Physical and anthropogenic drivers shaping the spatial distribution of microplastics in the marine sediments of Chilean fjords.

Several studies have focused on the presence and distribution of microplastics within the water column of coastal waters, but the dynamics of these particles in sediments have received little attention. Here we examine the concentrations and characteristics of microplastics in sediment samples collected from 35 stations within the Inner Sea of Chiloé, Chilean Patagonia. Current velocity, grain size, intensity of salmon farming activities, and human population density were all evaluated as factors potentially explaining concentrations and distribution of microplastic particles within these sediments. Microplastics were detected in all samples, with the highest abundance represented by fibers (88%), fragments (10%) and films (2%). Across the sampled sites, microplastic concentrations averaged 72.2 ± 32.4 (SD) items per kg dw (dry weight) sediment, with the principal polymers identified as polyethylene terephthalate (PET), acrylic, polypropylene (PP) and polyurethane (PUR). Approximately 40% of the variability in distribution and abundance of microplastics was explained by current velocity combined with proximity and intensity of local salmon production activities. SYNOPSIS: Marine currents and aquaculture intensity explain abundance and dynamics of microplastics in marine sediments.

Water column circulation drives microplastic distribution in the Martínez-Baker channels; A large fjord ecosystem in Chilean Patagonia.

We investigated the distribution of microplastics in the water column along a large remote estuarine system located between the Northern and Southern Patagonian Ice Fields in Chilean Patagonia, and connected with the Pacific Ocean through the Gulf of Penas. Microplastic particles were found in all samples, with abundances ranging from 0.1 to 7 particles/m3. Polymers identified were principally acrylics, PET, and cellophane. The average abundance of microplastics in surface waters was similar along the whole estuary (0.4 ± 0.3 particles/m3) with acrylics and epoxy resins being more abundant near Caleta Tortel, the only small village in the area. The observed higher abundance of microplastics in the deeper waters towards the Gulf of Penas points to intrusions of subsurface waters transporting plastic particles from the ocean into the channel system. This underlines the potential of ocean currents in transporting plastic pollution into pristine fjords and channels in Chilean Patagonia.

Bone Morphogenetic Protein-2 and Osteopontin Gene Expression in Epicardial Adipose Tissue from Patients with Coronary Artery Disease Is Associated with the Presence of Calcified Atherosclerotic Plaques.

PURPOSE: It has been proposed that the cardiovascular effects of obesity are related to epicardial adipose tissue (EAT), which seems to play an active role on the development and calcification of atherosclerotic plaques, but the mechanisms are still unknown. Therefore, the aim of this study was to determine whether the EAT expresses the genes of calcifying factors and whether such expression is associated with the body mass index (BMI) and with the presence of coronary artery calcium (CAC) in patients with coronary artery disease (CAD). PATIENTS AND METHODS: Forty-three patients with CAD were enrolled specifically for this study, and their CAC score and EAT volume were determined by computed tomography. As the group of comparison, 41 patients with aortic valve stenosis and CAC = 0 were included (control group). A representative subgroup of 16 CAD patients and 23 controls were selected to obtain EAT biopsies during the chirurgical procedure from the atrio-interventricular groove. The mRNA expression of bone morphogenetic protein-2 and -4 (BMP-2, BMP-4), osteopontin (OPN), osteonectin (ON), and osteoprotegerin (OPG) in EAT was determined by qPCR. RESULTS: The gene expression of OPN and BMP-2 was 70% and 52% higher in the EAT from CAD patients than that in controls, respectively, whereas the expression of OPG, ON, and BMP-4 was similar in both groups. The EAT volume positively correlated with OPG and with the BMI, suggesting a relationship of obesity with local higher expression of calcifying genes in the coronary territory. The logistic regression analysis showed that high levels of both OPN and BMP-2 increased about 6 and 8 times the odds of coronary calcification (CAC score > 0), respectively. CONCLUSION: EAT correlated with BMI and expressed the mRNA of calcifying genes but only OPN and BMP-2 expression was higher in CAD patients. Higher levels of both OPN and BMP-2 statistically determined the presence of calcium in coronary arteries of CAD patients.

