Pulmonary embolism versus pulmonary vasculitis in Hughes-Stovin syndrome: Characteristic computed tomography pulmonary angiographic findings and diagnostic and therapeutic implications. HSS International Study Group.

BACKGROUND AND AIM: Hughes-Stovin syndrome (HSS) is a rare systemic vasculitis with widespread venous/arterial thrombosis and pulmonary vasculitis. Distinguishing between pulmonary embolism (PE) and in-situ thrombosis in the early stages of HSS is challenging. The aim of the study is to compare clinical, laboratory, and computed tomography pulmonary angiography (CTPA) characteristics in patients diagnosed with PE versus those with HSS. METHODS: This retrospective study included 40 HSS patients with complete CTPA studies available, previously published by the HSS study group, and 50 patients diagnosed with PE from a single center. Demographics, clinical and laboratory findings, vascular thrombotic events, were compared between both groups. The CTPA findings were reviewed, with emphasis on the distribution, adherence to the mural wall, pulmonary infarction, ground glass opacification, and intra-alveolar hemorrhage. Pulmonary artery aneurysms (PAAs) in HSS were assessed and classified. RESULTS: The mean age of HSS patients was 35 ± 12.3 years, in PE 58.4 ± 17 (p < 0.0001). Among PE 39(78 %) had co-morbidities, among HSS none. In contrast to PE, in HSS both major venous and arterial thrombotic events are seen.. Various patterns of PAAs were observed in the HSS group, which were entirely absent in PE. Parenchymal hemorrhage was also more frequent in HSS compared to PE (P < 0.001). CONCLUSION: Major vascular thrombosis with arterial aneurysms formation are characteristic of HSS. PE typically appear loosely-adherent and mobile whereas "in-situ thrombosis" seen in HSS is tightly-adherent to the mural wall. Mural wall enhancement and PAAs are distinctive pulmonary findings in HSS. The latter findings have significant therapeutic ramifications.

Elevated serum IL-6 levels predict treatment interruption in patients with moderate to severe psoriasis: a 6-year real-world cohort study

Abstract Background: Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. Objective: The authors evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. Methods: The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-α, tumor necrosis factor-α, and inter-leukin (IL)-2, IL-4, IL-6, IL-10, and IL-17A were measured using a cytometric bead array; clinical data were assessed. The authors calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. Results: The authors included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI 1.01-1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI 1.29-3.08; p = 0.002) were associated with treatment interruption. Study limitations: The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation. Conclusions: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting biomarker candidate for predicting psoriasis treatment response.

Elevated serum IL-6 levels predict treatment interruption in patients with moderate to severe psoriasis: a 6-year real-world cohort study.

BACKGROUND: Real-world, primary data on the treatment of psoriasis are scarce, especially concerning the role of soluble biomarkers as outcome predictors. OBJECTIVE: The authors evaluated the utility of Th1/Th17 serum cytokines along with clinical characteristics as predictors of drug survival in the treatment of psoriasis. METHODS: The authors consecutively included participants with moderate to severe psoriasis who were followed up for 6 years. Baseline interferon-α, tumor necrosis factor-α, and interleukin (IL)-2, IL-4, IL-6, IL-10, and IL-17A were measured using a cytometric bead array; clinical data were assessed. The authors calculated hazard ratios (HRs) for drug survival using a Cox proportional hazards model. RESULTS: The authors included 262 patients, most of whom used systemic immunosuppressants or biologics. In the multivariate model, poor quality of life measured by the Dermatology Life Quality Index (HR = 1.04; 95% CI 1.01‒1.07; p = 0.012) and elevated baseline IL-6 (HR = 1.99; 95% CI 1.29‒3.08; p = 0.002) were associated with treatment interruption. STUDY LIMITATIONS: The main limitation of any cohort study is the presence of confounders that could not be detected in clinical evaluation. CONCLUSIONS: Poor quality of life and elevated baseline serum IL-6 level predicted treatment interruption in patients with moderate to severe psoriasis. Although IL-6 is not the most important mediator of the inflammatory pathway in the skin environment, it is an interesting biomarker candidate for predicting psoriasis treatment response.

Competing endogenous RNAs in human astrocytes: crosstalk and interacting networks in response to lipotoxicity.

