Internal Versus External Frame of Reference in Functional Movement Disorders.

OBJECTIVE: The purpose of this study was to determine whether patients with functional movement disorders (FMDs) differ in their internal versus external locus of control (LOC) and whether LOC in these patients affected disease severity, quality of life, and functional impairment compared with control subjects with degenerative (Parkinson's disease) and nondegenerative (focal dystonia) neurological conditions. METHODS: A total of 156 patients with FMD (N=45), Parkinson's disease (N=64), and focal dystonia (N=47) were recruited between June 2015 and August 2017. The authors administered the general Levenson Multidimensional LOC (LOC-G) and health-specific Multidimensional Health LOC (LOC-H) scales. An internal LOC was represented similarly in both scales: the external LOC included "chance" and "powerful others" in the LOC-G measure and chance, "other people," and "doctors" in the LOC-H measure. Quality of life, functional impairment, and FMD severity were assessed. One-way analysis of variance and adjusted logistic regressions were used, as well as ordinary least-squares between and within groups, respectively. RESULTS: Patients with FMD had lower external chance LOC-G scores compared with patients in the Parkinson's disease group (odds ratio=0.90, p=0.03) and higher internal (odds ratio=1.22, p=0.01) and lower external (odds ratio=0.77, p=0.02) doctors LOC-H scores compared with patients in the focal dystonia group. External powerful others LOC-G score was associated with functional impairment (regression coefficient=-0.04, p=0.02). There were no effects of LOC on quality of life or disease severity. CONCLUSIONS: Patients with FMD exhibited high "within our control" internal general and health-specific frame of reference. LOC had no influence on quality of life or disease severity in this patient population.

Level of acceptance of solid organ xenotransplantation among personnel in Spanish, Mexican, and Cuban hospitals.

BACKGROUND: Xenotransplantation is still a long way from becoming a clinical reality. However, in an emergency situation, it could be used as a bridge for replacing vital organs until the arrival of a human organ. To analyze the attitude toward xenotransplantation among hospital personnel from several hospitals in Spain and Latin America. METHODS: A random sample stratified according to the type of hospital and job category (n = 2618) in 10 hospitals in three different countries: Spain (n = 821), Mexico (n = 1595), and Cuba (n = 202). A validated questionnaire (PCID-XenoTx Rios) was self-administered and completed anonymously by the respondents. RESULTS: If the results of xenotransplantation were similar to those achieved using human donor organs, 61% (n = 1591) of the respondents would be in favor, while 9% (n = 234) would be against and 30% (n = 793) would be unsure. The analysis of the variables affecting attitude toward xenotransplantation revealed that attitude varied according to the country of reference and was more favorable among personnel in Cuban hospitals (70% a favor) than in Spanish (57%) and Mexican ones (62%; P = 0.000). However, these differences are mainly determined by job category with the physicians having the most favorable attitude. The ancillary staff, in contrast, had the least favorable attitude (76 vs. 51% respectively; P = 0.000). Of the remaining variables, attitude is significantly related to variables connected to human donation: attitude toward the different kinds of human organ donation (deceased [P < 0.001] and living [P < 0.001]), the possibility of needing a transplant oneself in the future (P < 0.001), and attitude toward donating the organs of a deceased family member (P = 0.004). CONCLUSIONS: A third of healthcare personnel from several hospitals are not in favor of xenotransplantation. It is necessary to provide more information about the matter, especially in hospitals where there is a preclinical xenotransplantation program or where there is access to one, such as in the hospitals in this study.

The attitude toward living kidney donation among personnel from units related to donation and transplantation in Spain, Mexico and Cuba.

