Efficacy of anti-suppression therapy in improving binocular vision in children with small-angle Esotropia

Purpose: To evaluate the efficacy of anti-suppression exercises in children with small-angle esotropia in achieving binocular vision. Methods: A retrospective review of patients aged 3–8 years who underwent anti-suppression exercises for either monocular or alternate suppression between January 2016 and December 2021 was conducted. Patients with esotropia less than 15 prism diopters (PD) and visual acuity ≥ 6/12 were included. Patients with previous intra-ocular surgery or less than three-month follow-up were excluded. Success was defined as the development of binocular single vision (BSV) for distance, near, or both (measured clinically with either the 4 prism base out test or Worth four dot test) and maintained at two consecutive visits. Qualified success was defined as the presence of diplopia response for both distance and near. Additionally, improvement in near stereo acuity was measured using the Stereo Fly test. Results: Eighteen patients with a mean age of 5.4 ± 1.38 years (range 3–8 years) at the time of initiation of exercises were included in the study. The male female ratio was 10:8. The mean best corrected visual acuity was 0.18 LogMAR unit(s) and the mean spherical equivalent was +3.8 ± 0.14 diopters (D). The etiology of the esotropia was fully accommodative refractive esotropia (8), microtropia (1), post–operative infantile esotropia (4), partially accommodative esotropia (1), and post-operative partially accommodative esotropia (4). Patients received either office-based, home-based, or both modes of treatment for an average duration of 4.8 months (range 3–8). After therapy, BSV was achieved for either distance or near in 66.6 % of patients (95 % CI = 40.03–93.31 %). Binocular single vision for both distance and near was seen in 50 % of children. Qualified success was observed in 38.46% of patients. Persistence of suppression was observed in one patient (5.5 %)... (AU)

Índice biespectral y tasa de supresión tras parada cardiaca: ¿son útiles para individualizar planes de escalada terapéutica? / Bispectral index and suppression ratio after cardiac arrest: are they useful as bedside tools for rational treatment escalation plans?

Introducción y objetivos: La disfunción miocárdica contribuye a la mortalidad precoz (24-72 horas) de los supervivientes de parada cardiaca (PC). Actualmente, la decisión de implantar un dispositivo de soporte circulatorio en este contexto se toma con información limitada acerca del potencial de recuperación neurológica (PRN) del paciente, lo que en muchas ocasiones termina en infratratamiento. Por tanto, requerimos de herramientas accesibles y fiables que añadan información sobre el PRN y ayuden a establecer planes individualizados de escalada terapéutica. Métodos: Se recogieron valores de índice biespectral (BIS) y tasa de supresión (TS) en supervivientes de una PC sometidos a control de la temperatura corporal. La función neurológica se evaluó con la escala Cerebral Performance Category (CPC). Resultados: Se incluyeron 340 pacientes. En la primera evaluación neurológica completa, 211 (62,1%) alcanzaron buen pronóstico (CPC 1-2). Los valores de BIS fueron significativamente mayores y los de TS menores, en pacientes con CPC 1-2. Un BIS promedio> 26 en las primeras 12 horas predijo buena evolución neurológica (sensibilidad 89,5%; especificidad 75,8%; AUC=0,869), mientras que una TS promedio> 24 en las primeras 12 horas predijo mala evolución o CPC 3-5 (sensibilidad 91,5%; especificidad 81,8%; AUC=0,906). Los valores horarios de BIS/TS mostraron buena capacidad predictiva (AUC> 0,85) desde la 2.a hora para TS y 4.a para BIS. Conclusiones: El BIS/TS permiten estimar el PRN tras una PC. Este hallazgo puede contribuir a crear conciencia con respecto a evitar la limitación de escalada terapéutica en pacientes potencialmente recuperables.(AU)

Introduction and objectives: Myocardial dysfunction contributes to early mortality (24-72 hours) among survivors of a cardiac arrest (CA). The benefits of mechanical support in refractory shock should be balanced against the patient's potential for neurological recovery. To date, these early treatment decisions have been taken based on limited information leading mainly to undertreatment. Therefore, there is a need for early, reliable, accessible, and simple tools that offer information on the possibilities of neurological improvement. Methods: We collected data from bispectral index (BIS) and suppression ratio (SR) monitoring of adult comatose survivors of CA managed with targeted temperature management (TTM). Neurological status was assessed according to the Cerebral Performance Category (CPC) scale. Results: We included 340 patients. At the first full neurological evaluation, 211 patients (62.1%) achieved good outcome or CPC 1-2. Mean BIS values were significantly higher and median SR lower in patients with CPC 1-2. An average BIS> 26 during first 12hours of TTM predicted good outcome with 89.5% sensitivity and 75.8% specificity (AUC of 0.869), while average SR values> 24 during the first 12hours of TTM predicted poor outcome (CPC 3-5) with 91.5% sensitivity and 81.8% specificity (AUC, 0.906). Hourly BIS and SR values exhibited good predictive performance (AUC> 0.85), as soon as hour 2 for SR and hour 4 for BIS. Conclusions: BIS/SR are associated with patients’ potential for neurological recovery after CA. This finding could help to create awareness of the possibility of a better outcome in patients who might otherwise be wrongly considered as nonviable and to establish personalized treatment escalation plans.(AU)

Effect of a ward-based outreach team and adherence game on retention and viral load suppression

Background: Only 66% of South African people living with HIV (PLWH) are virologically suppressed. Therefore, it is important to develop strategies to improve outcomes.Objectives: Assess the effect of interventions on 12-month retention in care and virological suppression in participants newly initiated on antiretroviral therapy.Method: Fifty-seven clinics were randomised into four arms: Ward-based primary health care outreach teams (WBPHCOTs); Game; WBPHCOT­Game in combination; and Control (standard of care). Sixteen clinics were excluded and four re-allocated because lay counsellors and operational team leaders failed to attend the required training. Seventeen clinics were excluded due to non-enrolment. Results: A total of 558 participants from Tshwane district were enrolled. After excluding ineligible participants, 467 participants were included in the analysis: WBPHCOTs (n = 72); Games (n = 126); WBPHCOT­Games (n = 85); and Control (n = 184). Retention in care at 12 months was evaluable in 340 participants (86.2%) were retained in care and 13.8% were lost to follow-up. The intervention groups had higher retention in care than the Control group, but this only reached statistical significance in the Games group (96.8% vs 77.8%; relative risk [RR] 1.25; 95% confidence interval [CI]: 1.13­1.38; P = 0.01). The 12 month virologic suppression rate was 75.3% and was similar across the four arms.Conclusion: This study demonstrated that an adherence game intervention could help keep PLWH in care.What this study adds: Evidence that interventions, especially Games, could improve retention in care

