Protective HLA alleles against severe COVID-19: HLA-A*68 as an ancestral protection allele in Tapachula-Chiapas, Mexico.

HLA is a polymorphic antigen presenter which has provided valuable information on the susceptibility of populations to viruses. Therefore, the study of HLA can reveal specific susceptibility or resistance alleles to severe COVID-19 in an ethnically dependent manner. This pilot study investigated HLA alleles associated with COVID-19 severity in Tapachula, Chiapas, Mexico. A total of 146 Mexican Mestizos were typed for HLA class I and II using PCR-SSP. The patients were classified according to the outcome (death or improvement) and the infection's severity (mild or severe). In addition, a group of exposed uninfected individuals was included. HLA-A*68 was found to be a protective allele against the severe infection and fatal outcome; pC = 0.03, OR = 0.4, 95% CI =0.20-0.86, and pC =0.009, OR = 0.3, 95% CI =0.13-0.71 respectively. HLA-DRB1*03 also appears to be a protective factor against fatal outcome pC = 0.009, OR = 0.1, 95%IC = 0.01-0.66; however, the low frequency of this allele in the studied population limits the statistical power. The severity and fatal outcome of COVID-19 patients in Tapachula, Chiapas depend more on the lack of resistance than susceptibility HLA alleles.

Translation, adaptation, and reliability of the Stanford Integrated Psychosocial Assessment for Transplantation in the Spanish population.

BACKGROUND: Psychosocial risk factors influence the course of transplantation. Psychosocial evaluation is an important part of pre-transplantation evaluation processes, yet there are no standardized instruments in Spanish. OBJECTIVE: To translate, adapt, and test the reliability of the Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) in organ and cell transplantation patients in the Spanish context. METHOD: A Spanish version was developed and adapted using WHO's guidelines. The first 30 candidates' SIPAT interviews were recorded and scored by four independent examiners to test the inter-rater reliability. The internal consistency of the SIPAT items was calculated with a sample of 150 heart, liver, and allogeneic haematopoietic stem cell transplant candidates. Evaluations were conducted by SIPAT-trained and transplantation-experienced clinical psychologists and psychiatrists. RESULTS: Stanford Integrated Psychosocial Assessment for Transplantation achieved excellent intra-class correlation reliability coefficients between investigators (ICC = 0.93 for the general score and from 0.77 to 0.94 for domain scores). Good internal consistency was found with Cronbach's alpha of 0.84 (from 0.69-0.71 for domains). DISCUSSION: This study presents the translated and adapted version of SIPAT. It has been found to have strong inter-rater reliability and good internal consistency. Further research is needed to confirm reliability (eg, test-retest) and establish its validity (eg, concurrent, predictive).

Psychotic disorders versus other psychiatric diagnoses in consultation-liaison psychiatry: 10 years of a single-center experience.

INTRODUCTION: The clinical management of patients with psychotic disorders (PDs) can be particularly complex if it takes place in the context of consultation-liaison psychiatry (CLP) services within a general hospital. However, there are few studies specifically investigating the acute treatment procedures for these patients in CLP settings. OBJECTIVES: To examine the characteristics of a sample of inpatients with a primary PD referred to a CLP service over a 10-year period and to compare the clinical features of this subgroup with patients with other diagnoses (ODs). MATERIALS AND METHODS: Observational and descriptive study over a 10-year period (2005-2014) assessing prospectively adult inpatients admitted to non-psychiatric units of the University Clinical Hospital of Barcelona who were consecutively referred to our CLP service. We performed a posthoc analysis to compare the clinical features between the subgroup of patients with PDs and the rest of patients who meet the criteria for ODs. RESULTS: We requested 393 consultations for patients who either already had the diagnosis of a primary PD and 9,415 for patients with ODs. Our results showed that patients with PDs were younger than the patients with ODs, had a higher prevalence of somatic illnesses related with an unhealthy lifestyle (such as infectious, endocrine, or metabolic diseases), less frequency of cancer, and a need to receive a more intensive psychiatric care. CONCLUSIONS: Inpatients with PDs referred to CLP have different clinical features compared with those who met the criteria for ODs. They are a highly complex group with specific psychiatric care needs.

Clinical profile of inpatients referred to a consultation-liaison psychiatry service: an observational study assessing changes over a 10-yearperiod.

OBJECTIVE: Previous research has described the characteristics of Consultation-liaison psychiatry (CLP) services over one or more years. The aim of this paper was to examine the patterns of a large sample of patients receiving CLP service over a 10-year-period (2005–2014) and to determine the possible changes over time of the clinical practice. The sample size of our study, the duration of the observation period and the application of standardized operating procedures for acquiring and coding data, will provide more robust evidence than has been reported by most similar studies published in the last years. METHODS: Longitudinal observational and descriptive study. Data were collected prospectively with standardized operating procedures on consecutive inpatient consultation requests to the University Clinical Hospital of Barcelona CLP service. RESULTS: 9,808 psychiatric consultation were requested (referral rate=2.2%). The referrals to our CLP service were requested mainly by medical units. The most frequent psychiatric diagnoses were alcohol-related disorders, delirium and adjustment disorders. The mean percentage of patients treated with psychopharmacologic drugs was 81.6%. The mean length of the hospital stays of patients with psychiatric comorbidity referred to our CLP service was significantly longer than that of all the admissions to the hospital during that period. Most of the studied variables remained constant over the 10-year-period. However, some somatic diagnoses at admission, reasons for referral and recommendations of psychotropic drugs presented significant changes. CONCLUSIONS: Despite the continuous evolution and changes of several factors in the last two decades, like the health care systems, the clinical practice of CLP services has been quite stable over time. However, our results support the idea of a non-static specialty.