BACKGROUND: Living kidney donation (LKD) is becoming increasingly necessary as a treatment option for reducing the deficit in transplant organs. Hospital personnel in services related to donation and transplantation play a key role in promoting this kind of donation. OBJECTIVE: To analyze the attitude toward LKD among hospital workers in services related to donation and transplantation in Spain and Latin America. METHODS: Eight hospitals in the "International Collaborative Donor Project" were selected (Spain-Mexico-Cuba). A random sample was taken which was stratified according to the type of service and job category, in transplant-related services. RESULTS: Of the 878 respondents, 90% were in favor of related LKD, and 28% were in favor if the LKD was not related. Attitude was more favorable among Latin Americans workers compared to the Spanish (p=0.014). Other factors associated to attitude included: age (p=0.004); an attitude in favor of deceased donation and living liver donation (p<0.001); and acceptance of a kidney from a donor (p<0.001). CONCLUSIONS: The attitude toward related LKD was very favorable among hospital personnel in units related to the donation and transplantation process in Spain and Latin America, which means that they could contribute to its promotion particularly at the current time when living kidney donation needs to be expanded.

[Current genetic issues and phenotypic variants in Kallmann syndrome]. / Síndrome de Kallmann. Aspectos genéticos y variantes fenotípicas.

Kallmann syndrome is characterized by hypogonadotropic hypogonadism and anosmia/hyposmia. The hypogonadotropic hypogonadism is due to deficiency of gonadotropin-releasing hormone, caused by a defect in the migration of neurons synthesizing gonadotropin-releasing hormone, and anosmia/hyposmia is related to the absence or hypoplasia of the olfactory bulb and tracts. Some patients may have other associated abnormalities such as renal agenesis, cleft palate, dental agenesis, synkinesis, shortening of metacarpal, sensory neural hearing loss and seizures. The aim of this paper is to present an updated review of the clinical and molecular basis, highlighting the relevance of knowledge of phenotypic variants in Kallmann syndrome.

Movement Disorders in Prionopathies: A Systematic Review.

Background: Movement disorders are frequent features of prionopathies. However, their prevalence and onset remain poorly described. Methods: We performed a systematic review of case reports and case series of pathologically- and genetically confirmed prionopathies. Timing of symptom and movement disorder onset were documented. Continuous variables were compared between two groups using the Wilcoxon rank sum test and between multiple groups using Kruskal-Wallis test. Categorical variables were compared using Fisher's exact test. Results: A total of 324 cases were included in this analysis. Movement disorders were a common feature at the onset of symptoms in most prionopathies. Gait ataxia was present in more than half of cases in all types of prionopathies. The prevalence of limb ataxia (20%) and myoclonus (24%) was lower in Gerstmann-Sträussler-Scheinker disease compared to other prionopathies (p ≤ 0.004). Myoclonus was common but often a later feature in sporadic Creutzfeldt-Jakob disease (2 months before death). Chorea was uncommon but disproportionately prevalent in variant Creutzfeldt-Jakob disease (30% of cases; p < 0.001). In genetic Creutzfeldt-Jakob disease, E200K PRNP carriers exhibited gait and limb ataxia more often when compared to other mutation carriers. Discussion: Movement disorders are differentially present in the course of the various prionopathies. The movement phenomenology and appearance are associated with the type of prion disease and the PRNP genotype and likely reflect the underlying pattern of neurodegeneration. Reliance on myoclonus as a diagnostic feature of sporadic Creutzfeldt-Jakob disease may delay its recognition given its relatively late appearance in the disease course.

Huntington's disease-like disorders in Latin America and the Caribbean.

Diseases with a choreic phenotype can be due to a variety of genetic etiologies. As testing for Huntington's disease (HD) becomes more available in previously resource-limited regions, it is becoming apparent that there are patients in these areas with other rare genetic conditions which cause an HD-like phenotype. Documentation of the presence of these conditions is important in order to provide appropriate diagnostic and clinical care for these populations. Information for this article was gathered in two ways; the literature was surveyed for publications reporting a variety of genetic choreic disorders, and movement disorders specialists from countries in Latin America and the Caribbean were contacted regarding their experiences with chorea of genetic etiology. Here we discuss the availability of molecular diagnostics for HD and for other choreic disorders, along with a summary of the published reports of affected subjects, and authors' personal experiences from the regions. While rare, patients affected by non-HD genetic choreas are evidently present in Latin America and the Caribbean. HD-like 2 is particularly prevalent in countries where the population has African ancestry. The incidence of other conditions is likely determined by other variations in ethnic background and settlement patterns. As genetic resources and awareness of these disorders improve, more patients are likely to be identified, and have the potential to benefit from education, support, and ultimately molecular therapies.