Evolución del cáncer papilar de tiroides en acromegalia: serie de casos / Evolution of papillary thyroid cancer in acromegaly: case series / Evolução do câncer papilar de tireoide na acromegalia: série de casos

Introducción: La acromegalia se produce por un adenoma hipofisario somatotropo, que secreta una excesiva producción de GH e IGF1, se relaciona con mayor riesgo de tumores malignos, no guardando asociación con un patrón especifico de presentación y el objetivo de este estudio es analizar la evolución del cáncer papilar de tiroides en acromegalia. Casos: Se trata de tres pacientes diagnosticados de carcinoma papilar de tiroides (CPT) con diferente pronóstico, con características faciales, y sintomatología como cefalea, alteraciones del campo visual, alteraciones menstruales, que condujeron a la realización de estudios bioquímicos, de imagen y al diagnóstico de acromegalia. Evolución: La aparición de cáncer de tiroides varía en el tiempo de evolución de la acromegalia, en dos de los casos lo antecedió y en el tercero se presentó a la par con esta patología. La respuesta al tratamiento en el CPT es indeterminada en la primera paciente y \excelente en los otros casos; en una paciente se alcanzó remisión. Conclusiones: la coexistencia de acromegalia con cáncer tiroides es posible, que los cambios acrales, faciales y la sintomatología expansiva del tumor conducen al diagnóstico de acromegalia y que la identificación de malignidades no guarda relación con la evolución de la enfermedad.

Introduction: Acromegaly is produced by a somatotropic pituitary adenoma, which secretes an excessive production of GH and IGF1, it is related to a higher risk of malignant tumors, not being associated with a specific pattern of presentation and the objective of this study is to analyze the evolution of papillary thyroid cancer in acromegaly. Cases report: These were three patients diagnosed with CPT with different prognosis, with facial characteristics, and symptoms such as headache, visual field alterations, menstrual alterations, which led to biochemical and imaging studies and the diagnosis of acromegaly. Evolution: The appearance of thyroid cancer in the time of evolution of acromegaly is different, in two of the cases it preceded it and in the third it was presented alongside this pathology. The re-sponse to treatment in CPT is indeterminate in the first patient and excellent in the other cases; re-mission was achieved in one patient. Conclusions: It is concluded that the coexistence of acromegaly with thyroid cancer is possible, that the acral and facial changes and the expansive symptomatology of the tumor lead to the diag-nosis of acromegaly and that the identification of malignancies is not related to the evolution of the disease.

Introdução: A acromegalia é produzida por um adenoma hipofisário somatotrópico, que secreta uma produção excessiva de GH e IGF1, está relacionada a um maior risco de tumores malignos, não estando associada a um padrão específico de apresentação e o objetivo deste estudo é analisar a evolução de câncer papilar de tireoide na acromegalia. Casos: São três pacientes com diagnóstico de carcinoma papilífero de tireoide (CPT) de prognóstico diferente, com características faciais e sintomas como cefaleia, alterações do campo visual, alterações menstruais, que levaram à realização de estudos bioquímicos, de imagem e diagnóstico de acromegalia. Evolução: O aparecimento do câncer de tireoide varia com o tempo de evolução da acromegalia, em dois dos casos ela o precedeu e no terceiro foi apresentado concomitantemente a esta patologia. A resposta ao tratamento no CPT é indeterminada no primeiro paciente e excelente nos demais casos; a remissão foi alcançada em um paciente. Conclusões: a coexistência de acromegalia com câncer de tireoide é possível, que as alterações acrais e faciais e a sintomatologia expansiva do tumor levam ao diagnóstico de acromegalia e que a identificação de neoplasias não está relacionada à evolução da doença.

The effect of suppressing funeral rituals during the COVID-19 pandemic on bereaved families / Efectos de la supresión de rituales fúnebres durante la pandemia de COVID-19 en familiares enlutados / Efeitos da supressão de rituais fúnebres durante a pandemia de COVID-19 em familiares enlutados

Objective amidst the greatest health crisis in history triggered by COVID-19, this documental study was intended to understand the meanings individuals who have lost loved ones in this context assign to the phenomenon of suppressed funeral rituals. Method based on the theory of grief, the corpus of this study was composed of documents published in digital media containing personal writings and reports of experiences freely and easily available to the public. Two researchers with expertise in the field used inductive thematic analysis to interpret data. Results the experiences shared in the reports reflect the suffering experienced by the sudden death of a significant person, which is amplified by the absence or impediment to performing familial farewell rituals. The suppression or abbreviation of funeral rituals is a traumatic experience because family members are prevented from fulfilling their last homage to the loved one who has suddenly passed away, causing feelings of disbelief and indignation. Conclusion alternatives and new ways to celebrate passage rituals in emergencies of strong social commotion such as a pandemic are needed to provide support and comfort to family members, friends, and relatives. These rituals help survivors to overcome the critical moment, decreasing the risk of developing complicated grief.