Neurodegenerative diseases (NDs) are characterized by a progressive deterioration of neuronal function, leading to motor and cognitive damage in patients. Astrocytes are essential for maintaining brain homeostasis, and their functional impairment is increasingly recognized as central to the etiology of various NDs. Such impairment can be induced by toxic insults with palmitic acid (PA), a common fatty acid, that disrupts autophagy, increases reactive oxygen species, and triggers inflammation. Although the effects of PA on astrocytes have been addressed, most aspects of the dynamics of this fatty acid remain unknown. Additionally, there is still no model that satisfactorily explains how astroglia goes from being neuroprotective to neurotoxic. Current incomplete knowledge needs to be improved by the growing field of non-coding RNAs (ncRNAs), which is proven to be related to NDs, where the complexity of the interactions among these molecules and how they control other RNA expressions need to be addressed. In the present study, we present an extensive competing endogenous RNA (ceRNA) network using transcriptomic data from normal human astrocyte (NHA) cells exposed to PA lipotoxic conditions and experimentally validated data on ncRNA interaction. The obtained network contains 7 lncRNA transcripts, 38 miRNAs, and 239 mRNAs that showed enrichment in ND-related processes, such as fatty acid metabolism and biosynthesis, FoxO and TGF-ß signaling pathways, prion diseases, apoptosis, and immune-related pathways. In addition, the transcriptomic profile was used to propose 22 potential key controllers lncRNA/miRNA/mRNA axes in ND mechanisms. The relevance of five of these axes was corroborated by the miRNA expression data obtained in other studies. MEG3 (ENST00000398461)/hsa-let-7d-5p/ATF6B axis showed importance in Parkinson's and late Alzheimer's diseases, while AC092687.3/hsa-let-7e-5p/[SREBF2, FNIP1, PMAIP1] and SDCBP2-AS1 (ENST00000446423)/hsa-miR-101-3p/MAPK6 axes are probably related to Alzheimer's disease development and pathology. The presented network and axes will help to understand the PA-induced mechanisms in astrocytes, leading to protection or injury in the CNS under lipotoxic conditions as part of the intricated cellular regulation influencing the pathology of different NDs. Furthermore, the five corroborated axes could be considered study targets for new pharmacologic treatments or as possible diagnostic molecules, contributing to improving the quality of life of millions worldwide.

A systematic review of the evaluation of agricultural policies: Using prisma.

Background: The food security of each country depends on agricultural development, which is sensitive to the implementation of agricultural public policies. These must evolve as new ruralities arise, with new phenomena, such as climate change, ecosystem services, changes in consumer preferences, globalization, sustainability and ecological awareness. Hence, of ex-ante and ex-post evaluations of agricultural policies, are important because they provide timely information to government entities. There are different methodologies for policy evaluation, which have evolved over time. Aims: This systematic review aims to identify manuscript that systematically review methodologies, policies and variables evaluated during the last 50 years to determine whether a policy has been efficient. To assess the quality of the included manuscript and to describe the measures and domains identified. Methods: EBSCO, Dialnet, SciELO, Scopus, Science Direct, Dimensions and Web of Science were searched. A total of 154 manuscript were identified, the review was finalized by reviewing the title, and abstract and the review was finalized by reviewing the title, abstract and full text, resolving disagreements. Of these 154 manuscripts, 37 met the criteria and were included in the analysis. PRISMA checklists were used to evaluate the methodology. Outcomes and results: It were found that there are few studies on the design of evaluation methodologies for agricultural policies in the literature. Research shows that the latest policy evaluation proposals present more complex methodologies involving tools such as machine learning and agent-based modelling (ABM). On the other hand, the issue of sustainability as a policy is seen in the agri-environmental policy evaluation. Conclusions and implications: The evolution of agricultural policy methodologies can be observed at the beginning with the use of quantitative methodologies, such as matrices, statistics and econometrics. With the emergence of new variables, such as agri-environmental variables, citizen participation and market opening, methodologies have become more comprehensive, combining qualitative and quantitative variables. Methodologies were identified that evaluate robust agricultural policies and others that focus on the evaluation of one or two policies. These studies are important for research that focuses not only on the evaluation of agricultural policies but also on their design and implementation processes.

Effect of an Albumin Infusion Treatment Protocol on Delayed Cerebral Ischemia and Relevant Outcomes in Patients with Subarachnoid Hemorrhage.

BACKGROUND: An institutional management protocol for patients with subarachnoid hemorrhage (SAH) based on initial cardiac assessment, permissiveness of negative fluid balances, and use of a continuous albumin infusion as the main fluid therapy for the first 5 days of the intensive care unit (ICU) stay was implemented at our hospital in 2014. It aimed at achieving and maintaining euvolemia and hemodynamic stability to prevent ischemic events and complications in the ICU by reducing periods of hypovolemia or hemodynamic instability. This study aimed at assessing the effect of the implemented management protocol on the incidence of delayed cerebral ischemia (DCI), mortality, and other relevant outcomes in patients with SAH during ICU stay. METHODS: We conducted a quasi-experimental study with historical controls based on electronic medical records of adults with SAH admitted to the ICU at a tertiary care university hospital in Cali, Colombia. The patients treated between 2011 and 2014 were the control group, and those treated between 2014 and 2018 were the intervention group. We collected baseline clinical characteristics, cointerventions, occurrence of DCI, vital status after 6 months, neurological status after 6 months, hydroelectrolytic imbalances, and other SAH complication. Multivariable and sensitivity analyses that controlled for confounding and considered the presence of competing risks were used to adequately estimate the effects of the management protocol. The study was approved by our institutional ethics review board before study start. RESULTS: One hundred eighty-nine patients were included for analysis. The management protocol was associated with a reduced incidence of DCI (hazard ratio 0.52 [95% confidence interval 0.33-0.83] from multivariable subdistribution hazards model) and hyponatremia (relative risk 0.55 [95% confidence interval 0.37-0.80]). The management protocol was not associated with higher hospital or long-term mortality, nor with a higher occurrence of other unfavorable outcomes (pulmonary edema, rebleeding, hydrocephalus, hypernatremia, pneumonia). The intervention group also had lower daily and cumulative administered fluids compared with historic controls (p < 0.0001). CONCLUSIONS: A management protocol based on hemodynamically oriented fluid therapy in combination with a continuous albumin infusion as the main fluid during the first 5 days of the ICU stay appears beneficial for patients with SAH because it was associated with reduced incidence of DCI and hyponatremia. Proposed mechanisms include improved hemodynamic stability that allows euvolemia and reduces the risk of ischemia, among others.

Understanding the psychosocial impact of the COVID-19 pandemic on Latinx emerging adults.

There is growing evidence about the potential negative psychosocial impact of the COVID-19 pandemic on ethnoracially minoritized young adults. Emerging adulthood is a developmental stage (ages 18-29 years old) that is characterized by identity exploration, instability, self-focus, feeling "in between" and having a sense of possibilities. Latinx emerging adults have reported significant socio-emotional consequences as a result of the COVID-19 pandemic. The aim of this study was to explore the psychosocial impact of the COVID-19 pandemic on Latinx emerging adults (N = 31; ages 18-29) in California and Florida through online focus group interviews. A qualitative constructivist grounded theory approach was used in an effort to develop empirical knowledge, as research on the psychosocial impact of the COVID-19 pandemic on Latinx young adults is limited. This method served to capture the richness of the experiences of participants by allowing analytic codes and categories to drive theory development. In total, seven focus groups were held and participants attended a virtual focus group with other Latinx emerging adults from their state. The focus groups were transcribed verbatim and coded using constructivist grounded theory. Five themes were identified from the data concerning the impact of the pandemic on Latinx emerging adults, which centered around mental health experiences, navigating family factors, pandemic-related communication, career and academic disruptions, and systemic and environmental factors. A theoretical model was constructed to generate an understanding about factors influencing psychosocial functioning for Latinx emerging adults during the pandemic. The study has implications for advancing science on the consequences of pandemics on mental health and cultural considerations that may influence disaster recovery. Examples of these cultural considerations that emerged from this study include multigenerational values, heightened responsibilities, and mediating pandemic information. Results can inform efforts to increase support and resources for Latinx emerging adults in order to address the psychological difficulties resulting from the COVID-19 pandemic.

Heart transplantation as salvage treatment of intractable infective endocarditis.

BACKGROUND: For infective endocarditis (IE) with extensive perivalvular lesions or end-stage cardiac failure, heart transplantation (HT) may be the last resort. METHODS: We retrospectively collected all cases of HT for IE within the International Collaboration on Endocarditis (ICE) network. RESULTS: Between 1991 and 2021, 20 patients (5 women, 15 men), median age 50 years [interquartile range, 29-61], underwent HT for IE in Spain (n = 9), France (n = 6), Switzerland (n = 2), Colombia, Croatia, and USA (n = 1). IE affected prosthetic (n = 10), and native valves (n = 10), primarily aortic (n = 11) and mitral (n = 6). The main pathogens were oral streptococci (n = 8), Staphylococcus aureus (n = 5), and Enterococcus faecalis (n = 2). The major complications included heart failure (n = 18), peri-annular abscess (n = 10), and prosthetic valve dehiscence (n = 4). Eighteen patients had previous cardiac surgery for this episode of IE, and four were on circulatory support before HT (left ventricular assist-device and extra-corporeal membrane oxygenation, 2 patients each). The median time interval between first symptoms of IE and HT was 44.5 days [22-91.5]. The main post-HT complication was acute rejection (n = 6). Seven patients died (35%), four during the first month post-HT. Thirteen (81%) of the 16 patients discharged from the hospital survived with a median follow-up of 35.5 months [4-96.5] after HT, and no relapse of IE. CONCLUSIONS: IE is not an absolute contraindication for HT: Our case series and the literature review support that HT may be considered as a salvage treatment in highly-selected patients with intractable IE.

MicroRNA: A Linking between Astrocyte Dysfunction, Mild Cognitive Impairment, and Neurodegenerative Diseases.

The importance of miRNAs in cellular processes and their dysregulation has taken significant importance in understanding different pathologies. Due to the constant increase in the prevalence of neurodegenerative diseases (ND) worldwide and their economic impact, mild cognitive impairment (MCI), considered a prodromal phase, is a logical starting point to study this public health problem. Multiple studies have established the importance of miRNAs in MCI, including astrocyte regulation during stressful conditions. Additionally, the protection mechanisms exerted by astrocytes against some damage in the central nervous system (CNS) lead to astrocytic reactivation, in which a differential expression of miRNAs has been shown. Nevertheless, excessive reactivation can cause neurodegeneration, and a clear pattern defining the equilibrium point between a neuroprotective or detrimental astrocytic phenotype is unknown. Therefore, the miRNA expression has gained significant attention to understand the maintenance of brain balance and improve the diagnosis and treatment at earlier stages in the ND. Here, we provide a comprehensive review of the emerging role of miRNAs in cellular processes that contribute to the loss of cognitive function, including lipotoxicity, which can induce chronic inflammation, also considering the fundamental role of astrocytes in brain homeostasis.