Prevalence, resistance patterns, and risk factors for antimicrobial resistance in bacteria from retail chicken meat in Colombia.

As a step toward implementing the Colombian Integrated Program for Antimicrobial Resistance Surveillance (COIPARS), this study aimed to establish the baseline antimicrobial resistance patterns of Salmonella serovars, Escherichia coli, and Enterococcus spp. isolates in retail poultry meat from independent stores and from a main chain distributor center. MICs of the isolates were determined for antimicrobials used both in humans and animals, using an automated system. Salmonella serovars were isolated from 26% of the meat samples and E. coli from 83%, whereas Enterococcus faecalis and Enterococcus faecium were detected in 81 and 13% of the meat samples, respectively. A principal finding of concern in this study was that almost 98% of isolates tested were multidrug resistant. Ceftiofur, enrofloxacin, nalidixic acid, and tetracycline were the antimicrobials that showed the highest frequency of resistance among Salmonella and E. coli isolates. For enterococci, 61.5% of E. faecium isolates were found to be resistant to quinupristin-dalfopristin; this is significant because it is used to treat nosocomial infections when vancomycin resistance is present. Vancomycin resistance was detected in 4% of the E. faecalis isolates. The results of our study highlight the need for rapid implementation of an integrated program for surveillance of antimicrobial resistance by the Colombian authorities in order to monitor trends, raise awareness, and help promote practices to safeguard later generation antimicrobial agents.

Molecular characterization of Salmonella paratyphi B dT+ and Salmonella Heidelberg from poultry and retail chicken meat in Colombia by pulsed-field gel electrophoresis.

Salmonella Paratyphi B dT+ variant (also termed Salmonella Java) and Salmonella Heidelberg are pathogens of public health importance that are frequently isolated from poultry. As a step toward implementing the Colombian Integrated Program for Antimicrobial Resistant Surveillance, this study characterized molecular patterns of Salmonella Paratyphi B dT+ and Salmonella Heidelberg isolated from poultry farms, fecal samples, and retail chicken meat using pulsed-field gel electrophoresis (PFGE). The objective of this study was to determine the genetic relationship among isolates and to determine potential geographically predominant genotypes. Based on PFGE analysis, both serovars exhibited high heterogeneity: the chromosomal DNA fingerprints of 82 Salmonella Paratyphi B dT+ isolates revealed 42 PFGE patterns, whereas the 21 isolates of Salmonella Heidelberg revealed 10 patterns. Similar genotypes of both serovars were demonstrated to be present on farms and in retail outlets. For Salmonella Paratyphi B dT+, closely genetically related strains were found among isolates coming from different farms and different integrated poultry companies within two departments (Santander and Cundinamarca) and also from farms located in the two geographically distant departments. For Salmonella Heidelberg, there were fewer farms with genetically related isolates than for Salmonella Paratyphi B dT+. A possible dissemination of similar genotypes of both serovars along the poultry production chain is hypothesized, and some facilitating factors existing in Colombia are reviewed.

[Terminology in clinical bioethics]. / Terminología en bioética clínica.

In this article some of the most relevant terms in clinical bioethics are defined. The terms were chosen based on three criteria: impact on the most important problems in clinical bioethics, difficulty in understanding, and need to clarify their meaning. For a better understanding, the terms were grouped into 5 areas: general concepts (conflict of values, deliberation, conflict of interest, conscientious objection); justice (justice, distributive justice, models of justice, triage); clinical matters (information, competency, capability, informed consent, mature minor, coercion, secrecy, privacy, confidentiality, professional secrecy); end of life (prior instructions, limitation of therapeutic efforts, professional obstinacy, futility, palliative care, palliative sedation, principle of double effect, euthanasia, assisted suicide, persistent vegetative state, minimally conscious state, locked-in syndrome, brain death), and beginning of life (assisted reproduction, genetic counseling, preimplantation genetic diagnosis).