Objetivo en medio a la mayor crisis sanitaria de la historia, deflagrada por la pandemia de COVID-19, este estudio documental tuvo por objetivo comprender los sentidos atribuidos al fenómeno de la supresión de rituales fúnebres por personas que sufrieron pérdidas de seres queridos en ese contexto. Método amparado en la teoría del luto, fue constituido el corpus de investigación a partir de documentos publicados en los medios de comunicación digital, conteniendo escritos personales y relatos de experiencias abiertas al público. El análisis temático inductivo de los textos fue realizado por dos investigadores con pericia. Resultados la experiencia compartida en las declaraciones repercute el padecimiento por la muerte repentina de persona significativa, ampliado por la ausencia o truncamiento de rituales familiares de despedida después de la muerte. La supresión o abreviación de rituales fúnebres es vivida como una experiencia traumática, ya que los familiares se encuentran impedidos de cumplir las últimas homenajes al ser que se fue súbitamente, generando sentimientos de incredulidad e indignación. Conclusión es necesario crear alternativas y reinventar maneras de celebrar los rituales de pasaje en situaciones de emergencia de fuerte conmoción social como una pandemia, de modo a ofrecer amparo y confort a los familiares, amigos y parientes. Esto auxilia a los supervivientes a superar el momento crítico, reduciendo el riesgo de desarrollar un luto complicado.

Objetivo em meio à maior crise sanitária da história, deflagrada pela pandemia de COVID-19, o objetivo deste estudo documental foi compreender os sentidos atribuídos ao fenômeno da supressão de rituais fúnebres por pessoas que amargaram perdas de entes queridos, nesse contexto. Método com amparo da teoria do luto, foi constituído o corpus de pesquisa a partir de documentos publicados na mídia digital, contendo escritos pessoais e relatos de experiências abertos ao público. A análise temática indutiva dos textos foi realizada por dois pesquisadores com expertise. Resultados a experiência compartilhada nos depoimentos repercute o padecimento pela morte repentina de pessoa significativa, ampliado pela ausência ou truncamento de rituais familiares de despedida após o óbito. A supressão ou abreviação de rituais fúnebres é vivida como uma experiência traumática, pois familiares se veem impedidos de cumprirem suas últimas homenagens ao ente que se foi subitamente, gerando sentimentos de incredulidade e indignação. Conclusão é preciso criar alternativas e reinventar maneiras de celebrar os rituais de passagem em situações emergenciais de forte comoção social como uma pandemia, de modo a oferecer amparo e conforto aos familiares, amigos e parentes. Isso auxilia os sobreviventes a superarem o momento crítico, reduzindo o risco de desenvolvimento do luto complicado.

Suppression of cardiomyocyte functions by ß-CTX isolated from the Thai king cobra (Ophiophagus hannah) venom via an alternative method

Beta-cardiotoxin (ß-CTX), the three-finger toxin isolated from king cobra (Ophiophagus hannah) venom, possesses ß-blocker activity as indicated by its negative chronotropy and its binding property to both ß-1 and ß-2 adrenergic receptors and has been proposed as a novel ß-blocker candidate. Previously, ß-CTX was isolated and purified by FPLC. Here, we present an alternative method to purify this toxin. In addition, we tested its cytotoxicity against different mammalian muscle cell types and determined the impact on cardiac function in isolated cardiac myocyte so as to provide insights into the pharmacological action of this protein. Methods: ß-CTX was isolated from the crude venom of the Thai king cobra using reverse-phased and cation exchange HPLC. In vitro cellular viability MTT assays were performed on mouse myoblast (C2C12), rat smooth muscle (A7r5), and rat cardiac myoblast (H9c2) cells. Cell shortening and calcium transient dynamics were recorded on isolated rat cardiac myocytes over a range of ß-CTX concentration. Results: Purified ß-CTX was recovered from crude venom (0.53% w/w). MTT assays revealed 50% cytotoxicity on A7r5 cells at 9.41 ± 1.14 µM (n = 3), but no cytotoxicity on C2C12 and H9c2 cells up to 114.09 µM. ß-CTX suppressed the extend of rat cardiac cell shortening in a dose-dependent manner; the half-maximal inhibition concentration was 95.97 ± 50.10 nM (n = 3). In addition, the rates of cell shortening and re-lengthening were decreased in ß-CTX treated myocytes concomitant with a prolongation of the intracellular calcium transient decay, indicating depression of cardiac contractility secondary to altered cardiac calcium homeostasis. Conclusion: We present an alternative purification method for ß-CTX from king cobra venom. We reveal cytotoxicity towards smooth muscle and depression of cardiac contractility by this protein. These data are useful to aid future development of pharmacological agents derived from ß-CTX.(AU)

Avaliação da resistência transmitida e adquirida entre crianças e adolescentes infectados pelo HIV-1 / Evaluation of transmitted and acquired resistance among HIV-1 infected children and adolescents

Crianças e adolescentes infectados pelo HIV e em uso de terapia antirretroviral (TARV) requerem uma atenção especial por ser um grupo mais vulnerável. Algumas limitações como fatores psicológicos e socioeconômicos, podem afetar na adesão ao tratamento e levar à falha terapêutica. O teste de genotipagem é importante para a identificação de mutações de resistência a drogas (Drug Resistance Mutation ­ DRM) para subsidiar na troca de antirretrovirais (ARV). O presente estudo teve como objetivo avaliar a resistência transmitida e adquirida entre crianças e adolescentes do Estado de São Paulo, a partir de amostras analisadas no Instituto Adolfo Lutz. No total, 324 sequências parciais do gene da polimerase do HIV-1 (RNA ­ Sequenciamento de Sanger) foram avaliadas, com genotipagem de entre 2009 e 2019. Os dados clínicos e laboratoriais, subtipo viral, DRMs e resistência aos antirretrovirais (Genotypic Susceptibility Score ­ GSS) foram avaliados contribuindo para os resultados desta pesquisa. Para avaliar os preditores da supressão viral dos pacientes em tratamento, foram realizadas análises de regressão logística. Entre os pacientes sem tratamento (naives) n=76, a taxa de resistência transmitida foi de 13,2% (10/76) de acordo com a ferramenta CPR e de 17,1% (13/76) quando considerado as mutações pelo algoritmo GRI-HIVdb. A resistência adquirida nos pacientes tratados em falha virológica (n=248), foi observada nas três classes de ARV, principalmente para os inibidores da transcriptase reversa análogo de nucleosídeo (ITRN) que foi de 83,4% (206/248). Das sequências dos pacientes expostos pelo menos a um IP (162/248), o Darunavir (DRV) foi o que apresentou a menor taxa de resistência (3,1%; 5/162). Após um ano da genotipagem, as crianças e adolescentes tratadas do subtipo B (55/110; 50,0%), C (6/7, 86,7%) e outras formas recombinantes (4/5; 80,0%) alcançaram a supressão viral de acordo com a métrica abaixo de 40 cópias/mL (p=0,004). Na regressão logística ajustada, a supressão viral teve associação (p≤0,05) com o sexo, níveis de faixa de carga viral (CV) e sequências do subtipo F versus B. Foi observada uma queda na resistência adquirida nas classes dos ITRN (p=0,011) e dos IP (p=0,000) no período de outubro de 2012 até agosto de 2018. Tanto os pacientes naives como os tratados apresentaram maior taxa de resistência no subtipo F e menor no subtipo C. Os resultados obtidos demonstram uma taxa intermediária de resistência transmitida e uma alta de resistência adquirida. O aumento do subtipo C na população pediátrica e com uma boa resposta ARV. Além disso, associação significativa do subtipo B com a supressão viral. (AU)