EMDR therapy vs. supportive therapy as adjunctive treatment in trauma-exposed bipolar patients: A randomised controlled trial.

INTRODUCTION: Patients with bipolar disorder (BD) are frequently exposed to traumatic events which worsen disease course, but this study is the first multicentre randomised controlled trial to test the efficacy of a trauma-focused adjunctive psychotherapy in reducing BD affective relapse rates. MATERIALS AND METHODS: This multicentre randomised controlled trial included 77 patients with BD and current trauma-related symptoms. Participants were randomised to either 20 sessions of trauma-focused Eye Movement Desensitization and Reprocessing (EMDR) therapy for BD, or 20 sessions of supportive therapy (ST). The primary outcome was relapse rates over 24-months, and secondary outcomes were improvements in affective and trauma symptoms, general functioning, and cognitive impairment, assessed at baseline, post-treatment, and at 12- and 24-month follow-up. The trial was registered prior to starting enrolment in clinical trials (NCT02634372) and carried out in accordance with CONSORT guidelines. RESULTS: There was no significant difference between treatment conditions in terms of relapse rates either with or without hospitalisation. EMDR was significantly superior to ST at the 12-month follow up in terms of reducing depressive symptoms (p=0.0006, d=0.969), manic symptoms (p=0.027, d=0.513), and improving functioning (p=0.038, d=0.486). There was no significant difference in dropout between treatment arms. CONCLUSIONS: Although the primary efficacy criterion was not met in the current study, trauma-focused EMDR was superior to ST in reducing of affective symptoms and improvement of functioning, with benefits maintained at six months following the end of treatment. Both EMDR and ST reduced trauma symptoms as compared to baseline, possibly due to a shared benefit of psychotherapy. Importantly, focusing on traumatic events did not increase relapses or dropouts, suggesting psychological trauma can safely be addressed in a BD population using this protocol.

Psychogenic non-epileptic seizures: a case report.

Psychogenic Non-Epileptic Seizures (PNES) are paroxysmal episodes of altered behavior that superficially resemble epileptic seizures but lack both the expected electroencephalographical epileptic changes and the association to dysfunction of central nervous system. They account for 17 to 30% of the population admitted to epilepsy units of tertiary hospitals for evaluation of seizures refractory to the pharmacological treatment. These episodes include most of the paroxysmal non-epileptic events and diverse studies have found a high prevalence of multiple psychiatric disorders during the lifetime. The simultaneous presence of 2 or more psychiatric disorders has even been observed in 70% of the patients. When there is evidence on the absence of real epileptic seizures, the first step is to slowly suppress the antiepileptic treatment. After, adequate psychopharmacological treatment should be initiated in relationship with the psychopathological state of the patient. The different emotional and psychological variables that may be affecting the appearance and perpetuation of PNES must be identified and then resolved with psychological treatment. The aim of the present case report is to present the difficulties of differential diagnosis between epilepsy and PNES, emphasizing the great importance of both neurological and psychiatric management in the treatment of these clinical symptoms.

Conocimiento de bioética en personal de salud en un hospital de tercer nivel de atención / Knowledge of bioethics in health care workers in a tertiary care hospital

Resumen Objetivo: Identificar el nivel de conocimiento sobre bioética en el personal salud que labora en un hospital de tercer nivel de atención, para que los dilemas bioéticos se turnen al Comité Hospitalario de Bioética. Materiales y Métodos: Se realizó un estudio descriptivo, transversal y prospectivo. Mediante un muestreo probabilístico por estratos, se calculó el tamaño de muestra para una población finita n=302 con un 95% de nivel de confianza, se realizó una visita a las áreas por turnos, se aplicó un cuestionario obtenido de 2 cuestionarios validados por Lynch y cols, y Hernández y cols. Dentro de las consideraciones éticas se aplicó un consentimiento informado previo a contestar el cuestionario. Se realizó un análisis estadístico descriptivo. Resultados: Los principios bioéticos que revisa el cuestionario son: Autonomía la cual fue identificada de manera correcta en 17.2%, Justicia en 10.3% y Los principios bioéticos que revisa el cuestionario son: Autonomía la cual fue identificada de manera correcta en 17.2%, Justicia en 10.3% y Beneficencia en 14.6%. Con respecto al nivel de conocimiento se encontró un2% de conocimiento alto, 33% de conocimiento regular, 33% de conocimiento bajo y 32% de conocimiento nulo. Conclusiones: Todos los días se presentan dilemas éticos, el identificarse de manera adecuada por el personal de salud y canalizarlos al Comité Hospitalario de Bioética sería el ideal de todo hospital que permitiría coadyuvar de manera adecuada en una mejor toma de decisiones en la atención al paciente.

Abstract Objective: Identify the level of knowledge about Bioethics in the health care workers in a third level hospital, so that the bioethical dilemmas turn to the Hospital Committee of Bioethics. Materials and Methods A descriptive, cross-sectional and prospective study was conducted. By means of a probabilistic sampling by strata, the sample size was calculated for a finite population n = 302 with a 95% confidence level, a visit to the areas was made in shifts, a questionnaire obtained from 2 questionnaires validated by Lynch et al., and Hernández et al. was applied. Within the ethical considerations, a prior informed consent was applied to answer the questionnaire. A descriptive statistical analysis was performed. Results: The bioethical principles that the questionnaire reviews are autonomy which was correctly identified in 17.2%, justice in 10.3%and charity in 14.6%. With respect to the level of knowledge, a 2% high knowledge, 33% regular knowledge, 33% knowledge low and 32% of null knowledge was found. Conclusions: Ethical dilemmas are presented every day, identifying properly by health care workers and channeling them to the Bioethics Hospital Committee would be the ideal of every hospital that would allow us to properly contribute toa better decision -making in patient care.

Electrophysiological mechanisms of action of electroconvulsive therapy.

In spite of the guidelines and consensus on its indications and application, electroconvulsive therapy (ECT) continues to be one of the therapeutic procedures with less knowledge on its mechanism of action. It is interesting to evaluate the way in which the factors that modulate the convulsant activity can be modified by this therapy and its relation with the therapeutic effect. The aim of the present article is to review, in the context of neurobiological theories, the bibliography regarding the electrophysiological mechanisms of action of ECT, mainly the anticonvulsant hypothesis. Having better knowledge about these mechanisms can achieve an improvement in the clinical practice and provide a starting point to search for alternative treatments based on the same physical bases. After doing a study of all the papers and reference books, those works which, according to their methodology and design, provide relevant scientific information with regard to the principal topic of this review and that have been published between 1993 and 2007 were selected. In order to provide better consistency to the text, a series of articles prior to 1993 that were considered important within the setting studied have been included, since they establish the theoretical bases of ECT and have been frequently mentioned after their sublication. The scientific evidence obtained is systematized into three sections: basic concepts, neurophysiological hypotheses and electrophysiological findings.

Evaluación de un método de análisis de plomo y cadmio en aguas por espectrometría de absorción atómica empleando extracción con disolvente / Evaluation of a method for the analysis of lead and cadmium in waters by atomic absorption spectrometry

Se comprobó la validez de un método para la determinación de plomo y cadmio en aguas por espectrometría de absorción atómica en el que se empleó extracción simultánea de ambos metales con disolvente (dietilditiocarbamato de sodio y cloroformo). Se compararon los resultados con un método de referencia. Se reportaron los datos referentes a precisión, recuperación y sensibilidad para el 1 % de absorción y límite de detección. El método resulta más económico que los normalizados internacionalmente a estos fines y es aplicable al control sanitario de la calidad del agua en los centros de higiene y epidemiología del país que cuentan con el equipamiento necesario

Evaluación de un método para la determinación de cromo en orina por espectrometría de absorción atómica / Evaluation of a method for the determination of chromium in urine by atomic absorption spectrometry

Se propone un método para la determinación de cromo en orina por espectrometría de absorción atómica empleando la atomización electrotérmica con cubetas de grafito pirolítico. Las determinaciones se realizan por adición de estándar. El método es aplicable al monitoreo biológico de poblaciones con diferentes grados de exposición. Se utiliza, además, en el análisis de cromo en sedimentos. Se presentan resultados de cromo en orina de un grupo poblacional no expuesto al metal

Método espectrométrico de absorción atómica sin llama para determinación de mercurio en aguas naturales / Flameless atomic absorption spectrometric method for the determination of mercury in natural water

Se efectúa la evaluación de un método de espectrometría de absorción atómica empleando vapor frío con vistas a su posible utilización en el pesquisaje de la calidad del agua en los Centros de Higiene y Epidemiología del país que cuentan con el equipamiento necesario, atendiendo a la sencillez del procedimiento de digestión de la muestra. Se reportan los datos referentes a precisión, sensibilidad para el 1% de absorción, límite de detección y recuperación de mercurio orgánico e inorgánico. Se efectuó la comparación con un método normalizado internacionalmente

Evaluación sanitaria del mercurio en aguas destinadas al consumo / Sanitary evaluation of mercury in waters for human consumption

Se realizó, por primera vez en el país, una escuesta en la zona de captación de las fuentes de abastecimiento subtérraneas y superficiales de más de 5 mil habitantes para determinar los niveles de mercurio en agua y evaluarlos con referencia al valor fijado en las normas cubanas vigentes. En el 3,7 por ciento de las fuentes de abastecimiento subterráneas se detectó frecuentemente la presencia de mercurio en cifras ligeramente superiores a la norma fijada. Se encontró diferencia significativa entre las concentraciones de mercurio en cabello de 2 grupos con diferente grado de exposición a través del agua