En el artículo se definen algunos de los términos más relevantes en bioética clínica. Los términos se han escogido con base en tres criterios: repercusión en los problemas más importantes en bioética clínica, dificultad en su comprensión y necesidad de aclarar su significado. Para su mejor comprensión, los términos se han agrupado en 5 áreas temáticas: conceptos generales (conflicto de valores, deliberación, conflicto de intereses, objeción de conciencia); justicia (justicia, justicia distributiva, modelos de justicia, triage); relación clínica (información, competencia, capacidad, consentimiento informado, menor maduro, coacción, intimidad, privacidad, confidencialidad, secreto profesional); final de la vida (instrucciones previas, limitación de los esfuerzos terapéuticos, obstinación profesional, futilidad, cuidados paliativos, sedación paliativa, principio del doble efecto, eutanasia, suicidio asistido, estado vegetativo persistente, estado de mínima conciencia, síndrome de enclaustramiento, muerte encefálica), e inicio de la vida (reproducción asistida, consejo genético, diagnóstico genético preimplantacional).

Counts, serovars, and antimicrobial resistance phenotypes of Salmonella on raw chicken meat at retail in Colombia.

The objective of this study was to determine Salmonella counts, serovars, and antimicrobial-resistant phenotypes on retail raw chicken carcasses in Colombia. A total of 301 chicken carcasses were collected from six departments (one city per department) in Colombia. Samples were analyzed for Salmonella counts using the most-probable-number method as recommended by the U.S. Department of Agriculture, Food Safety Inspection Service protocol. A total of 378 isolates (268 from our previous study) were serotyped and tested for antimicrobial susceptibility. The overall Salmonella count (mean log most probable number per carcass ± 95% confidence interval) and prevalence were 2.1 (2.0 to 2.3) and 37%, respectively. There were significant differences (P < 0.05) by Salmonella levels (i.e., counts and prevalence) by storage temperature (i.e., frozen, chilled, or ambient), retail store type (wet markets, supermarkets, and independent markets), and poultry company (chicken produced by integrated or nonintegrated company). Frozen chicken had the lowest Salmonella levels compared with chicken stored at other temperatures, chickens from wet markets had higher levels than those from other retail store types, and chicken produced by integrated companies had lower levels than nonintegrated companies. Thirty-one Salmonella serovars were identified among 378 isolates, with Salmonella Paratyphi B tartrate-positive (i.e., Salmonella Paratyphi B dT+) the most prevalent (44.7%), followed by Heidelberg (19%), Enteritidis (17.7%), Typhimurium (5.3%), and Anatum (2.1%). Of all the Salmonella isolates, 35.2% were resistant to 1 to 5 antimicrobial agents, 24.6% to 6 to 10, and 33.9% to 11 to 15. Among all the serovars obtained, Salmonella Paratyphi B dT+ and Salmonella Heidelberg were the most antimicrobial resistant. Salmonella prevalence was determined to be high, whereas cell numbers were relatively low. These data can be used in developing risk assessment models for preventing the transmission of Salmonella from chicken to humans in Colombia.

Opinion toward living liver donation of hospital personnel from units related to organ donation and transplantation: a multicenter study from Spain and latin-america.