Validity of the Pulmonary Embolism Rule-Out Criteria (PERC) for ruling out pulmonary embolism in low-risk patients at high altitudes

Abstract Objectives: to validate the diagnostic yield of the PERC score for ruling out pulmonary embolism in low-risk patients at high altitudes (>2500 meters above sea level [ASL]). Methods: a cross-sectional study with diagnostic test analysis in patients over the age of 18 with suspected pulmonary embolism on admission or during hospitalization, who underwent chest computed tomography angiography between August 2009 and January 2020 in a tertiary care hospital located on the Bogotá savannah. The yield of the PERC score was assessed, calculated with an SaO2<95% and an SaO2<90% in patients with different risk levels according to the Wells, Geneva and Pisa scores for pulmonary embolism. Results: one thousand eighty-seven were included in the final analysis, 42% with PE. Patients classified as low-risk using the Wells score had a PERC ACOR calculated with SaO2<95% of 0.56 (95%CI:0.50-0.62) (p=0.049), and calculated with SaO2<90% of 0.60 (95%CI:0.54-0.66) (p=0.002). The ACOR for subjects classified as low-risk using the Geneva score, with a PERC calculated with SaO2<95%, was: 0.53 (95%CI:0.45-0.60) (p=0.459) and for a PERC calculated with SaO2<90% it was: 0.55 (95%CI:0.47-0.62) (P=0.218). The ACOR for subjects with a less than 10% probability of PE according to the Pisa score classification, with a PERC calculated with SaO2<95%, was: 0.54 (95%CI:0.44-0.64)(p=0.422), and for a PERC calculated with SaO2<90% it was: 0.56 (95%CI:0.46-0.66)(p=0.236). Conclusions: the PERC score calculated with an oxygen saturation <90% has a similar diagnostic yield to the PERC score calculated with an oxygen saturation <95% for ruling out PE in patients classified as low-risk by the Wells score at high altitudes (>2,500 meters ASL). (Acta Med Colomb 2021; 46. DOI: https://doi.org/10.36104/amc.2021.2010).

Pulmonary vasculitis in Hughes-Stovin syndrome (HSS): a reference atlas and computed tomography pulmonary angiography guide-a report by the HSS International Study Group.

INTRODUCTION: Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by widespread venous/arterial thrombosis and pulmonary artery aneurysms (PAAs), which is associated with serious morbidity and mortality. All fatalities reported in HSS resulted from unpredictable fatal suffocating hemoptysis. Therefore, it is necessary to recognize pulmonary complications at an early stage of the disease. OBJECTIVES: The aims of this study are to develop a reference atlas of images depicting the characteristic features of HSS by computed tomography pulmonary angiography (CTPA). To make a guide for physicians by developing a classification of PAAs according to the severity and risk of complications associated with each distinct lesion type. METHODS: The Members of the HSS International Study Group (HSSISG) collected 42 cases, with high-quality CTPA images in one radiology station and made reconstructions from the source images. These detailed CTPA studies were reviewed for final image selection and approved by HSSISG board members. We classified these findings according to the clinical course of the patients. RESULTS: This atlas describes the CTPA images that best define the wide spectrum of pulmonary vasculitis observed in HSS. Pulmonary aneurysms were classified into six radiographic patterns: from true stable PAA with adherent in-situ thrombosis to unstable leaking PAA, BAA and/or PAP with loss of aneurysmal wall definition (most prone to rupture), also CTPA images demonstrating right ventricular strain and intracardiac thrombosis. CONCLUSION: The HSSISG reference atlas is a guide for physicians regarding the CTPA radiological findings, essential for early diagnosis and management of HSS-related pulmonary vasculitis. Key Points • The Hughes-Stovin syndrome (HSS) is a systemic vasculitis characterized by extensive vascular thrombosis and pulmonary artery aneurysms (PAAs) that can lead to significant morbidity and mortality. • All fatalities reported in HSS were related to unpredictable massive hemoptysis; therefore, it is critical to recognize pulmonary complications at an early stage of the disease. • The HSS International Study Group reference atlas  classifies pulmonary vasculitis in HSS at 6 different stages of the disease process and defines the different radiological patterns of pulmonary vasculitis notably pulmonary artery aneurysms, as detected by computed tomography pulmonary angiography (CTPA). • The main aim of the classification is to make a guide for physicians about this rare syndrome. Such a scheme has never been reached before since the first description of the syndrome by Hughes and Stovin since 1959. This classification will form the basis for future recommendations regarding diagnosis and treatment of this syndrome.

The First Contact of Human Dendritic Cells With Trypanosoma cruzi Reveals Response to Virus as an Unexplored Central Pathway.

Chagas disease is a debilitating and neglected disease caused by the protozoan Trypanosoma cruzi. Soon after infection, interactions among T. cruzi and host innate immunity cells can drive/contribute to disease outcome. Dendritic cells (DCs), present in all tissues, are one of the first immune cells to interact with Trypanosoma cruzi metacyclic trypomastigotes. Elucidating the immunological events triggered immediately after parasite-human DCs encounter may aid in understanding the role of DCs in the establishment of infection and in the course of the disease. Therefore, we performed a transcriptomic analysis of a 12 h interaction between T. cruzi and MoDCs (monocyte-derived DCs) from three human donors. Enrichment analyses of the 468 differentially expressed genes (DEGs) revealed viral infection response as the most regulated pathway. Additionally, exogenous antigen processing and presentation through MHC-I, chemokine signaling, lymphocyte co-stimulation, metallothioneins, and inflammasome activation were found up-regulated. Notable, we were able to identify the increased gene expression of alternative inflammasome sensors such as AIM2, IFI16, and RIG-I for the first time in a T. cruzi infection. Both transcript and protein expression levels suggest proinflammatory cytokine production during early T. cruzi-DCs contact. Our transcriptome data unveil antiviral pathways as an unexplored process during T. cruzi-DC initial interaction, disclosing a new panorama for the study of Chagas disease outcomes.

A critical analysis of 57 cases of Hughes-Stovin syndrome (HSS). A report by the HSS International Study Group (HSSISG).

BACKGROUND: Hughes-Stovin syndrome (HSS) is a systemic disease characterized by widespread vascular thrombosis and pulmonary vasculitis with serious morbidity and mortality. The HSS International Study Group is a multidisciplinary taskforce aiming to study HSS, in order to generate consensus recommendations regarding diagnosis and treatment. METHODS: We included 57 published cases of HSS (43 males) and collected data regarding: clinical presentation, associated complications, hemoptysis severity, laboratory and computed tomography pulmonary angiography (CTPA) findings, treatment modalities and cause of death. RESULTS: At initial presentation, DVT was observed in 29(33.3 %), thrombophlebitis in 3(5.3%), hemoptysis in 24(42.1%), and diplopia and seizures in 1 patient each. During the course of disease, DVT occurred in 48(84.2%) patients, and superficial thrombophlebitis was observed in 29(50.9%). Hemoptysis occurred in 53(93.0%) patients and was fatal in 12(21.1%). Pulmonary artery (PA) aneurysms (PAAs) were bilateral in 53(93%) patients. PAA were located within the main PA in 11(19.3%), lobar in 50(87.7%), interlobar in 13(22.8%) and segmental in 42(73.7%). Fatal outcomes were more common in patients with inferior vena cava thrombosis (p = 0.039) and ruptured PAAs (p < 0.001). Death was less common in patients treated with corticosteroids (p < 0.001), cyclophosphamide (p < 0.008), azathioprine (p < 0.008), combined immune modulators (p < 0.001). No patients had uveitis; 6(10.5%) had genital ulcers and 11(19.3%) had oral ulcers. CONCLUSIONS: HSS may lead to serious morbidity and mortality if left untreated. PAAs, adherent in-situ thrombosis and aneurysmal wall enhancement are characteristic CTPA signs of HSS pulmonary vasculitis. Combined immune modulators contribute to favorable outcomes.

Psychosocial influences on posttraumatic growth among university students following a mass murder.

To understand the range of psychosocial outcomes associated with a mass violence incident (MVI), there is a need to study posttraumatic growth (PTG). PTG is the experience of positive change that can result from contending with highly challenging life crises (Tedeschi & Calhoun, 1996). Studies have documented how characteristics of the individual, their trauma exposure, and how they cope or process the event can influence PTG. However, to our knowledge, none have addressed how the activities in which an individual may engage in following the trauma can influence PTG. Following a mass murder that impacted a university community, this study examined how pretragedy factors, objective exposure, psychosocial factors (e.g., core beliefs, posttraumatic stress symptoms, social support), and the posttragedy activities in which participants engaged may influence PTG. The posttragedy activities assessed were Mental Health Services, Informational Support, Grieving and Remembrance, Taking Action, and Coping Activities. Participants (N = 116; 68.1% female; 40% White, 31.3% Asian/Pacific Islander, 14.8% biracial, and 13.9% Latinx) who were enrolled in a college adjustment study the year prior to the tragedy were recontacted and asked to complete an online survey approximately 5-6 months following the MVI. Hierarchical regression results revealed that core beliefs and the posttragedy activity category of Taking Action were associated with PTG. Findings contribute to our understanding of the influences on PTG for university students impacted by a MVI and highlight the need to further examine the role of posttragedy activities, such as Taking Action on posttragedy adjustment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Measuring media exposure to acute mass violence.

OBJECTIVE: Researchers have studied the influence of media exposure to acute mass violence (e.g., terror attack, mass shooting, etc.) on distress in populations not directly experiencing the trauma; however, the field has yet to achieve consensus on the measurement of media exposure. There has been a rapidly changing media environment since this body of research began, with the rise of social media. To address this, we developed a measure using the most relevant items from media exposure surveys and accounting for evolving social media. METHOD: We asked a sample of youth and adults (N = 1,249), ages 14 - 59 years old, about average time spent consuming news in general, time spent viewing coverage of specific terror attacks, and their emotional reactions to the media coverage. RESULTS: A confirmatory factor analysis specifying a 3-factor model was run on a subsample of the data (n = 308), and the data fit the model well, χ2(17) = 30.799, p < .05, root mean square error of approximation = .051 [90% confidence interval = .020, .080], comparative fit index = .989, and standardized root mean square error of approximation = .043. Measurement invariance was examined on the remainder of the participants (n = 937) to determine whether the model was invariant across participant sex. CONCLUSION: Analyses support that the factor structure of the measure was consistent across male and female participants. Implications on measuring media exposure to acute mass violence will be discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Características neuro-psicopedagógicas de las dificultades de aprendizaje escolar: un estudio de caso / Neuro-psychopedagogical characteristics of school learning difficulties: a case study

Este artículo tiene como objetivo presentar las características neuropsicopedagógicas de un niño con dificultades escolares y de comportamiento. Se llevó a cabo un estudio de caso con un participante de 11 años de edad, quien durante la investigación cursaba el grado quinto de básica primaria en una institución educativa de carácter privado del municipio de Itagüí, Antioquia. Los instrumentos aplicados para la evaluación fueron: el Test Breve de Inteligencia de KAUFMAN (K-BIT), la Batería Psicopedagógica EVALÚA - 5, el Cuestionario de Depresión para Niños (CDS) y una entrevista semiestructurada para padres y docentes, relacionada con los aspectos del desarrollo, el aprendizaje y la conducta del estudiante. Los resultados demostraron que el niño presentaba un coeficiente intelectual dentro de los parámetros normales y las principales dificultades se encontraron en el contexto familiar-social, lo que permitió evidenciar que el rendimiento escolar es el resultado de la interacción de diferentes factores que abarcan componentes cognitivos, del neurodesarrollo, emocionales, familiares y contextuales. Así mismo, se evidenció que las dificultades en el comportamiento asociadas al contexto escolar no siempre están relacionadas con trastornos del aprendizaje o de la conducta. Se hace necesaria la obtención de este tipo de perfiles neuropsicopedagógicos con el fin de establecer rutas de intervención pertinentes y eficaces que incorporen las características cognitivas individuales, los vínculos socio afectivos, el entorno social, escolar, y la dinámica familiar del estudiante.

This article aims to present the neuropsychopedagogical characteristics of a child with school and behavior difficulties. A case study was carried out with an 11-year- old participant, who during the research was studying the fifth grade of elementary school in a private educational institution in the municipality of Itagüí, Antioquia. The instruments applied for the evaluation were: the KAUFMAN Brief Intelligence Test (K-BIT), the EVALÚA Psychopedagogical Battery­5, the Depression Questionnaire for Children (CDS) and a semi-structured interview for parents and teachers, related to aspects of development, learning and behavior of the student. The results showed that the child had an IQ within normal parameters and the main difficulties were found in the social family context, which allowed to show that school performance is the result of the interaction of different factors, which include cognitive, neurodevelopmental, emotional, family and contextual components. It was also evidenced that behavioral difficulties associated with the school context are not always related to learning or conduct disorders. Obtaining this type of neuropsychopedagogical profiles is necessary in order to establish relevant and effective intervention routes, which incorporate individual cognitive characteristics, socio-affective ties, the social and school environment and the student's family dynamics.

Efectos de un programa educativo para cuidadores de pacientes con afecciones respiratorias en el domicilio / Effects of an educational program in caregivers of patients with respiratory diseases in the home

Introducción: La educación en salud en el ámbito domiciliario, es determinante para fortalecer las competencias del equipo de salud. Objetivo: Identificar los efectos de un programa educativo en cuidadores con formación técnica en enfermería de un programa de atención domiciliaria. Métodos: Estudio cuasi experimental. Se tomó la población total de cuidadores con formación técnica en enfermería de una institución, correspondientes a 55 sujetos pertenecientes a las sedes de la ciudad de Cali y al municipio de Palmira, en 2017. El programa educativo consistió en capacitar en temas del cuidado respiratorio en casa, las estrategias de comunicación se enmarcaron en talleres, folletos y videos. Se creó una base de datos ajustada al propósito de los objetivos planteados, la cual fue analizada en el formato SPSS versión 20, y sometida a procesos de revisión y consistencia de datos. Los instrumentos de medición fueron cuestionarios autoadministrados, realizados por las autoras y validados en una prueba piloto aplicada a 33 auxiliares de enfermería externos a la institución, con las mismas características de la población de estudio. Resultados: Tras la ejecución de la intervención educativa se evidenciaron cambios en el puntaje global de los test de succión de la vía aérea (diferencia media pretest vs postest 2,034 p = 0,0001) e inhaloterapia (diferencia media pretest vs postest 1,355 p = 0,043). Conclusiones: La educación en salud en el contexto domiciliario se convierte en una estrategia importante para garantizar intervenciones oportunas dentro de los planes de atención(AU)