Children and adolescents infected with HIV and using antiretroviral therapy (ART) require special attention because they are a more vulnerable group. Some limitations, such as psychological and socioeconomic factors, can affect adherence to treatment and lead to therapeutic failure. The genotyping test is important for the identification of drug resistance mutations (Drug Resistance Mutation - DRM) to support the exchange of antiretrovirals (ARV). The present study is aimed to assess the transmitted and acquired resistance among children and adolescents in the State of São Paulo, based on samples analyzed at the Adolfo Lutz Institute. In total, 324 partial HIV-1 polymerase gene sequences (RNA - Sanger Sequencing) were evaluated, with genotyping between 2009 and 2019. Clinical and laboratory data, viral subtype, DRMs and resistance to antiretrovirals (Genotypic Susceptibility Score Score) - GSS) were evaluated contributing to the results of this research. To assess the predictors of viral suppression in patients undergoing treatment, logistic regression analyzes were performed. Among patients without treatment (naïve) n=76, the rate of resistance transmitted was 13.2% (10/76) according to the CPR tool and 17.1% (13/76) when considering the mutations by the algorithm GRI-HIVdb. The acquired resistance in patients treated for virological failure (n = 248), was observed in three classes of ARV, mainly for inhibitors of nucleoside analog reverse transcriptase (NRTI), which was 83.4% (206/248). Of the sequences of patients exposed to at least one PI (162/248), Darunavir (DRV) had the lowest resistance rate (3.1%; 5/162). One year after genotyping, children and adolescents treated for subtype B (55/110; 50.0%), C (6/7, 86.7%) and other recombinant forms (4/5; 80.0%), achieved viral suppression according to the metric below 40 copies / mL (p = 0.004). In the adjusted logistic regression, viral suppression was associated (p≤0.05) with gender levels of viral load range (CV), and subtype F versus B sequences. A decrease in the resistance acquired in the NRTI (p = 0.011), and PI (p = 0.000) classes, was observed in the period from October 2012 to August 2018. Both näive and treated patients had a higher resistance rate in subtype F and lower in subtype C. The results obtained demonstrate an intermediate rate of transmitted resistance and a higher rate of acquired resistance, also an increase in subtype C in the pediatric population and with a good ARV response, and in addition, a significant association of subtype B with viral suppression. (AU)

Prática de imunoterapia e candidatos biomarcadores: visita à resposta cutânea tardia e à IgG4 específica / Practice of immunotherapy and biomarker candidates: a visit to the late cutaneous response and specific IgG4

O sucesso da imunoterapia específica (ITE) com alérgenos está marcado pela diminuição dos sintomas quando da exposição aos mesmos. Significantes aumentos de IgG4 específica têm sido verificados em múltiplos estudos com pacientes recebendo ITE de manutenção por via subcutânea (30-40 vezes). Foi selecionado um grupo de 36 pacientes com idade média de 24 anos (mediana de 22 anos), sendo a maioria do sexo masculino (58%). A característica desses pacientes, com rinite e/ou rinoconjuntivite alérgica, era de estarem em uso na fase de manutenção (mais de 10 meses), ou haviam finalizado a ITE subcutânea nos últimos dois anos, após um período de três a cinco anos consecutivos. Procurou-se verificar as respostas cutâneas imediatas (20 min) e a tardia (de 6h a 8h), após injeção intradérmica (TID) na superfície volar do antebraço de 0,02 mL de extrato alergênico contendo 1AU (unidade de alergia), associada a um grupo controle com rinoconjuntivite sem uso de ITE. Foi analisada a dimensão das pápulas na leitura imediata, observando-se uma semelhança entre os grupos de ITE e de controle (9,1± 3,3/10,8 ± 2,1 mm; p = 0,124). Na leitura tardia, nota-se uma dimensão significativamente menor no grupo de ITE (2,6 ± 2,6/6,0 ± 1,6 mm; p < 0,001) em relação ao de controle. Admite-se, portanto, ter havido um elevado aumento da IgG4 específica bloqueadora, influenciando na resposta cutânea do TID. A supressão da resposta cutânea tardia correlaciona-se com o aumento da IgG4, sendo considerados ambos os parâmetros candidatos biomarcadores para ITE.

The success of allergen-specific immunotherapy (SIT) is marked by a decrease in symptoms after exposure to an allergen. Significant increases in specific IgG4 have been seen in multiple studies of patients receiving maintenance SIT subcutaneously (30- to 40-fold). A group of 36 patients was selected; their mean age was 24 years (median age of 22 years), and most were male (58%). These patients had rhinitis and/or allergic rhinoconjunctivitis and were in the maintenance phase (more than 10 months) or had had subcutaneous SIT in the past 2 years, after a period of 3 to 5 consecutive years. Immediate (20 minutes) and late (6 hours to 8 hours) cutaneous responses were examined after intra-dermal injection (IDI) on the volar surface of the forearm of 0.02-mL allergen extract containing 1 AU (allergy unit). A group with rhinoconjunctivitis and not on SIT was used as control. Wheal size in the immediate response was assessed, showing a similarity between the SIT and control groups (9.1 ± 3.3/10.8 ± 2.1 mm; p = 0.124). In the late response, a significantly smaller dimension was observed in the SIT group (2.6 ± 2.6/6.0 ± 1.6 mm; p < 0.001) compared to the control group. Thus, there was a high increase in the specific blocking IgG4, influencing the cutaneous response to the IDI. The suppression of the late cutaneous response correlates with the increase in IgG4, both of which are considered biomarker candidates for SIT.

The Role of Inner Speech in Emotion Dysregulation and Emotion Regulation Strategy Use / El Rol del Habla Interna en la Desregulación Emocional y el uso de Estrategias de Regulación Emocional

Abstract Recent studies have suggested that emotion regulation (ER) strategies, such as reappraisal and suppression, rely on the use of verbal thinking. Outside the field of ER, verbal thinking, particularly in the form of inner speech, has been largely linked to behavior and cognitive regulation. However, no article has yet directly addressed the potential role of inner speech in ER. In this study, 180 participants completed a survey that included measures of inner speech usage (Inner Speech Questionnaire), ER difficulties (Difficulties in Emotion Regulation Scale), ER strategy use (Emotion Regulation Questionnaire) and symptoms (HADS). Correlational analyses and hierarchical linear regression models were used to explore the potential relationship between inner speech and ER variables. A positive relationship was found between Inner Speech usage and the Difficulties in Emotion Regulation Scale overall score. This relationship was, however, heavily mediated by level of symptomatology. As for the ER strategies, only reappraisal presented a significant positive relationship, of medium size, with inner speech usage, which was independent of the level of symptoms. The results of this study are discussed in relation to the current conceptualization of reappraisal as well as its implications for clinical practice.

Resumen Estudios recientes han sugerido que estrategias de regulación emocional (RE) como la re-interpretación y supresión dependen del pensamiento verbal. Fuera del campo de la RE, el pensamiento verbal, como habla interna, ha sido vinculado con la regulación cognitivo/conductual. Sin embargo, a la fecha ningún estudio ha explorado el rol del habla interna en la RE. En esta investigación, 180 sujetos completaron cuestionarios de uso de habla interna (Inner Speech Questionnaire, ISQ), dificultades en la RE (Difficulties in Emotion Regulation Scale, DERS), uso de estrategias de RE (Emotion Regulation Questionnaire, ERQ) y sintomatología (HADS). Se realizaron análisis correlacionales y modelos de regresión lineal para explorar la relación entre habla interna y variables de RE. Una relación positiva fue encontrada entre frecuencia de uso de habla interna y la puntuación global de la escala de dificultades en RE -relación altamente mediada por el nivel de sintomatología. Respecto a las estrategias de RE, solo la reinterpretación presentó una relación positiva y significativa, de tamaño medio, con la frecuencia de uso de habla interna -con independencia del nivel de síntomas. Los resultados de este estudio son discutidos en relación a la conceptualización actual de la re-interpretación así como su relevancia para la práctica clínica.

Opilation and menstrual suppression: an 18 th century medical prescription in the new kingdom of granada / Opilación y supresión de menstruos: una receta médica del siglo XVIII en el nuevo reino de granada

ABSTRACT Objective: To present and define the context of a medical prescription dating from the eighteenth century in the New Kingdom of Granada, used for the suppression of menstruation, and to analyze it in the light of current knowledge as to whether its ingredients as a whole, may or may not achieve inhibition of menstrual bleeding. Materials and methods: Documentary search in the Historical Archives of the Octavio Arizmendi Posada Library at Universidad de La Sabana where the prescription "Opilation and menstrual suppression" was found. A review of the literature available in SciELO/proQuest databases was subsequently conducted for the period 1993-2015. Conclusions: The manuscript found describes multiple ingredients that, as a whole, and analyzed in light of current knowledge, are not valid to achieve the alleged suppressive effect. However, the components of the "liquid vitriol of Mars" could be recognized as having antianemic properties, and the potential suppressive effect of prescribing vigorous exercise in the middle of the menstrual cycle, although the recipe does not accurately describe the frequency or intensity of exercising to achieve the desired effect.

RESUMEN Objetivo: Presentar y definir el contexto de una receta médica que data del siglo XVIII en el Nuevo Reino de Granada, utilizada para la supresión de la menstruación, y analizar, a la luz de los conocimientos actuales, si sus ingredientes en conjunto podrían o no lograr la inhibición del sangrado menstrual. Materiales y métodos: Búsqueda documental en el Archivo Histórico de la Biblioteca Octavio Arizmendi Posada en la Universidad de La Sabana, donde se identifica la receta "Opilación y supresión de menstruos", y, posteriormente, se realizó una revisión de la literatura disponible en las bases de datos SciELO/proQuest en el periodo 1993-2015. Conclusiones: En la receta manuscrita hallada se describen múltiples ingredientes que, analizados a la luz de los conocimientos actuales, y en su conjunto, no tienen validez para lograr el pretendido efecto supresor. Sin embargo, se reconocen las propiedades antianémicas del "vitriolo líquido de Marte", y el posible efecto que ejercería el ejercicio excesivo formulado en medio del ciclo menstrual, aunque en la receta no se describe con exactitud la frecuencia ni la intensidad con la que este debería ser realizado para lograr una supresión del menstruo.

Papel do vírus Epstein-Barr e de fatores genéticos nos perfis imunes do microambiente tumoral no linfoma de Hodgkin clássico pediátrico / [Role of the Epstein-Barr virus and genetic factors in immune profiles of tumor microenvironment in pediatric classic Hodgkin's lymphoma]

O linfoma de Hodgkin clássico (LHc) é caracterizado por apresentar 0,5-1% de células neoplásicas (Hodgkin e Reed-Sternberg) com alta dependência do microambiente tumoral (MAT) formado por células inflamatórias e estromais. Este linfoma encontra-se associado ao vírus Epstein-Barr (EBV) em ~40-50% dos casos em nossa região. No LHc pediátrico EBV+, o MAT apresenta um perfil imune pró-inflamatório (células T citotóxicas/Th1), que poderia estar sendo inibido por mecanismos supressores pró-tumorais. Nosso objetivo foi investigar o MAT do LHc, o papel potencial do EBV e o papel do background genético individual na modulação do MAT. Por isto, foi proposto avaliar perfis de expressão gênica relacionados a potenciais mecanismos supressores e variantes genéticas associadas à resposta imune local, definida pela quantificação de subpopulações imunes mediante imunohistoquímica quantitativa, em linfonodos de pacientes pediátricos com LHc EBV+ e EBV-. Análises dos polimorfismos genéticos nas posições -1082/-592 do gene IL10 e +49/CT60 do gene CTLA4. Expressão de genes associados à resposta imune por RT-qPCR [perfil pro-inflamatório: CXCL10, IFNG e STAT1; supressor: IL10 e STAT6; checkpoint imune: CTLA4 (isoformas flCTLA4, completa e sCTLA4, solúvel), PDCD1, PD1L/CD274, HAVCR2/TIM3 e BTLA e; fatores de transcrição: EOMES e TBX21/TBET] foram analisados em relação às características clínicas-epidemiológicas, composição do MAT e resposta terapêutica. Análises bioinformáticas foram desenvolvidas na procura de uma assinatura relacionada à exaustão celular associada ao EBV. No gene IL10, genótipos -1082AA+AG foram associados a altos níveis de RNAm (P=0,014) e, os genótipos -1082GG/-592CC (baixa expressão) a um menor número de células MAF+ e haplótipo ATA (alta expressão) a um incremento de células MAF+ (P<0,05) no MAT. Pior sobrevida livre de progressão (SLP) preponderou nos pacientes com genótipos -1082AA+AG vs. GG, -592AA+AC vs. CC e no haplótipo ATA (P<0,05). No gene CTLA4, genótipos +49GG e CT60GG (baixo poder inibitório) foram associados a maior número de células citotóxicas (P<0,05). Pacientes com alta expressão de HAVCR2/TIM3, sCTLA4 e razões sCTLA4/flCTLA4>1,5 e EOMES/TBX21>1,5 apresentaram pior SLP (P<0,05). Alta expressão de IFNG e STAT1 e baixa de STAT6 foram identificadas nos casos EBV+ vs. EBV- (P<0,05). In silico, a presença do EBV foi associada a maior número de células citotóxicas e a menor número de células T CD4+ totais e subpopulações T CD4+ naïve e T reguladoras (P<0,05). Na potencial assinatura de exaustão específica do LHc, genes relacionados à ativação e inibição de células inflamatórias foram identificados (CD80, CD86, KLRB1, IL1RB2), já nos LHcEBV+ uma resposta antiviral foi identificada (FASLG, SLAMF7, GRZA, GRZK, CEACAM1). Com isto, estes resultados mostram que variantes genéticas regulam os níveis de expressão e composição do MAT, impactando no desfecho terapêutico; perfis moleculares/celulares distintos são identificados nos casos EBV+ vs. EBV- , mostrando que a presença do EBV está associada a uma resposta pró-inflamatória, porém poderia mediar um estado celular de exaustão via contato célula-célula; a identificação de mediadores de supressão, como variantes genéticas e expressão de IL10 e genes do checkpoint imune, sugerem mecanismos supressores e de exaustão imune que poderia, em parte, ser responsável pela resposta inflamatória não funcional.

¿Existe evidencia científica de que la supresión de las enfermedades agudas en la niñez induce enfermedades crónicas en el futuro? / Is there scientific evidence that suppression of disease childhood acute induces chronic diseases in the future?

La búsqueda de la comprensión del individuo en su totalidad sintomática ha sido uno de los propósitos de la Homeopatía desde sus comienzos. A todo lo largo de su historia, los homeópatas se han interesado por la cuestión de que el tratamiento inadecuado de las enfermedades agudas en la infancia pudiera conducir a enfermedadescrónicas futuras. Hahnemann advirtió que tratar las enfermedades agudas con medicina alopática, con fuertes dosis de fármacos, o bien suprimir los síntomas locales detales enfermedades, incrementaría el riesgo de sufrir enfermedades crónicas futuras. Burnett propuso la teoría de la vacunosis y advirtió de las manifestaciones crónicas subsiguientes a la vacunación contra la viruela. Buscando el origen fisiopatológico de las enfermedades crónicas, homeópatas franceses las correlacionaron con la reacción anormal del sistema reticuloendotelial (RES, por sus siglas en inglés). Estudiando la patología experimental, Maffei atribuyó las manifestaciones sintomáticas al desequilibrio entre los fenómenos inmunológicos de la alergia y la inmunidad. Denominó “meta-alergia” y “para-alergia” a los efectos sensibilizantes y patogénicos de los medicamentos y vacunas, respectivamente. La hipótesis de la higiene se basa en evidencia de que el desequilibrio de la respuesta inmunológica en la niñez, específicamente entre las subpoblaciones de linfocitos Th1 y Th2, es responsable del desarrollo de ciertas enfermedades alérgicas y crónicas en el futuro.El factor perturbador para la predisposición a presentar una respuesta alérgica en el futuro (Th2) es la obstrucción de las manifestaciones naturales de las enfermedadesinfecciosas (respuesta de Th1) en los niños pequeños. El tratamiento homeopático busca equilibrar la reacción vital, correspondiente a una respuesta fisiológica integrativa, con la posibilidad de regular el desequilibrio de Th1/Th2. Sin embargo, se carece de estudios clínicos que sustenten tal hipótesis. (AU)

Seeking to understand the individual in his symptomatic totality has been an aim of homeopathy since its beginning. Throughout its history, homeopaths have beenconcerned that inadequate treatment of acute diseases in childhood may lead to future chronic diseases. Hahnemann cautioned that by treating acute diseases withallopathic medicine, with strong doses of drugs, or suppressing local symptoms of those diseases, would increase the risk of future chronic diseases. Burnett proposedthe theory of vaccinosis and warned of chronic manifestations subsequent to smallpox vaccination. French homeopaths, seeking the physiopathological origin of chronic diseases, correlated it to the abnormal reaction of the reticuloendothelial system (RES). Through the study of experimental pathology, Maffei attributed symptomaticmanifestations to the imbalance between the immunological phenomena of allergy and immunity. He termed the sensitizing and pathogenic effects of medications and vaccines, ‘metallergy’ and ‘parallergy’, respectively. The hygiene hypothesis is based on evidence that the imbalance of immunological response in childhood, specifically among the Th1 and Th2 lymphocyte subpopulations, is responsible for the development of some allergic and chronic diseases in the future. The deranging factor for the predisposition to future allergic response (Th2) is the obstruction of natural manifestations of infectious diseases (Th1 response) in young children. Homeopathic treatment aims to equilibrate vital reaction, corresponding to an integrative physiological response, it may regulate Th1/Th2 imbalance. However, clinical trials to support this hypothesis are lacking. Homeopathy (2002) 91, 207–216. (AU)

Curación, paliación y supresión. Conceptos y antecedentes / Cure, palliation and suppression. Concepts and background

Desde la creación de la doctrina homeopática los conceptos de curación, paliación y supresión han causado inquietud, ya que en muchos círculos médico homeopáticos se tiene la percepción de que la supresión y la paliación son dos acciones que no se deben realizar, o peor aún, se tiene la idea equivocada de que la supresión homeopática no existe. Por eso, muchos médicos pasan buena parte de su vida profesional tratando de conseguir la “curación” de sus pacientes, por imposible o riesgosa que parezca. Pero, ¿por qué se le teme tanto a la supresión? ¿Por qué se piensa que la paliación es jugar con los pacientes? Quizás a lo largo de los años del desarrollo doctrinario se han malinterpretado las definiciones que Samuel Hahnemann otorgó a estos conceptos. Así, en el presente artículo se describen estos términos de manera general y se profundiza en la forma en que se aplican en el ámbito homeopático, con la finalidad de generar un contexto más amplio al respecto...

Since the creation of homeopathic doctrine, the healing concepts palliation and suppression have caused concern because in many homeopathic medical circles there is a perception that the suppression and palliation are two actions that cannot be performed, or even worse, it has the misconception that homeopathic suppression doesn´t exist. Therefore, many doctors spend much time in their professional lives trying to get the “cure” for their patients, as risky and impossible as it may be. But, why worry about suppression? Why think that palliation is playing with patients? Perhaps over the years of doctrinal development, the definitions that Samuel Hahnemann gave about these concepts have been misinterpreted. So, in this article these terms are described in general and explore in a deep way on how they are applied in the homeopathic field in order to generate a broader context about it...

Curación, paliación y supresión. Conceptos y antecedentes / Cure, palliation and suppression. Concepts and background

Desde la creación de la doctrina homeopática los conceptos de curación, paliación y supresión han causado inquietud, ya que en muchos círculos médico homeopáticos se tiene la percepción de que la supresión y la paliación son dos acciones que no se deben realizar, o peor aún, se tiene la idea equivocada de que la supresión homeopática no existe. Por eso, muchos médicos pasan buena parte de su vida profesional tratando de conseguir la “curación” de sus pacientes, por imposible o riesgosa que parezca. Pero, ¿por qué se le teme tanto a la supresión? ¿Por qué se piensa que la paliación es jugar con los pacientes? Quizás a lo largo de los años del desarrollo doctrinario se han malinterpretado las definiciones que Samuel Hahnemann otorgó a estos conceptos. Así, en el presente artículo se describen estos términos de manera general y se profundiza en la forma en que se aplican en el ámbito homeopático, con la finalidad de generar un contexto más amplio al respecto. (AU)

Since the creation of homeopathic doctrine, the healing concepts palliation and suppression have caused concern because in many homeopathic medical circles there is a perception that the suppression and palliation are two actions that cannot be performed, or even worse, it has the misconception that homeopathic suppression doesn´t exist. Therefore, many doctors spend much time in their professional lives trying to get the “cure” for their patients, as risky and impossible as it may be. But, why worry about suppression? Why think that palliation is playing with patients? Perhaps over the years of doctrinal development, the definitions that Samuel Hahnemann gave about these concepts have been misinterpreted. So, in this article these terms are described in general and explore in a deep way on how they are applied in the homeopathic field in order to generate a broader context about it. (AU)

Informe final: encuesta de resistencia del VIH a los medicamentos antirretrovirales, Guatemala 2015-2016 / Final report: survey of HIV resistance to antiretroviral drugs, Guatemala 2015-2016

Informe que presenta los resultados de las encuestas realizadas según las recomendaciones de la OMS, para la vigilancia de resistencia pretratamiento y resistencia adquirida del VIH.

Pacientes de alto riesgo cardiovascular. ¿Se pueden suprimir los hipolipemiantes? / No disponible

No disponible

Indication of acid suppression therapy and predictors for the prophylactic use of protonpump inhibitors vs. histamine-2 receptor antagonists in a Malaysian tertiary hospital / Indicación del tratamiento de supresión ácida y predictors del uso profiláctico de inhibidores de la bomba de protones vs. Antagonista de receptores de histamina-2 en un hospital terciario malayo

Background: Proton-pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA) are common acid suppressants used in gastrointestinal disorders. The trend of usage in Malaysia has changed from predominantly H2RA to PPI from 2007 to 2008, 3.46 versus 2.87 and 2.99 versus 3.24 DDD (Defined Daily Dose)/1000 population/day respectively. This raises concerns as PPI overutilization amounts to higher cost expenditure and are associated with various untoward consequences such as Clostridium difficile-associated diarrhea, pneumonia, and osteoporosis. Objectives: To evaluate the indication of acid suppression therapy (AST) and to look for predictors associated with the prophylactic use of PPI as compared to H2RA. Methods: Data collection was conducted via a standardized surveillance form over a 2-month period in the general medical wards of Sarawak General Hospital. All patients who received at least one dose of PPI or H2RA in any dosage form were included in the study. Appropriateness of prophylaxis was determined using current available guidelines. Selected risk factors were analysed using simple logistic regression to look for predictors associated with the choice of PPI in prophylactic AST. Results: Out of 212 cases in the present cohort, about three quarters (75.5%, n=160) of acid suppressants were given as prophylaxis. Over half of these did not have appropriate indications for prophylactic AST (58.1%, n=93). Among all cases given prophylactic AST, 75.0% (n=120) of them were given PPI. Renal insufficiency was identified as the only predictor associated with the use of prophylactic PPI in preference to H2RA (OR=2.86, 95%CI 1.21:6.72, p=0.011). Conclusion: Inappropriate prophylactic AST is a major concern and may even be underestimated due to the lack of appropriate guidelines. More data is required to guide the selection between PPI and H2RA, specifically the more cost-effective use of H2RA in patients with lower gastrointestinal risk or in whom PPI has no clear advantage (AU)

Antecedentes: Los inhibidores de la bomba de protones (PPI) y los antagonistas de los receptores de histamina-2 (H2RA) son antiácidos comunes que se usan en desordenes gastrointestinales. La tendencia de uso en Malasia ha cambiado de la predominancia de H2RA a PPI entre 2007 y 2008 de 3,46 vs. 2,87 y 2,99 vs. 3,24 DDD (Dosis Diarias Definida)/1000 habitantes/día, respectivamente. Esto preocupa ya que la sobreutilización de PPI produce mayores costes y están asociados a varias consecuencias indeseadas como diarrea asociada a Clostridium difficile, neumonía, y osteoporosis. Objetivos: Evaluar la indicación del tratamiento de supresión ácida (AST) y buscar predictores asociados con el uso de PPI comparados con H2RA. Métodos: Se recogieron datos mediante un formulario de vigilancia estandarizado durante 2 meses en los servicios de medicina heneral del Hospital General de Sarawak. Todos los pacientes que recibieron, al menos una dosis de PPI o de H2RA en cualquier forma fueron incluidos en el estudio. La adecuación del tratamiento fue determinada usando las guías disponibles actualmente. Se analizaron los factores de riesgo usando una regresión logística simple para buscar predictores asociados con la elección de PPI en AST profiláctica. Resultados: De los 200 casos presentes en la cohorte, cerca de tres cuartos (75,5; n=160) de los antiácidos fueron usado como profilácticos. Más de la mitad de ellos no tenían una indicación apropiada para AST profiláctica (58,1%, n=93). Entre todos los casos con AST profiláctica, el 75,0% (n=120) eran PPI. La insuficiencia renal fue el factor asociado con el uso de profilaxis con PPI en preferencia a los H2RA (OR=2,86; 95%CI 1,21:6,72, p=0,011). Conclusión: La AST profiláctica inadecuada es una gran problema y podría estar subestimada debido a la ausencia de guías apropiadas. Se requieren más datos para guiar la selección entre PPI y H2RA, específicamente el uso más coste-efectivo de los H2RA en pacientes con riesgo gastrointestinal bajo, o en los que no hay una clara ventaja de los PPI (AU)

Las enfermedades crónicas de hahnemann. la supresión y el estrés oxidativo (parte 2 de 3) / Chronic Diseases Hahnemann. Suppression and Oxidative Stress (Part 2 of 3)

En un abordaje teórico previo (2003) sobre los miasmas o enfermedades crónicas de Hahnemann (EC o MR) se presentó una explicación de estos conceptos desde la biología celular y corporal, tanto en su funcionamiento normal como en la patología, durante los tres estadios de toda célula u organismo: funcionamiento homeostasis, reproducción y muerte. Esta segunda parte plantea el papel de la supresión y los mecanismos fisiopatológicos por los cuales se genera ésta, así como las consecuencias biológicas, funcionales, estructurales y genéticas que dan lugar a lo que llamamos enfermedades miasmáticas o modos reaccionales.

Part I of this theoretical paper (2003) on Hahnemann’s miasms or reaccional modes, talked about explanation of them from cellular and organisms biology, giving a perspective in heath or disease, in three stages of every cell or organism: healthy stage-homeostasis, reproduction and death. This part II go further trying to explain what is the “suppression”, how does is generated, and which are its multiple functional, structural and genetic consequences that we call miasmatic disease or reaccional modes.

Las enfermedades crónicas de hahnemann. la supresión y el estrés oxidativo (parte 2 de 3) / Chronic Diseases Hahnemann. Suppression and Oxidative Stress (Part 2 of 3)

En un abordaje teórico previo (2003) sobre los miasmas o enfermedades crónicas de Hahnemann (EC o MR) se presentó una explicación de estos conceptos desde la biología celular y corporal, tanto en su funcionamiento normal como en la patología, durante los tres estadios de toda célula u organismo: funcionamiento homeostasis, reproducción y muerte. Esta segunda parte plantea el papel de la supresión y los mecanismos fisiopatológicos por los cuales se genera ésta, así como las consecuencias biológicas, funcionales, estructurales y genéticas que dan lugar a lo que llamamos enfermedades miasmáticas o modos reaccionales.(AU)

Part I of this theoretical paper (2003) on Hahnemann’s miasms or reaccional modes, talked about explanation of them from cellular and organisms biology, giving a perspective in heath or disease, in three stages of every cell or organism: healthy stage-homeostasis, reproduction and death. This part II go further trying to explain what is the “suppression”, how does is generated, and which are its multiple functional, structural and genetic consequences that we call miasmatic disease or reaccional modes. (AU)

Neumoencéfalo como causa de descenso del índice biespectral / Pneumocephalus as a cause of a decrease in the bispectral index

En un paciente sometido a extirpación de un tumor epidermoide del ángulo pontocerebeloso por vía retrosigmoidea derecha con anestesia general, se observó un descenso brusco de los valores del índice biespectral (BIS) con elevación de la tasa de supresión, que probablemente fue debido a la aparición de neumoencéfalo a nivel frontal. No se observó clínica neurológica simultánea, y el paciente fue extubado en la sala de reanimación sin incidencias después de que las cifras del BIS volvieran a elevarse. Se optó por el tratamiento conservador contando con la reabsorción y redistribución del aire (AU)

A sharp decrease in the values of the bispectral index (BIS), along with an increase in suppression rate, was observed in a patient after the removal of an epidermoid tumor in the cerebellopontine angle by right retrosigmoid access under general anesthesia. This was probably related to a frontal pneumocephalus. No accompanying neurological signs were observed. The patient was extubated in the Recovery Room with no further incidents, as the BIS increased again. The neurosurgeons chose conservative treatment, relying on the reabsorption and redistribution of the air (AU)