BACKGROUND: Hospital personnel of services related to donation and transplantation process play a fundamental role in the development of transplantation. OBJECTIVES: The aim of this study was to investigate the attitude toward living liver donation (LLD) among hospital personnel from services related to donation and transplantation in hospital centers in Spain and Latin America. MATERIALS AND METHODS: Eight hospitals within the "International Donor Collaborative Project" were selected, three in Spain, three in Mexico and two in Cuba. The study was performed in transplant-related services, using a randomized sample, which was stratified by the type of service and job category. RESULTS: In total, 878 workers were surveyed of which 82% (n = 720) were in favor of related LLD, 10% (n = 90) were against and 8% (n = 68) undecided. Attitudes toward related LLD were more favorable in the following groups: the Latin Americans (86% in favor vs. 77% among the Spanish; P = 0.007); younger people (37 vs. 40 years, P = 0.002); those in favor of either deceased donation (P < 0.001) or living kidney donation (P < 0.001); those who believed that they might need a transplant in the future (P < 0.001); those who would accept a liver from a living donor (P < 0.001); those who discussed the subject of donation and transplantation with their families (P = 0.040); and those whose partner was in favor of donation and transplantation (P = 0.044). CONCLUSIONS: Personnel from donation and transplantation-related units had a favorable attitude toward LLD. This attitude was not affected by psychosocial factors, although it was influenced by factors directly and indirectly related to the donation and transplantation process.

Knowledge of the brain death concept by personnel in Spanish and Latin-American healthcare centers.

BACKGROUND: The knowledge and acceptance of the concept of brain death (BD) among health care personnel is fundamental. OBJECTIVE: To analyze the level of understanding of the BD concept among personnel in Spanish and Latin American healthcare centers and to determine the factors affecting this attitude. MATERIAL AND METHODS: Data from 12 hospitals and 32 primary care centers in 4 countries within the International Collaborative Donor Project were selected (Spain, Mexico, Cuba and Costa Rica (n=4378)). RESULTS: 62% of the personnel (n=2714) understood BD and believed that this was the death of an individual. Of the rest, 30% (n=1333) did not understand it and the remaining 8% (n=331) believed it did not mean the death of a patient. 83% (n=931) of physicians understood BD, compared to 75% (n=895) of nurses, 55% (n=299) of healthcare assistants, 53% (n=108) of non-healthcare university-educated personnel and 36% (n=481) of those without a university education (p<0.001). 68% (n=1084) of Mexicans understood BD compared to 66% (n=134) of Cubans, 58% (n=1411) of Spaniards, and 52% (n=85) (p<0.001) of Costa Ricans. There were significant relationships between knowledge of the concept and the following: type of healthcare center (p<0.001), clinical service (p<0.001), having spoken about organ donation within the family (p<0.001) and one's partner's attitude to the subject (p<0.001). A direct relationship has been found between understanding the concept and attitude toward deceased donation (p<0.001). CONCLUSIONS: The understanding of BD by personnel from healthcare centers was not as good as expected. There were marked differences depending on job category.

Asociacion entre el nivel de fibrinogeno y severidad en la hemorragia posparto / Association between fibrinogen levels and the severity of postpartum haemorrhage

Objective: To determine if the level of fibrinogen at the onset of postpartum haemorrhage is associated with bleeding severity and a higher number of complications; to determine outcome-related cut-off points. Materials and methods: Secondary analysis of a cohort study conducted with 79 mothers admitted to the Intensive Care Unit between February 1st, 2012 and January 31st, 2013, with a diagnosis of postpartum haemorrhage, defined as all cases of blood loss greater than 1000 mL. Fibrinogen levels were measured at the onset of the postpartum haemorrhage. Fibrinogen values were compared between patients with severe obstetric bleeding and those with mild-to-moderate bleeding, in order to establish the correlation with severity of blood loss and complications. Results: Overall, 24.1% of the patients showed severe postpartum haemorrhage compared to 75.9% of the patients classified as having mild-to-moderate haemorrhage. There were 12 complications (15.2%), including 9 cases of acute renal injury, 2 cases of disseminated intravascular coagulation, and one death, all of them only in patients with severe obstetric haemorrhage. Regarding the initial fibrinogen value, the AUC-ROC for fibrinogen levels and their relationship with the severity was 0.71, with a cut-off point of <200 mg/dL to predict severity (100% positive predictive value). Conclusion: The initial fibrinogen level in obstetric postpartum haemorrhage is a predictor of severity that helps in alerting to the need for treatment in these patients.

Objetivo: determinar si el nivel de fibrinógeno al inicio de la hemorragia posparto se asocia con la severidad del sangrado y mayor número de complicaciones; además definir los puntos de corte que se relacionan con el desenlace. Materiales y métodos: análisis secundario de un estudio de cohortes realizado en 79 madres que ingresaron con diagnóstico de hemorragia posparto, definido como todo sangrado mayor de 1000 mL, a la Unidad de Cuidados Intensivos entre el 1 de febrero de 2012 al 31 de enero de 2013. Los niveles de fibrinógeno se realizaron al inicio de la hemorragia posparto. Se comparó el valor de fibrinógeno entre las pacientes que presentaron hemorragia obstétrica severa contra las hemorragias obstétricas leve-moderada, y de esta forma se correlaciona el valor del fibrinógeno con la severidad de la hemorragia y las complicaciones presentadas en las pacientes. Resultados: el 24,1% de las pacientes presentaron hemorragia posparto severa y se comparó contra el 75,9% de las pacientes clasificadas como leve y moderada. Se presentaron 12 complicaciones (15,2%), 9 fueron injuria renal aguda, 2 coagulación intravascular diseminada y muerte en 1 paciente, sólo en las pacientes con hemorragia obstétrica severa. En cuanto al nivel inicial de fibrinógeno, el AUC-ROC para el valor de fibrinógeno y su relación con severidad fue de 0,71 con un punto de corte < 200 mg/dL para predecir severidad (valor predictivo positivo 100%) Conclusión: el nivel de fibrinógeno inicial en hemorragia obstétrica posparto es un predictor de severidad que ayuda a alertar el tratamiento en estas pacientes.

La reproducción zootécnica desde una nueva ética naturalista (neovitalismo) y la bioética como ciencia de la supervivencia: el caso bovino / Zootechnical reproduction from a new naturalistic ethics (neovitalism) and bioethics as

En la Medicina Veterinaria, la supervivencia de los animales es el norte funcional para cumplir con su objetivo profesional. Eventos secundarios como permitir la alimentación o la compañía son el resultado de las acciones que logran la primera meta. En este artículo se postula que la máxima obligación de todo conocimiento o acción humana (Supraimperativo Categórico) es el cuidado de la vida incluyendo la animal. Ese planteamiento es antítesis para la Ética Utilitarista sobre la cual se ha basado la progresiva explotación y cosificación del ser vivo animal disminuyendo sus posibilidades de supervivencia. Una correlación biopolítica de la dinámica poblacional humana y bovina es presentada contradiciendo posturas culturales nocivas para la simbiosis entre especies. El presente análisis bioético reivindica una reformulación del vitalismo aristotélico y a los bovinos como merecedores de un trato más sabio a partir del ser humano. La figura metafísica del templo como lugar de respeto donde reside la vida es usada a lo largo del artículo...

Reflexión general en torno a bioética clínica animal y presentación del término zooética / Baseline overview recarding Clinical Animal Bioethics and Introduction of the term Zooethics

La bioética es un campo del conocimiento constituido en diálogo de saberes. Sin embargo, para el caso del análisis sobre los hechos y costumbres del humano en relación con el ser animal, la ausencia de la práctica clínica veterinaria es notoria. La medicina veterinaria es un interlocutor científico planamente válido para hacer aportes necesarios a una bioética demasiado humana en sus consideraciones ético-médicas. En el presente artículo, se hace un recuento de algunos de los principales autores y puntos de vista sobre lo que ha sido estructurada la bioética animal, reflexionando sobre la necesidad de abordar el tema clínico. Es propuesto el término zooética como concepto que incluya los estudios éticos sobre la vivencia del animal en la bioética. Se hace un llamado a recordar la historia, la medicina de los animales, la espiritualidad, y los médicos veterinarios como profesionales a quienes más les preocupa el animal, diariamente conocido, como ser que siente e interactúa en la sociedad...