Introduction: Health education in the home environment is crucial to strengthen the competences of the health team. Objective: To identify the effects of an educational program in caregivers with technical training in nursing of a home care program, 2017. Methodology: Type of quasi-experimental study, the total population of caregivers with technical training in nursing of an institution was taken, corresponding 55 subjects belonging to the headquarters of the city of Cali and the municipality of Palmira. The educational program consisted of training in topics of respiratory care at home, communication strategies were framed in workshops, brochures and videos. A database adjusted to the purpose of the proposed objectives was created, which was analyzed in the SPSS version 20 format, and subjected to data review and consistency processes. The measurement instrument was a self-administered questionnaire, carried out by the authors and validated in a pilot test applied to 33 nursing auxiliaries external to the institution, with the same characteristics of the study population. Results: It was found that there is a significant difference after providing education regarding airway suction technique, with an average difference of 2.03 P value of 0.000. Conclusions: health education in the home context becomes an important strategy to ensure timely interventions within the care plans(AU)

Síndrome De Sturge-Weber: Reporte De Un Caso Y Revisión De La Literatura / Sturge-Weber Syndrome: A Case Report And Literature Review

Resumen El Síndrome de Sturge-Weber es un trastorno poco común del desarrollo neuroectodérmico, caracterizado por un angioma facial tipo nevus flammeus y una angiomatosis leptomeníngea, con frecuencia ipsilateral al nevus. Este síndrome predispone a calcificaciones, atrofia cerebral y convulsiones refractarias. Propósito: En este artículo se realiza una revisión de la literatura sobre el Síndrome de Sturge-Weber y se reporta el caso de un paciente de 18 meses de edad diagnosticado con esta patología que ingresa a urgencias por presentar cuadro febril de tres días y comienzo de convulsiones tónico clónicas localizadas en hemicuerpo derecho refractarias al tratamiento convencional; en esta revisión se resalta la importancia del diagnóstico y manejo oportuno al igual que un adecuado seguimiento. Desarrollo: se realizaron búsquedas en las bases de datos PubMed, Science Direct y Scielo, confirmando que aún se desconocen algunos aspectos de esta patología, sin embargo, con el descubrimiento de la mutación somática de GNAQ hay un amplio campo para próximas investigaciones. Hallazgos y conclusiones: Es importante en el ejercicio médico no pasar de alto las lesiones angiomatosas que posean una ubicación trigeminal en los recién nacidos, con el fin de establecer un diagnóstico oportuno e intentar conseguir un mejor desarrollo a futuro.

Abstract Sturge-Weber Syndrome is a rare developmental neuroectodermical disorder. It is characterized by a facial port-wine stain and a leptomeningeal angiomata, frequently localized ipsilateral to the facial port-wine stain. This syndrome predisposes either to brain atrophy, calcifications and refractory seizures. In this paper a Sturge-Weber Syndrome literature review was made and a 18 month aged child case with this diagnosis is reported. He was admitted to the emergency department of a local hospital with a history of three days of fever and tonic-clonic seizures localized on the right side and refractory to conventional treatment. This review highlights the importance of an early diagnosis and an appropriate follow up. To carry out this review a search in PubMed, Science Direct and Scielo databases was done, confirming that there are some issues about this disorder that are still unknown. However, with the GNAQ somatic mutation discovery, there is an open field for new researches. It is very important in medical practice not to understimate a facial port-wine stain over trigeminal territory in newborns in order to make an early diagnosis and try to achieve a better future neurodevelopment.

Negovsky y Safar unidos por la ciencia de la reanimación / Negovsky and Safar together for science of resuscitation

OBJECTIVE: This article characterize the contributions of Peter Safar and Vladimir Negovsky to the field of resuscitation and critical medicine during the 20th century and the dawn of the 21st century with the purpouse to correlate the discoveries and developments of each one, with their life stories and with the historical moments throughout the 20th century. MATERIALS AND METHODS: A review of literature on the subject was conducted, in which primary and secondary sources on the life and scientific and academic production of Vladimir Negovsky and Peter Safar were searched in online databases, in English as well as Spanish. RESULTS: Peter Safar and Vladimir Negovsky, although they had two very different life histories and developed their academic contributions in opposite political contexts, this did not prevent each of them from laying the foundations of cardiopulmonary resuscitation, both in the concepts and the physiopathological understanding of the damage processes, as well as the procedures to act in a timely manner, minimizing them. They also contributed to critical medicine, and to the formation of intensive care units. This work aims to show how a field of knowledge is based on collective work, as the discovery does not depend on a single character, but on a social, historical process, which is also based on the knowledge and elements developed by others.

OBJETIVO: Con este artículo se caracterizan los aportes de Peter Safar y Vladimir Negovsky en el campo de la reanimatología y de la medicina crítica durante el siglo XX y albores del siglo XXI, y se correlacionan sus investigaciones y descubrimientos con sus historias de vida y momentos compartidos. MATERIALES Y MÉTODOS: Se realizó una revisión de literatura sobre el tema, mediante la búsqueda de fuentes primarias y secundarias sobre la vida y producción científica y académica de Vladimir Negovsky y Peter Safar, en bases de datos en línea, en inglés y en español. RESULTADOS: Peter Safar y Vladimir Negovsky, pese a tener dos historias de vida muy distintas y desarrollar sus aportes académicos en contextos políticos diferentes, coincidieron en un campo de la ciencia que no les impidió que cada uno sentara las bases de la reanimación cardio cerebro pulmonar, tanto en los conceptos y en la comprensión fisiopatológica de los procesos de lesión, como en los procedimientos para prevenir la muerte y minimizar los efectos del proceso isquemia/reperfusión. Así mismo, concibieron y desarrollaron las unidades de medicina crítica y cuidado intensivo, el sistema integral para el transporte de los pacientes y el campo vasto en la formación de posgrados como anestesiología y medicina crítica. CONCLUSIÓN: Definitivamente la ciencia no tiene fronteras políticas y se fundamenta en el trabajo colectivo. Estos dos personajes vivieron tiempos políticos y sociales adversos, unieron lazos de amistad y compartieron experiencias para producir cambios históricos en la ciencia de la reanimación conocida como Reanimatología.