Microencapsulated Pomegranate Modifies the Composition and Function of High-Density Lipoproteins (HDL) in New Zealand Rabbits.

Previous studies demonstrated that pomegranate, which is a source of several bioactive molecules, induces modifications of high-density lipoproteins (HDL) lipid composition and functionality. However, it remains unclear whether the beneficial effects of pomegranate are related to improvement in the lipid components of HDL. Therefore, in this placebo-controlled study, we characterized the size and lipid composition of HDL subclasses and assessed the functionality of these lipoproteins after 30 days of supplementation with a pomegranate microencapsulated (MiPo) in New Zealand white rabbits. We observed a significant decrease in plasma cholesterol, triglycerides, and non-HDL sphingomyelin, as well as increases in HDL cholesterol and HDL phospholipids after supplementation with MiPo. Concomitantly, the triglycerides of the five HDL subclasses isolated by electrophoresis significantly decreased, whereas phospholipids, cholesterol, and sphingomyelin of HDL subclasses, as well as the HDL size distribution remained unchanged. Of particular interest, the triglycerides content of HDL, estimated by the triglycerides-to-phospholipids ratio, decreased significantly after MiPo supplementation. The modification on the lipid content after the supplementation was associated with an increased resistance of HDL to oxidation as determined by the conjugated dienes formation catalyzed by Cu2+. Accordingly, paraoxonase-1 (PON1) activity determined with phenylacetate as substrate increased after MiPo. The effect of HDL on endothelial function was analyzed by the response to increasing doses of acetylcholine of aorta rings co-incubated with the lipoproteins in an isolated organ bath. The HDL from rabbits that received placebo partially inhibited the endothelium-dependent vasodilation. In contrast, the negative effect of HDL on endothelial function was reverted by MiPo supplementation. These results show that the beneficial effects of pomegranate are mediated at least in part by improving the functionality of HDL, probably via the reduction of the content of triglycerides in these lipoproteins.

First Molecular Identification of Canine Parvovirus Type 2 (CPV2) in Chile Reveals High Occurrence of CPV2c Antigenic Variant.

Canine parvovirus type 2 (CPV2) is one of the most important intestinal pathogens in dogs and puppies. CPV2 has been evolved into three genetic and antigenic variants (2a, 2b, and 2c), which are distributed worldwide. We reported the first study of genetic diversity of CPV2 in Chile. Sixty-five samples were collected from puppies presenting with severe gastroenteritis and different vaccination statuses. PCR, restriction fragment length polymorphism (RFLP), and partial sequencing of the coding region of the structural viral protein VP2 was performed. Thirty of a total of 65 samples tested positive by PCR out of which 19 were further classified as CPV2c and one as CPV2a using RFLP and Sanger sequencing. The phylogeny was in concordance with the RFLP analysis. This is the first report of the genetic characterization of CPV2 in Chile and reveals a high occurrence of CPV2c.

Atorvastatin and Fenofibrate Increase the Content of Unsaturated Acyl Chains in HDL and Modify In Vivo Kinetics of HDL-Cholesteryl Esters in New Zealand White Rabbits.

Previous studies demonstrated modifications of high-density lipoproteins (HDL) structure and apolipoprotein (apo) A-I catabolism induced by the atorvastatin and fenofibrate combination. However, it remains unknown whether such structural and metabolic changes of HDL were related to an improvement of the HDL-cholesteryl esters (HDL-CE) metabolism. Therefore, we determined the structure of HDL and performed kinetic studies of HDL-CE radiolabeled with tritium in rabbits treated with atorvastatin, fenofibrate, and a combination of both drugs. The atorvastatin and fenofibrate combination increased the HDL size and the cholesterol and phospholipid plasma concentrations of the largest HDL subclasses. Moreover, the relative amount of unsaturated fatty acids contained in HDL increased, in detriment of saturated fatty acids as determined by gas chromatography-mass spectrometry. The transfers of cholesteryl esters (CE) from HDL to very low-density lipoproteins/low-density lipoproteins (VLDL/LDL) and vice versa were enhanced with atorvastatin, alone or in combination. Moreover, the direct elimination of CE from plasma via VLDL/LDL decreased with fenofibrate, whereas the direct elimination of CE via HDL augmented with the combination treatment. Taken together, the rise of unsaturated fatty acid content and the size increase of HDL, suggest that atorvastatin and fenofibrate induce more fluid HDL particles, which in turn favor an enhanced CE exchange between HDL and VLDL/LDL. Our results contribute to a better understanding of the relationship between the structure and function of HDL during the use of anti-dyslipidemic drugs.

Atorvastatin and Fenofibrate Exert Opposite Effects on the Vascularization and Characteristics of Visceral Adipose Tissue in New Zealand White Rabbits.

Statins may precipitate the onset of type 2 diabetes (T2D) in high-risk patients. In contrast, only the subset of individuals with insulin resistance and/or diabetes receives cardiovascular benefits with fibrates. In this context, previous observations from our laboratory suggested that atorvastatin induced an increase in visceral adipose tissue (VAT), whereas fenofibrate had the opposite effects in rabbits. Therefore, we determined the mass, morphology, and vascularization of VAT in New Zealand white rabbits (n = 6/group) that received 0.33 or 2.6 mg/kg/d of atorvastatin or fenofibrate, respectively, during 2 months. As expected, the cholesterol from the atorvastatin group was lower after treatment, while triglycerides decreased in the fenofibrate group. The mass of VAT from the fenofibrate group was 46% lower compared to the controls, meanwhile atorvastatin was associated with a larger diameter of adipocytes (+65%) than that of the control and fenofibrate groups. Fibroblast growth factor 2 (FGF2) gene expression was lower in the fenofibrate group than in the control group (-54%). By contrast, vascular endothelial growth factor A (VEGF-A) gene expression in fenofibrate-treated rabbits was 110% higher than in the control group. In agreement with the gene expression, the marker of angiogenesis platelet endothelial cell adhesion molecule 1 was slightly but significantly higher (+10%) in rabbits treated with fenofibrate than in controls, as determined by immunohistochemistry. These results suggest that fenofibrate is associated with a favorable remodeling of VAT, that is, reduced mass and increased vascularization in normolipemic rabbits; in contrast, atorvastatin induced a nonfavorable remodeling of VAT. These results may be related to the cardiovascular benefits of fenofibrate and the increased risk of T2D in high-risk patients induced by atorvastatin.

Hyperuricemia is Associated with Increased Apo AI Fractional Catabolic Rates and Dysfunctional HDL in New Zealand Rabbits.

The potential cause-effect relationship between uric acid plasma concentrations and HDL functionality remains elusive. Therefore, this study aimed to explore the effect of oxonic acid (OA)-induced hyperuricemia on the HDL size distribution, lipid content of HDL subclasses, and apo AI turnover, as well as HDL functionality in New Zealand white rabbits. Experimental animals received OA 750 mg/kg/day by oral gavage during 21 days. The HDL-apo AI fractional catabolic rate (FCR) was determined by exogenous labeling with 125I, and HDL subclasses were determined by sequential ultracentrifugation and PAGE. Paraoxonase-1 activity (PON-1) and the effect of HDL on relaxation of aorta rings in vitro were determined as an indication of HDL functionality. Oxonic acid induced a sixfold increase of uricemia (0.84 ± 0.06 vs. 5.24 ± 0.12 mg/dL, P < 0.001), and significant decreases of triglycerides and phospholipids of HDL subclasses, whereas HDL size distribution and HDL-cholesterol remained unchanged. In addition, HDL-apo AI FCR was significantly higher in hyperuricemic rabbits than in the control group (0.03697 ± 0.0038 vs. 0.02605 ± 0.0017 h-1 respectively, P < 0.05). Such structural and metabolic changes were associated with lower levels of PON-1 activities and deleterious effects of HDL particles on endothelium-mediated vasodilation. In conclusion, hyperuricemia is associated with structural and metabolic modifications of HDL that result in impaired functionality of these lipoproteins. Our data strongly suggest that uric acid per se exerts deleterious effects on HDL that contribute to increase the risk of atherosclerosis.

First parasitological study of the African clawed frog (Xenopus laevis, Amphibia) in Chile.

Introduced species can arrive into new territories with parasites; however, these species are expected to face lower parasite richness than in their original regions. Both introduced hosts and parasites can affect native fauna. Since their release into the wild in Chile following laboratory use, Xenopus laevis Daudin, 1802 has widely spread throughout central Chile. The only pathogen described on the host is the fungus Batrachochytrium dendrobatidis Longcore, Pessier, Nichols, 1999; thus, this is the first parasitological study of this species in Chile. In 10 localities in central Chile, 179 specimens of X. laevis were captured and examined for parasites in the gastrointestinal tube, cavities, lungs, liver, and skin. Only nine specimens of the genus Contracaecum Railliet, Henry, 1912 were found in six specimens of X. laevis from a private dam in La Patagua. It is likely that these parasites originated from species of native birds. This is the first record of Contracaecum sp. in Chilean amphibians.

First parasitological study of the African clawed frog (Xenopus laevis, Amphibia) in Chile / Primeiro estudo parasitológico em rã com garras Africano (Xenopus laevis, Anfibia) no Chile

Abstract Introduced species can arrive into new territories with parasites; however, these species are expected to face lower parasite richness than in their original regions. Both introduced hosts and parasites can affect native fauna. Since their release into the wild in Chile following laboratory use, Xenopus laevis Daudin, 1802 has widely spread throughout central Chile. The only pathogen described on the host is the fungus Batrachochytrium dendrobatidis Longcore, Pessier, Nichols, 1999; thus, this is the first parasitological study of this species in Chile. In 10 localities in central Chile, 179 specimens of X. laevis were captured and examined for parasites in the gastrointestinal tube, cavities, lungs, liver, and skin. Only nine specimens of the genus Contracaecum Railliet, Henry, 1912 were found in six specimens of X. laevis from a private dam in La Patagua. It is likely that these parasites originated from species of native birds. This is the first record of Contracaecum sp. in Chilean amphibians.

Resumo Espécies exóticas podem se introduzir em um novo território com seus parasitas, porém nesses casos, a riqueza parasitária seria menor. Contudo, hospedeiros exóticos e seus parasitas associados podem afetar a fauna nativa. Depois de ser dispensado do uso em laboratórios e solto em ambientes naturais, Xenopus laevis Daudin, 1802 tem se espalhado massivamente no Chile central. O único patógeno descrito para este anuro é o fungo Batrachochytrium dendrobatidis Longcore, Pessier, Nichols, 1999. O presente estudo constitui a primeira pesquisa parasitológica realizada nesta espécie de rã introduzida no Chile. Em 10 localidades do Chile central, foram capturados 179 espécimes de X. laevis que foram examinadas em busca de parasitos dentro tubo digestivo, cavidades corporais, pulmões, fígado e pele. Nove espécimes do gênero Contracaecum Railliet, Henry, 1912 foram encontrados em seis espécimes de X. laevis de uma barragem em La Patagua. É provável que a origem destes parasitas sejam espécies de aves nativas. Este é o primeiro relato de Contracaecum sp. em anuros do Chile.

Small HDL subclasses become cholesterol-poor during postprandial period after a fat diet intake in subjects with high triglyceridemia increases.

BACKGROUND: Postprandial triglyceridemia may transitory affect the structure of HDL subclasses and probably their antiatherogenic properties but little is known in this field. We analyzed the HDL subclasses lipid content along postprandial period. METHODS: Fifteen metabolic syndrome (MS) patients and 15 healthy controls were enrolled. HDL were isolated from plasma samples obtained at fasting and every 2-h up to 8-h, after a 75-g fat meal. Cholesterol (C), triglycerides (TAG), and phospholipid (Ph) plasma concentrations of five HDL subclasses were determined by densitometry of electrophoresis gels enzymatically stained. RESULTS: The increase of postprandial triglyceridemia expressed as the incremental area under the curve (iAUC) was twice in MS patients than in controls. Only large HDL2b-TAG were higher in MS than controls at 4, 6 and 8h after meal intake, whereas cholesterol of HDL2a, 3a and 3b were lower at 8h. HDL size distribution shifted towards large HDL and HDL3a-, 3b- and 3c-subclasses had a lower content of cholesterol (estimated by the C-to-Ph ratio) in subjects whose iAUC>289.5mgh/dl (n=15) in comparison with those subjects with iAUC below this cutoff point (n=15), independently of the MS status and fasting TAG. Triglycerides content of HDL subclasses changed only discreetly along the postprandial period, whereas paraoxonase-1 remained unchanged. CONCLUSIONS: A high postprandial triglyceridemia conditions the shift of HDL size distribution towards large particles and the decrease of cholesterol in HDL3 subclasses. These data demonstrate that postprandial hypertriglyceridemia contributes to a transitory hypoalphalipoproteinemia that may increase the risk of cardiovascular disease.

Increased HDL Size and Enhanced Apo A-I Catabolic Rates Are Associated With Doxorubicin-Induced Proteinuria in New Zealand White Rabbits.

The catabolism and structure of high-density lipoproteins (HDL) may be the determining factor of their atheroprotective properties. To better understand the role of the kidney in HDL catabolism, here we characterized HDL subclasses and the catabolic rates of apo A-I in a rabbit model of proteinuria. Proteinuria was induced by intravenous administration of doxorubicin in New Zealand white rabbits (n = 10). HDL size and HDL subclass lipids were assessed by electrophoresis of the isolated lipoproteins. The catabolic rate of HDL-apo A-I was evaluated by exogenous radiolabelling with iodine-131. Doxorubicin induced significant proteinuria after 4 weeks (4.47 ± 0.55 vs. 0.30 ± 0.02 g/L of protein in urine, P < 0.001) associated with increased uremia, creatininemia, and cardiotoxicity. Large HDL2b augmented significantly during proteinuria, whereas small HDL3b and HDL3c decreased compared to basal conditions. HDL2b, HDL2a, and HDL3a subclasses were enriched with triacylglycerols in proteinuric animals as determined by the triacylglycerol-to-phospholipid ratio; the cholesterol content in HDL subclasses remained unchanged. The fractional catabolic rate (FCR) of [(131)I]-apo A-I in the proteinuric rabbits was faster (FCR = 0.036 h(-1)) compared to control rabbits group (FCR = 0.026 h(-1), P < 0.05). Apo E increased and apo A-I decreased in HDL, whereas PON-1 activity increased in proteinuric rabbits. Proteinuria was associated with an increased number of large HDL2b particles and a decreased number of small HDL3b and 3c. Proteinuria was also connected to an alteration in HDL subclass lipids, apolipoprotein content of HDL, high paraoxonase-1 activity, and a rise in the fractional catabolic rate of the [(131)I]-apo A-I.

Atorvastatin and fenofibrate combination induces the predominance of the large HDL subclasses and increased apo AI fractional catabolic rates in New Zealand white rabbits with exogenous hypercholesterolemia.

The anti-atherogenic properties of high-density lipoproteins (HDLs) may be related to their structure and metabolism. The HDL physicochemical characteristics that determine their plasma clearance during treatment with statins and fibrates are not well understood. In this study, we analyzed HDL-apo AI fractional catabolic rates (FCRs), size distributions, and the lipid composition of the HDL subclasses in New Zealand white rabbits with exogenous dyslipidemia that received low doses of atorvastatin and fenofibrate. Hypercholesterolemia decreased only partially with the combination of both drugs. HDL size distribution shifted toward larger particles among the groups of rabbits that received atorvastatin, fenofibrate, or their combination, compared with both the control group and the dyslipidemic group. The HDL subclasses were significantly rich in cholesterol in each of the groups compared with controls. The structural changes noted in the HDL subclasses were not associated with impaired plasma paraoxonase-1 (PON1) activity. The groups receiving monotherapy and the drug combination group were all associated with a higher apo AI FCR value compared with both the dyslipidemic rabbits and the control group. In conclusion, the combination of atorvastatin and fenofibrate induced a more favorable HDL subclass profile than did the individual use of these drugs. Similarly, the apo AI FCR values were augmented in every group receiving drug treatment (either monotherapy or combination therapy) in the setting of hypercholesterolemia. The anti-atherogenic properties of HDLs, excluding their capacity to bind PON1, may be enhanced by the structural and metabolic modifications induced by the combination of atorvastatin and fenofibrate.

El test de relaciones objetales en la evaluación de abuso sexual: comparación de tres grupos de adolescentes / The object relations test in sexual abuse assesment: a three adolescent groups comparison

El test de relaciones objetales en la evaluación de abuso sexual comparación de tres grupos de adolescentes En este artículo se presentan los resultados iniciales de una línea de investigación en evaluación de abuso sexual de la Unidad de Psiquiatría Infantil y de la Adolescencia de la Clínica Psiquiátrica Universitaria. El estudio es de carácter no-experimental, cuali-cuantitativo, descriptivo y comparativo, de muestreo no probabilístico e intencionado entre tres grupos de adolescentes, en igual proporción hombres-mujeres y de similares condiciones escolares y socioeconómicas. Incluye la comparación de los protocolos del Test de Relaciones Objetales (Phillipson, 1955) de 18 adolescentes, divididos en tres grupos: G1: adolescentes consultantes con antecedentes de abuso sexual; G2: adolescentes consultantes con trastorno del desarrollo de la personalidad Límite y GC: grupo control no clínico, con análisis ciego, utilizando modalidad de indicadores y de estilos relacionales y el análisis no paramétrico pertinente. Aunque la muestra es de reducido tamaño, permite una mayor precisión en la asociación de determinados indicadores y los antecedentes de abuso, ya que incluye la comparación de tres grupos, entre los cuales está un grupo clínico. De manera que los indicadores diferenciales no son atribuibles sólo a un distres emocional (como ocurre en otras investigaciones).Se observan diferencias significativas tanto en indicadores como en estilos relacionales. Entre los tres grupos estudiados, seis de los diecisiete indicadores son significativos asociados al G1 y cuatro de las diez variables de estilos relacionales difieren respecto al G1. La dimensión más distintiva entre G1 y G2 es la visión de mundo restrictiva y excluyente, asociada al antecedente de abuso.

This article presents the initial results of an investigation line regarding the evaluation of Sexual Abuse of the Infantile and Adolescence Psychiatric Unit of the Psychiatric Clinic of the Universidad de Chile. The study is of non-experimental, qualitative-quantitative, descriptive and comparative nature, of non-probabilistic and intended sample between three groups of teenagers, men and women in equal proportions, and of similar school and socioeconomic conditions. It includes the comparison of the Object Relations Test (Phillipson, 1955) protocols of 18 teenagers divided in three groups: G1: consultant teens with sexual abuse precedents; G2: consultant teens with abnormal personality development in the bordering line and GC: non clinical control group. The comparison was made with blind analysis, using relational styles and indicators modalities and non parametric pertinent analysis. Despite the reduced size of the sample, it allows a greater precision in the association of certain indicators and the abuse precedents since it includes the comparison of three groups, comprising a clinical group, therefore, the differential indicators are not attributable to only an emotional distress, as happens in other researches. Significant differences, either in indicators or in relational styles are observed. Among the three groups analyzed, 6 of 17 indicators are meaningful related to G1, and 4 out 10 variables of relational styles differ from G1. The most distinctive dimension between G1 y G2 is the restrictive and excluding vision of the world, associated to the event of the abuse. Correlations are observed among some indicators and specific relational styles, such as fights and arguments with the indicator of anxiety, another with anxiety and inexact logic or inexact logic with depressing feelings.

Treatment of postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile: a randomised controlled trial.

BACKGROUND: The optimum way to improve the recognition and treatment of postnatal depression in developing countries is uncertain. We compared the effectiveness of a multicomponent intervention with usual care to treat postnatal depression in low-income mothers in primary-care clinics in Santiago, Chile. METHODS: 230 mothers with major depression attending postnatal clinics were randomly allocated to either a multicomponent intervention (n=114) or usual care (n=116). The multicomponent intervention involved a psychoeducational group, treatment adherence support, and pharmacotherapy if needed. Usual care included all services normally available in the clinics, including antidepressant drugs, brief psychotherapeutic interventions, medical consultations, or external referral for specialty treatment. The primary outcome measure was the Edinburgh postnatal depression scale (EPDS) score at 3 and 6 months after randomisation. Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00518830. FINDINGS: 208 (90%) of women randomly assigned to treatment groups completed assessments. The crude mean EPDS score was lower for the multicomponent intervention group than for the usual care group at 3 months (8.5 [95% CI 7.2-9.7] vs 12.8 [11.3-14.1]). Although these differences between groups decreased by 6 months, EPDS score remained better in multicomponent intervention group than in usual care group (10.9 [9.6-12.2] vs 12.5 [11.1-13.8]). The adjusted difference in mean EPDS between the two groups at 3 months was -4.5 (95% CI -6.3 to -2.7; p<0.0001). The decrease in the number of women taking antidepressants after 3 months was greater in the intervention group than in the usual care group (multicomponent intervention from 60/101 [59%; 95% CI 49-69%] to 38/106 [36%; 27-46%]; usual care from 18/108 [17%; 10-25%] to 11/102 [11%; 6-19%]). INTERPRETATION: Our findings suggest that low-income mothers with depression and who have newly born children could be effectively helped, even in low-income settings, through multicomponent interventions. Further refinements to this intervention are needed to ensure treatment compliance after the acute phase.

Extra-axial chordoma.

Chordomas are low-grade malignant tumors of bone that occur almost exclusively in the axial skeleton. Other neoplasms with a similar histologic picture but an extra-axial location have been described, including parachordoma, myxoid chondrosarcoma, and extra-axial chordoma. We herein present another case of the rare extra-axial chordoma. A 41-year-old woman developed an 8.3 cm mass in the pubic bone. The gross, microscopic, and immunohistochemical findings were identical to those of a classic chordoma. Parachordoma and myxoid chondrosarcoma were excluded from the differential diagnosis. Five previously reported cases of extra-axial chordoma were reviewed and found also to demonstrate clinical and pathologic features specific to chordoma, despite arising in an extra-axial location. Although rare, extra-axial chordoma does exist and should be recognized and managed in a similar fashion to its well-described counterpart. It must be differentiated from other histologic mimics, because the treatment and prognosis can differ significantly.

Opciones terapéuticas en depresión posparto / Therapeutics alternatives in postpartum depression

La depresión posparto es una enfermedad del ánimo que constituye una complicación médica frecuente en el puerperio. Su diagnóstico y adecuado manejo son importantes debido a que tienen consecuencias a corto y largo plazo, tanto en la madre como en el/la hijo/a. El objetivo de este artículo es describir las opciones terapéuticas disponibles en la actualidad. Específicamente, se ha demostrado la eficacia de intervenciones psicoterapéuticas interpersonales, cognitivo-conductuales y consejería no directiva en el tratamiento de esta patología. Pese a que la eficacia de la farmacoterapia en la enfermedad depresiva está ampliamente demostrada, son escasos los ensayos clínicos controlados llevados a cabo en DPP. