed a 4 cm subcapsular cyst in segment IVa. Additional workup was unremarkable. Considering the diagnostic doubt the patient underwent laparoscopic cyst enucleation. Histology revealed a ciliated pseudostratified epithelium consistent with a CHFC. CLINICAL DISCUSSION: CHFC is a rare diagnostic entity that should be considered in the differential diagnosis of cystic hepatic lesions, particularly those located in segment IV of the liver. Since it is frequently asymptomatic, CHFC is usually found incidentally during surgery or imaging studies. Diagnosis of CHFC preoperatively is difficult due to the lack of specific radiographic findings. Moreover, metaplasia and squamous carcinoma can occur. Therefore complete surgical excision is the recommended treatment. CONCLUSION: Despite its rarity, CHFC carries a risk of malignant transformation. Accurate diagnosis is mandatory and surgical excision is recommended even in asymptomatic CHFC.

ANTIGENIC STIMULATION DURING PREGNANCY MODIFIES SPECIFIC IGA1 AND IGA2 SUBCLASSES IN HUMAN COLOSTRUM ACCORDING TO THE CHEMICAL COMPOSITION OF THE ANTIGEN.

BACKGROUND: Several studies have evaluated the effect of infectious diseases and vaccine protocols during pregnancy on maternal milk immunoglobulin (Ig) levels, to understand the protection conferred by lactation on newborns. Colostrum is the primary source of maternal IgA for the newborn. IgA participates in protection mechanisms in the neonate's mucosa. In humans, IgA has two subclasses with differential anatomical distribution among mucosal compartments. Total IgA levels in maternal milk vary after antigen stimulation and have differential affinities in function of the chemical composition of the antigens. We studied the effect of antigenic stimulation during pregnancy on the concentrations of specific IgA1 and IgA2 subclasses in human colostrum. METHODS: We analyzed data from 113 women in Mexico City and compared the amount of IgA subclasses in colostrum against three antigens: two from vaccine protocols (tetanus toxoid and pneumococcal polysaccharides) and lipopolysaccharide, a ubiquitous antigen in the gastrointestinal tract. RESULTS: In agreement with the previous reports, we showed that IgA1 from colostrum mainly recognized protein antigens; in sharp contrast, IgA2 was mostly directed against polysaccharide antigens. These levels increased in women who had previous contacts through vaccination or infections during pregnancy. CONCLUSIONS: Antigen interaction during pregnancy increased the amount of specific IgA subclasses, depending on the chemical composition of the antigen.

Antigenic stimulation during pregnancy modifies specific iga1 and iga2 subclasses in human colostrum according to the chemical composition of the antigen

ABSTRACT Background: Several studies have evaluated the effect of infectious diseases and vaccine protocols during pregnancy on maternal milk immunoglobulin (Ig) levels, to understand the protection conferred by lactation on newborns. Colostrum is the primary source of maternal IgA for the newborn. IgA participates in protection mechanisms in the neonate's mucosa. In humans, IgA has two subclasses with differential anatomical distribution among mucosal compartments. Total IgA levels in maternal milk vary after antigen stimulation and have differential affinities in function of the chemical composition of the antigens. We studied the effect of antigenic stimulation during pregnancy on the concentrations of specific IgA1 and IgA2 subclasses in human colostrum. Methods: We analyzed data from 113 women in Mexico City and compared the amount of IgA subclasses in colostrum against three antigens: two from vaccine protocols (tetanus toxoid and pneumococcal polysaccharides) and lipopolysaccharide, a ubiquitous antigen in the gastrointestinal tract. Results: In agreement with the previous reports, we showed that IgA1 from colostrum mainly recognized protein antigens; in sharp contrast, IgA2 was mostly directed against polysaccharide antigens. These levels increased in women who had previous contacts through vaccination or infections during pregnancy. Conclusions: Antigen interaction during pregnancy increased the amount of specific IgA subclasses, depending on the chemical composition of the antigen.

Avaliação da qualidade microbiológica e das boas práticas de fabricação em agroindústria de processamento de hortaliças / Microbiological quality evaluation and good manufacturing practices in agroindustries processed vegetables

No processamento de hortaliças, a qualidade e segurança dos produtos podem ser afetadas pela contaminação de microrganismos patogênicos. A implantação do programa de boas práticas de fabricação (BPF) seria uma das formas de implementar o controle de qualidade de tais alimentos. O objetivo do trabalho foi avaliar a aplicação das BPF e análise de qualidade microbiológica em uma agroindústria de processamento de vegetais no município de Volta Redonda-RJ. Foi realizada a aplicação de uma lista de verificação das BPF estabelecida pela Resolução RDC nº 275/2002. As análises microbiológicas foram realizadas na água de processamento (coliformes totais e pesquisa qualitativa de Escherichia coli), swab na superfície de equipamentos considerados críticos no processo (mesófilos aeróbios) e de produtos minimamente processados elaborados (coliformes 45°e Salmonella spp). A agroindústria avaliada obteve uma taxa de 73% de itens em conformidade nos requisitos avaliados das BPF. Observa-se que o pior desempenho, foi em relação ao bloco 5 (Registros e documentação), com 100% de não conformidade. Na análise microbiológica, todas as amostras de vegetais analisadas apresentaram-se em acordo com a legislação vigente, o que indica o cumprimento com as BPF. Os padrões microbiológicos para as amostras de água estão de acordo com os padrões microbiológicos segundo a legislação, para coliformes totais e Escherichia coli. No entanto, apresentou teores de cloro residual livre em desacordo com a legislação.

Foramen of Winslow hernia: case report of a minimally invasive approach.

Foramen of Winslow hernias account for 8% of all internal hernias. Their non-specific presentation and often late diagnosis are associated with an estimated mortality of 50%. The use of complementary diagnostic methods facilitates the diagnosis and planning of the therapeutic strategy. Urgent surgery is the appropriate treatment due to the risk of intestinal ischemia, being laparotomy the main form of approach described. Few cases of laparoscopy are referred to in the literature.

Liver Transplantation for Hepatic Trauma: A Study From the European Liver Transplant Registry.

BACKGROUND: Liver transplantation is the most extreme form of surgical management of patients with hepatic trauma, with very limited literature data supporting its use. The aim of this study was to assess the results of liver transplantation for hepatic trauma. METHODS: This retrospective analysis based on European Liver Transplant Registry comprised data of 73 recipients of liver transplantation for hepatic trauma performed in 37 centers in the period between 1987 and 2013. Mortality and graft loss rates at 90 days were set as primary and secondary outcome measures, respectively. RESULTS: Mortality and graft loss rates at 90 days were 42.5% and 46.6%, respectively. Regarding general variables, cross-clamping without extracorporeal veno-venous bypass was the only independent risk factor for both mortality (P = 0.031) and graft loss (P = 0.034). Regarding more detailed factors, grade of liver trauma exceeding IV increased the risk of mortality (P = 0.005) and graft loss (P = 0.018). Moreover, a tendency above the level of significance was observed for the negative impact of injury severity score (ISS) on mortality (P = 0.071). The optimal cut-off for ISS was 33, with sensitivity of 60.0%, specificity of 80.0%, positive predictive value of 75.0%, and negative predictive value of 66.7%. CONCLUSIONS: Liver transplantation seems to be justified in selected patients with otherwise fatal severe liver injuries, particularly in whom cross-clamping without extracorporeal bypass can be omitted. The ISS cutoff less than 33 may be useful in the selection process.

Liver Transplantation for Hereditary Transthyretin Amyloidosis: After 20 Years Still the Best Therapeutic Alternative?

BACKGROUND: Until recently, liver transplantation (Ltx) was the only available treatment for hereditary transthyretin (TTR) amyloidosis; today, however, several pharmacotherapies are tested. Herein, we present survival data from the largest available database on transplanted hereditary TTR patients to serve as a base for comparison. METHODS: Liver transplantation was evaluated in a 20-year retrospective analysis of the Familial Amyloidosis Polyneuropathy World Transplant Registry. RESULTS: From April 1990 until December 2010, data were accumulated from 77 liver transplant centers. The Registry contains 1940 patients, and 1379 are alive. Eighty-eight Ltx were performed in combination with a heart and/or kidney transplantation. Overall, 20-year survival after Ltx was 55.3%. Multivariate analysis revealed modified body mass index, early onset of disease (<50 years of age), disease duration before Ltx, and TTR Val30Met versus non-TTR Val30Met mutations as independent significant survival factors. Early-onset patients had an expected mortality rate of 38% that of the late-onset group (P < 0.001). Furthermore, Val30Met patients had an expected mortality rate of 61% that of non-TTR Val30Met patients (P < 0.001). With each year of duration of disease before Ltx, expected mortality increased by 11% (P < 0.001). With each 100-unit increase in modified body mass index at Ltx, the expected mortality decreased to 89% of the expected mortality (P < 0.001). Cardiovascular death was markedly more common than that observed in patients undergoing Ltx for end-stage liver disease. CONCLUSIONS: Long-term survival after Ltx, especially for early-onset TTR Val30Met patients, is excellent. The risk of delaying Ltx by testing alternative treatments, especially in early-onset TTR Val30Met patients, requires consideration.

CapsidMaps: protein-protein interaction pattern discovery platform for the structural analysis of virus capsids using Google Maps.

Structural analysis and visualization of protein-protein interactions is a challenging task since it is difficult to appreciate easily the extent of all contacts made by the residues forming the interfaces. In the case of viruses, structural analysis becomes even more demanding because several interfaces coexist and, in most cases, these are formed by hundreds of contacting residues that belong to multiple interacting coat proteins. CapsidMaps is an interactive analysis and visualization tool that is designed to benefit the structural virology community. Developed as an improved extension of the φ-ψ Explorer, here we describe the details of its design and implementation. We present results of analysis of a spherical virus to showcase the features and utility of the new tool. CapsidMaps also facilitates the comparison of quaternary interactions between two spherical virus particles by computing a similarity (S)-score. The tool can also be used to identify residues that are solvent exposed and in the process of locating antigenic epitope regions as well as residues forming the inside surface of the capsid that interact with the nucleic acid genome. CapsidMaps is part of the VIPERdb Science Gateway, and is freely available as a web-based and cross-browser compliant application at http://viperdb.scripps.edu.

Características clínicas, radiográficas e diagnóstico do ameloblastoma: relato de caso / Clinical and radiographic features and diagnosis of ameloblastoma: a case report

O ameloblastoma é um tumor benigno comumente encontrado nos ossos gnáticos, originário de remanescentes da lâmina dentária. Quanto ao comportamento clínico, trata-se de um tumor de crescimento lento, normalmente assintomático, podendo provocar deslocamento, mobilidade e reabsorção dentária, assim como parestesia. Radiograficamente, pode apresentar-se como lesões radiolúcidas uni ou multiloculares, normalmente com limites bem definidos de forma semelhante a "favos de mel" ou "bolhas de sabão". Histologicamente, possui diversos padrões, principalmente a variante multicística. Existem diversos métodos de tratamento, desde a enucleação e curetagem a ressecções mais agressivas, com ou sem perda da continuidade óssea. O ameloblastoma, por ser um tumor agressivo, possui grande percentual de recidiva e o prognóstico depende de vários fatores, desde os aspectos clínicos, radiográficos e histopatológicos que definem o seu comportamento biológico. O objetivo deste trabalho é relatar as características clínicas e radiográficas no direcionamento do diagnóstico e na escolha do tratamento adequado para o ameloblastoma baseado na descrição de um relato de caso clínico... (AU)

Ameloblastoma is a benign neoplasm commonly found in maxillary bones, formed from remnants of dental lamina. As regards its clinical behavior, it is a tumor of slow growth, usually asymptomatic, causing displacement, mobility, tooth resorption, and paresthesia. Radiographically, it may present as a radiolucent uni- or multiocular lesion, normally with well-defined boundaries resembling a "honeycomb" or "soap bubbles". Histologically, it presents various patterns, particularly the multicystic variant. There are various methods of treatment, ranging from enucleation and curettage to the more aggressive resections with or without loss of bone continuity. Being an aggressive tumor, ameloblastoma has a high percentage of recurrence and its prognosis depends on several factors involving clinical, radiological and histopathological features that characterize its biological behavior. The objective of this paper is to report the clinical and radiographic features in the diagnosis of ameloblastoma and the suitable choice of treatment, based on the report of a clinical case... (AU)

Elders Health Empowerment Scale. Spanish adaptation and psychometric analysis / Escala de Empoderamiento sobre la Salud para Adultos Mayores. Adaptación al español y análisis psicométrico

Introduction: Empowerment refers to patient skills that allow them to become primary decision-makers in control of daily self-management of health problems. As important the concept as it is, particularly for elders with chronic diseases, few available instruments have been validated for use with Spanish speaking people. Objective: Translate and adapt the Health Empowerment Scale (HES) for a Spanish-speaking older adults sample and perform its psychometric validation. Methods: The HES was adapted based on the Diabetes Empowerment Scale-Short Form. Where "diabetes" was mentioned in the original tool, it was replaced with "health" terms to cover all kinds of conditions that could affect health empowerment. Statistical and Psychometric Analyses were conducted on 648 urban-dwelling seniors. Results: The HES had an acceptable internal consistency with a Cronbach's α of 0.89. The convergent validity was supported by significant Pearson's Coefficient correlations between the HES total and item scores and the General Self Efficacy Scale (r= 0.77), Swedish Rheumatic Disease Empowerment Scale (r= 0.69) and Making Decisions Empowerment Scale (r= 0.70). Construct validity was evaluated using item analysis, half-split test and corrected item to total correlation coefficients; with good internal consistency (α> 0.8). The content validity was supported by Scale and Item Content Validity Index of 0.98 and 1.0, respectively. Conclusions: HES had acceptable face validity and reliability coefficients; which added to its ease administration and users' unbiased comprehension, could set it as a suitable tool in evaluating elder's outpatient empowerment-based medical education programs.

Introducción: Empoderamiento se refiere a las habilidades que le permiten al paciente convertirse en responsable de tomar las decisiones para el control diario de sus problemas de salud. A pesar de ser un concepto tan importante, particularmente para adultos mayores con problemas crónicos de salud, hay pocos instrumentos accesibles que hayan sido validados para su uso en hispano-hablantes. Objetivo: Traducir y adaptar la Escala de Empoderamiento sobre la Salud (EES) para una muestra de adultos mayores hispano-hablantes y llevar a cabo su validación psicométrica. Métodos: La EES se adaptó basándose en la Escala de Empoderamiento de la Diabetes versión corta. Donde se mencionaba "diabetes" en el instrumento original, se reemplazó con el término "salud" para cubrir todos los tipos de condiciones que podrían afectar el Empoderamiento sobre la salud. Se realizaron análisis estadísticos y psicométricos sobre 648 adultos mayores residentes urbanos. Resultados: La EES tuvo una consistencia interna aceptable con un α de Cronbach de 0.89. la validez convergente se apoyó en un coeficiente de correlación de Pearson significativo entre la EES total y por ítems y la Escala General de Auto-eficacia (r= 0.77), la Escala de Empoderamiento para la Enfermedad Reumática versión Sueca (r= 0.69) y la Escala de Empoderamiento Tomando Decisiones (r= 0.70). La validez de Constructo se evaluó mediante análisis de ítem, test de las dos mitades y coeficiente de correlación ítem corregido total (α >0.8). La validez de contenido se apoyó por los Índices de Validez de Contenido para la Escala y para los ítems de 0.98 y 1.0, respectivamente. Conclusiones: La EES tuvo una validez y confiabilidad aceptables, que sumados a su facilidad de administración y comprensión simple y sin sesgos podría constituirse en una herramienta confiable para evaluar programas educativos médicos basados en el Empoderamiento de pacientes mayores ambulatorios.

Elders Health Empowerment Scale: Spanish adaptation and psychometric analysis.

INTRODUCTION: Empowerment refers to patient skills that allow them to become primary decision-makers in control of daily self-management of health problems. As important the concept as it is, particularly for elders with chronic diseases, few available instruments have been validated for use with Spanish speaking people. OBJECTIVE: Translate and adapt the Health Empowerment Scale (HES) for a Spanish-speaking older adults sample and perform its psychometric validation. METHODS: The HES was adapted based on the Diabetes Empowerment Scale-Short Form. Where "diabetes" was mentioned in the original tool, it was replaced with "health" terms to cover all kinds of conditions that could affect health empowerment. Statistical and Psychometric Analyses were conducted on 648 urban-dwelling seniors. RESULTS: The HES had an acceptable internal consistency with a Cronbach's α of 0.89. The convergent validity was supported by significant Pearson's Coefficient correlations between the HES total and item scores and the General Self Efficacy Scale (r= 0.77), Swedish Rheumatic Disease Empowerment Scale (r= 0.69) and Making Decisions Empowerment Scale (r= 0.70). Construct validity was evaluated using item analysis, half-split test and corrected item to total correlation coefficients; with good internal consistency (α> 0.8). The content validity was supported by Scale and Item Content Validity Index of 0.98 and 1.0, respectively. CONCLUSIONS: HES had acceptable face validity and reliability coefficients; which added to its ease administration and users' unbiased comprehension, could set it as a suitable tool in evaluating elder's outpatient empowerment-based medical education programs.

INTRODUCCIÓN: Empoderamiento se refiere a las habilidades que le permiten al paciente convertirse en responsable de tomar las decisiones para el control diario de sus problemas de salud. A pesar de ser un concepto tan importante, particularmente para adultos mayores con problemas crónicos de salud, hay pocos instrumentos accesibles que hayan sido validados para su uso en hispano-hablantes. OBJETIVOS: Traducir y adaptar la Escala de Empoderamiento sobre la Salud (EES) para una muestra de adultos mayores hispano-hablantes y llevar a cabo su validación psicométrica. MÉTODOS: La EES se adaptó basándose en la Escala de Empoderamiento de la Diabetes versión corta. Donde se mencionaba "diabetes" en el instrumento original, se reemplazó con el término "salud" para cubrir todos los tipos de condiciones que podrían afectar el Empoderamiento sobre la salud. Se realizaron análisis estadísticos y psicométricos sobre 648 adultos mayores residentes urbanos. RESULTADOS: La EES tuvo una consistencia interna aceptable con un α de Cronbach de 0.89. La validez convergente se apoyó en un coeficiente de correlación de Pearson significativo entre la EES total y por ítems y la Escala General de Auto-eficacia (r= 0.77), la Escala de Empoderamiento para la Enfermedad Reumática versión Sueca (r= 0.69) y la Escala de Empoderamiento Tomando Decisiones (r= 0.70). La validez de Constructo se evaluó mediante análisis de ítem, test de las dos mitades y coeficiente de correlación ítem corregido total (α > 0.8). La validez de contenido se apoyó por los Índices de Validez de Contenido para la Escala y para los ítems de 0.98 y 1.0, respectivamente. CONCLUSIONES: La EES tuvo una validez y confiabilidad aceptables, que sumados a su facilidad de administración y comprensión simple y sin sesgos podría constituirse en una herramienta confiable para evaluar programas educativos médicos basados en el Empoderamiento de pacientes mayores ambulatorios.

A reminiscence program intervention to improve the quality of life of long-term care residents with Alzheimer's disease: a randomized controlled trial / Intervenção com um programa de reminiscência para melhorar qualidade de vida de residentes com Alzheimer com cuidados prolongados: ensaio controlado randomizado

OBJECTIVE: A single-blinded, parallel-groups (intervention, active and passive control groups) randomized controlled trial (RCT) was chosen to investigate whether a specific reminiscence program is associated with higher levels of quality of life in nursing home residents with dementia. METHODS: The intervention used a life-story approach, while the control groups participated in casual discussions. The Social Engagement Scale (SES) and Self Reported Quality of Life Scale (SRQoL) were used as the outcome measures, which were examined at baseline (T0), 12 weeks (T1), and six months (T2) after the intervention. The final sample had 135 subjects (active control group = 45; passive control group = 45; intervention group = 45). RESULTS: The Wilcoxon test showed significant differences in the intervention group between T2 and T0, and between T1 and T0 in the SES, and there were significant differences between T0 and T1 (intervention effect size = 0.267) and T1 and T2 (intervention effect size = 0.450) in the SRQoL. The univariate logistic regression scores showed that predictors of change in the SRQoL were associated with fewer baseline anxiety symptoms and lower depression scores. CONCLUSIONS: The intervention led to significant differences between the three groups over time, showing a significant improvement in the quality of life and engagement of the residents in the intervention group.

OBJETIVO: Elegeu-se um ensaio randomizado controlado simples cego, com grupos paralelos (intervenção, comparação e controle) para pesquisar se um programa específico de reminiscência associa-se com maiores níveis de qualidade de vida em residentes com demência com cuidados prolongados. MÉTODO: No grupo de intervenção usou-se o enfoque da história de vida, enquanto o grupo controle recebeu conversas amistosas. A Escala de Compromisso Social (SES) e a escala auto-referida de qualidade de vida (SRQoL) foram as medidas de resultados, examinados na linha de base, doze semanas, e seis meses após a intervenção. A mostra final teve 135 sujeitos (controle n = 45; comparação n = 45; intervenção n = 45). RESULTADOS: Wilcoxon test no grupo intervencional comparando os resultados entre T1 e T0, T2 e T1, e T2 e T0 mostraram diferenças significativas entre T2 e T0 (tamanho do efeito de intervenção = 0,460) e T1 e T0 (tamanho do efeito de intervenção = 0,486) em o SES; e entre T0 e T1 (tamanho do efeito de intervenção = 0,267) e T1 e T2 (tamanho do efeito de intervenção = 0,450) em o SRQoL no grupo de intervenção. As pontuações de regressão logística univariada mostraram que os predictores de mudança estavam associados com menores níveis de ansiedade basal e menores níveis de depresión. CONCLUSÕES: A intervenção produziu diferenças significativas entre os três grupos ao longo do tempo, mostrando uma melhoria significativa na qualidade de vida e compromisso dos residentes no grupo de intervenção.

A reminiscence program intervention to improve the quality of life of long-term care residents with Alzheimer's disease: a randomized controlled trial.

OBJECTIVE: A single-blinded, parallel-groups (intervention, active and passive control groups) randomized controlled trial (RCT) was chosen to investigate whether a specific reminiscence program is associated with higher levels of quality of life in nursing home residents with dementia. METHODS: The intervention used a life-story approach, while the control groups participated in casual discussions. The Social Engagement Scale (SES) and Self Reported Quality of Life Scale (SRQoL) were used as the outcome measures, which were examined at baseline (T0), 12 weeks (T1), and six months (T2) after the intervention. The final sample had 135 subjects (active control group = 45; passive control group = 45; intervention group = 45). RESULTS: The Wilcoxon test showed significant differences in the intervention group between T2 and T0, and between T1 and T0 in the SES, and there were significant differences between T0 and T1 (intervention effect size = 0.267) and T1 and T2 (intervention effect size = 0.450) in the SRQoL. The univariate logistic regression scores showed that predictors of change in the SRQoL were associated with fewer baseline anxiety symptoms and lower depression scores. CONCLUSIONS: The intervention led to significant differences between the three groups over time, showing a significant improvement in the quality of life and engagement of the residents in the intervention group.

[Biliary ileus: 10-year experience. Case series]. / Íleo biliar. Experiencia de 10 años. Serie de casos.

BACKGROUND: Biliary ileus is present in 0.06% of patients with gallstones as an outcome of a cholecystoenteric fistula, most frequently presenting as an intestinal obstruction. It is a clinic entity occasionally diagnosed, which translates into a significant margin of complications and mortality ranging from 12 to 27%. Our objective is to report the experience in the treatment of this pathology in a tertiary care hospital. METHODS: We carried out a retrospective study in patients with a diagnosis of biliary ileus during a 10-year period. RESULTS: thirteen patients were included in the study, nine males (69%) and four females (31%) with a mean age of 57 years. All patients had intestinal occlusion symptoms. Preoperative diagnosis was achieved in three patients (23%). The most common surgery was intestinal resection with anastomosis (54%). One patient from the study group died (8%). Hospitalization length was a mean of 15 days and average follow-up was 11 months. CONCLUSIONS: Bilary ileus is a pathology of patients of advanced age and must be suspected when symptoms of occlusion are present, regardless of gender. Early diagnosis can mean earlier intervention and potentially less traumatic surgery. Treatment is focused on urgent laparotomy and resolution of the intestinal occlusion, leaving management of the biliary fistula to only selected cases.

Red blood cell transfusions--are we narrowing the evidence-practice gap? An observational study in 5 Israeli intensive care units.

PURPOSE: The aim of the study was to document transfusion practices in a cross section of general intensive care units (ICUs) in Israel and to determine whether current guidelines are being applied. MATERIALS AND METHODS: This prospective study was performed in 5 general ICUs in Israel over a 3-month period. Red cell transfusion data collected on consecutive patients included the trigger, units transfused per transfusion event, and indications, categorized either to treat a specified condition for which transfusions may be beneficial (acute hemorrhage, acute myocardial ischemia, or severe sepsis) or to treat a low hemoglobin concentration. RESULTS: Of the 238 patients studied, 50% received at least one red blood cell transfusion. The main indication for transfusion (43.7%, or 162/368 U transfused) was to treat a low hemoglobin concentration, in the absence of one of the specified conditions. Total red cell use was 3.0 ± 2.9 U per admission, and patients received a mean of 1.2 ± 0.4 U per transfusion event. The transfusion trigger for the whole group was 7.9 ± 1.1 g/dL. This did not differ significantly between the indications apart from a significantly higher trigger for patients with acute myocardial ischemia (8.8 ± 0.9 g/dL). In addition, patients with a history of heart disease had a higher trigger irrespective of the primary indication for transfusion and received significantly more units per transfusion event. Patients receiving a transfusion had significantly longer ICU stay and hospital mortality. CONCLUSIONS: Our study showed that evidence-practice gaps continue to exist, and it appears that physician behavior is mainly driven by the absolute level of hemoglobin. Educational interventions focused on these factors are required to limit the widespread and often unnecessary use of this scarce and potentially harmful resource.

Disociación entre atribución de discapacidad explícita e implícita hacia adultos mayores en estudiantes de psicología / Dissociation between psychology student's implicit and explicit disability atribution to elders

Los adultos mayores son objeto de estereotipos negativos que pueden explorarse por medidas explícitas e implícitas. Dado que existen discrepancias entre ambas, es conveniente combinarlas. Son escasos los estudios sobre atribución de discapacidad hacia adultos mayores por parte de jóvenes en el ámbito educativo. El objetivo del estudio que se informa fue evaluar si existe una disociación entre las medidas implícitas y explícitas de atribución de discapacidad hacia adultos mayores en una cohorte de estudiantes de la Carrera de Psicología. Las actitudes explícitas se estudiaron con el Test de Evaluación de Actitudes hacia Adultos Mayores (EVAAM) y las implícitas, con un test de asociación implícita (TAI) en relación con categorías de capacidad / discapacidad, en combinaciones congruentes e incongruentes. Se correlacionaron ambas pruebas para verificar el grado de disociación entre ellos. Como resultado se observó que en el TAI, la combinación incongruente (capacidad + vejez) tuvo mayor tamaño de efecto implícito que la congruente (capacidad + juventud), demostrando la existencia de una atribución automática de discapacidad hacia adultos mayores. Los valores para la escala explícita fueron mejores y no correlacionaron con el TAI. Así se concluye que los adultos mayores reciben una atribución automática de discapacidad por parte de los estudiantes de Psicología, que no coincide con su preferencia explícita. Esto podría deberse a la intención de agradabilidad de los jóvenes, a la falta de introspección sobre representaciones implícitas o a una independencia de las representaciones explícitas e implícitas. Queda por considerar si las atribuciones implícitas y explícitas forman diferentes constructos, o son parte de uno solo, con valores positivos en el polo voluntario y negativos en el involuntario.

Negative attributions toward elders are a paramount feature creating an unfavorable trait which manifests itself as stereotypes and discriminatory behaviors. This turns to be more critical when those misattributions are covertly distributed in the general population. Negative attributions toward elders are greater than younger when comparing both groups, and are dependent on several factors such as amount of information provided, coherence of the data, age and even the year when the search was carried on, as recent studies show less differences between elders and young attributions compared with older ones, particularly on explicit measures. Probably this reflects the more acceptability and tolerance exhibited by new cohorts toward different social groups in such areas as ethnics, religion or sexuality. It is obvious that elders stereotypes must be explored using not only explicit but also implicit measures, which reveal more clearly automatic associations and attributions toward key social groups. As there are sound differences between both kinds of assessments, combination is highly recommended. There are few studies that have accomplished the investigation of disability attribution toward elders by young subjects in the field of Education using Implicit Association Tests (IAT). This may prove useful as ageism exists in the Psychology Career Programs, being studies about elders under-represented in the programs contents. Objectives: To evaluate whether dissociation between implicit and explicit disability attribution measures exists in a cohort of young university psychology students. Methods and instruments: 210 subjects were included in the study (121 female and 89 men), who were recruited from students attending regular courses at the Faculty of Psychology on the city of Rosario (Argentina), aged from 24 to 29-year-old. Implicit attributions were assessed with the IAT that measures automatic association's strength between two core concepts (in the present study abilities /disabilities) and the two poles of an evaluative dimension (elderhood / youth). Stimulus are displayed on a computer screen and the subject has to associate core concept and attribute dimension faster when both are of equal valence (shorter latency). Subjects holding strong association between disability and elderhood have faster responses when those share the same key that has to be pressed to accomplish a valid answer. Latency spread between congruent (ability / youth) and incongruent (ability / elderhood) associations is accounted for the automatic strength of the implicit effect. Explicit attitudes were studied with the Attitudes toward Elders Evaluation Test and implicit ones using the Implicit Association Test with ability / disability categories in congruent and incongruent combinations. Both tests were correlated to disclose any dissociation between them. Dependent variable to measure implicit attitudes was the value of d which represents the size of the implicit effect between congruent and incongruent condition. A 2 (cate gories) x 2 (attributes) x 2 (dimensions) matrix was used, and independent variables were rotated between participants. Valence of attributes ranged from positive to negative and were associated with categories using as control factor the order of task congruence (block 3 congruent and block 6 incongruent). Dependent variable for explicit attitudes was the overall mean answers of the EVAAM (Adult Evaluation Scale). Results: In the IAT, the incongruent combination (ability old age) had a greater implicit size effect than the congruent one (ability youth), showing the existence of an automatic disability attribution toward elders. Results in the explicit scale were better and didn't correlate with IAT. Conclusions: Elders receive a Psychology student's automatic disability attribution, which doesn't match their explicit preference. This may be due to young students' agreeability intention, lack of introspection on implicit representations, or explicit and implicit representations independence. It remains to be investigated whether explicit and implicit attributions belong to different constructs or to only one, with positive values in the voluntary pole and negative values in the involuntary pole.

[Resolving real dilemmas in the elderly. A comparative study in an Argentinian community]. / Resolución de dilemas reales en adultos mayores. Estudio comparativo en una comunidad argentina.

OBJECTIVES: To assess whether the differences in making decisions in real dilemmas between the institutionalised elderly and those living in the community are dependent on the context and life history, as well as on its development and subject matter. METHODS: Qualitative and cross-sectional study on resolving real life dilemmas using interviews and story life. Two groups were assessed, each one with 40 elderly participants aged 65 and over, one group who lived in the community and attended a Retirement Centre, and the other group living in a Long term Care Facility, in Rosario (Argentina). Answers to dilemmas in hypothetical and real contexts were assessed and were mainly about family, politics, welfare, support, authority, personal coherence and life satisfaction topics. RESULTS: Most of those residing in the Long Term Care Facility reached a conventional stage of moral reasoning, and the main topics were family, support and socio-political issues. Those living in the community reached conventional and post-conventional stages and the main topics were authority, personal coherence, and family, the latter with a negative trend. Social conditions and experience had a great influence on those living in the community and isolation in those living in Care Facilities. CONCLUSIONS: a) Moral reasoning depends on life contexts, b) it is not stereotyped, c) this knowledge must be incorporated into adult education programs in order to understand their developments from their own point of view and d) obtain a commitment from the rest of the society towards integration of the elderly, accepting their ethical postures even if these do not match current thinking.

Risk of late-onset hypogonadism (andropause) in Brazilian men over 50 years of age with osteoporosis: usefulness of screening questionnaires / Risco relativo de hipogonadismo tardio (andropausa) em brasileiros com mais de 50 anos com osteoporose e a utilidade de questionários de triagem

OBJECTIVE: To analyze the relative risk of late-onset hypogonadism in men with osteoporosis and the usefulness of screening questionnaires. METHODS: We correlated the Aging Male's Symptoms (AMS), Androgen Deficiency in Aging Male (ADAM) and International Index of Erectile Function (IIEF-5) questionnaires and the laboratory diagnosis of hypogonadism in 216 men aged 50-84 years (110 with osteoporosis and 106 with normal bone density, paired by age and ethnicity). RESULTS: Hypogonadism presented in 25 percent of the osteoporotic and in 12.2 percent of normal bone density men (OR 2.08; IC95 percent: 1.14-3.79) and was associated with ADAM first question (low libido, p=0.013). Levels of TT below 400 ng/dl correlated with an AMS score above 26 (p=0.0278). IIEF-5 showed no correlation with testosterone levels. CONCLUSION: Hypogonadism was 2.08 times more prevalent in osteoporotic men. The symptom that best correlated with late-onset hypogonadism was low libido (ADAM 1 positive).

OBJETIVOS: Avaliar o risco relativo de hipogonadismo tardio em homens com osteoporose e a utilidade de questionários de triagem. MÉTODOS: Correlacionamos a pontuação dos questionários Aging Male's Symptoms (AMS), Androgen Deficiency of the Aging Male (ADAM) e International Index of Erectile Function (IIEF-5) com dosagens de testosteronas em 216 homens entre 50 e 84 anos (110 com osteoporose e 106 com densidade óssea normal, pareados por idade e etnia). RESULTADOS: Hipogonadismo ocorreu em 25 por cento dos osteoporóticos e em 12,2 por cento dos com densidade óssea normal (RR 2,08; IC95 por cento: 1,143,79) e esteve associado à pergunta 1 do ADAM (diminuição de libido, p = 0,013). Testosterona total < 400 ng/dL associou-se a AMS > 26 (p = 0,0278). Disfunção erétil, avaliada pelo IIEF-5, não se correlacionou com dosagens de testosteronas. CONCLUSÃO: Hipogonadismo foi 2,08 vezes mais prevalente em homens com osteoporose e esteve associado à diminuição da libido (ADAM 1 positivo).