En búsqueda de la atención: necesidades en salud, itinerarios y experiencias / In search for health care: needs in health, itineraries and experiences / Em busca da atenção: necessidades em saúde, itinerários e experiências

Resumen Objetivo: El presente artículo analiza el proceso de una persona que deviene enferma para solucionar su condición de enfermedad, el surgimiento de la sensación de necesidad y cómo esta lo lleva por diferentes caminos (itinerarios), cada uno con sus cursos y particularidades, para buscar una atención. Nos enfocaremos en la búsqueda de los sujetos por una atención médica alopática institucional, representada por el hospital. Metodología: La metodología utilizada fue cualitativa, desde la teoría fundamentada, mediante la elaboración de 21 entrevistas semiestructuradas a pacientes de dos hospitales del departamento de Antioquia (Colombia). Se produjeron 1520 códigos y 42 categorías descriptivas, que derivaron en una categoría mayor: sentir la necesidad de consultar genera expectativas. Resultados: Como resultados se obtuvo que las necesidades configuran procesos complejos de búsqueda por la atención en salud, que involucra diversos sujetos e instituciones en las que se movilizan estrategias y recursos a fin de recibir una atención. Que la necesidad de atención en salud es producto de la concepción subjetiva de la enfermedad, a partir de la historia de vida, encuadrado en la cultura; lo que permite la construcción del síntoma y de la enfermedad y lleva al sujeto a una serie de itinerarios burocráticos y terapéuticos. Conclusiones: Concluimos que la condición de enfermedad, atravesada por la historia del sujeto construye una necesidad que, lo conduce a unos itinerarios en los que elabora múltiples expectativas en búsqueda de una solución, la cual pone en juego la institución médica hegemónica y la versión del sujeto sobre su cuerpo y sufrimiento.

Abstract Objective: This article analyzes the process of a person who becomes ill to solve his/her condition of illness, the emergence of the sensation of need and how this leads him/her through different paths (itineraries) each with its processes and particularities, to search for attention. The study focuses on the search of subjects for institutional allopathic medical care, represented by the Hospital. Methodology: The methodology used was qualitative, from the grounded theory, through the application of 21 semi-structured interviews to patients from two hospitals in the department of Antioquia, Colombia. There were 1520 codes and 42 descriptive categories, which led to a higher category: feeling the need to consult generates expectations. Results: The results showed that the needs set up complex processes of search for health care, involving various subjects and institutions, in which strategies and resources are mobilized in order to receive attention. They also show that the need for health care is a product of the subjective conception of the disease based on life histories which are framed in culture, allowing the construction of the symptom and the disease, and leads the subject to a series of bureaucratic and therapeutic itineraries. Conclusions: It was concluded that the disease condition traversed by the subject's history builds a need that leads him/her to some itineraries in which he/she elaborates multiple expectations in search of a solution that brings into play the hegemonic medical institution and the version of the subject on his/her body and suffering.

Resumo Objetivo: O presente artigo analisa o processo de uma pessoa que esta doente para solucionar sua condição de doença, o surgimento da sensação de necessidade e como esta o leva por diferentes caminhos (itinerários), cada um com seus cursos e particularidades, para buscar uma atenção. Enfocaremos-nos na busca dos sujeitos por uma atenção médica alopática institucional, representada pelo hospital. Metodologia: A metodologia utilizada foi qualitativa, desde a teoria fundamentada, mediante a elaboração de 21 entrevistas semi-estruturadas a pacientes de dois hospitais do departamento de Antioquia (Colômbia). Produziram-se 1520 códigos e 42 categorias descritivas, que derivaram em uma categoria maior: sentir a necessidade de consultar gera expectativas. Resultados: Como resultados se obtiveram que as necessidades configuram processos complexos de busca pela atenção em saúde, que envolvem diversos sujeitos e instituições nas que se movem estratégias e recursos a fim de receber uma atenção. Que a necessidade de atenção em saúde é produto da concepção subjetiva da doença, a partir da historia de vida, enquadrado na cultura; o que permite a construção do sintoma e da doença e leva ao sujeito a uma serie de itinerários burocráticos e terapêuticos. Conclusões: Concluímos que a condição de doença atravessada pela historia do sujeito constrói uma necessidade que o conduz a uns itinerários nos que elabora múltiplas expectativas em busca de uma solução, a qual põe em jogo a instituição médica hegemônica e a versão do sujeito sobre seu corpo e sofrimento.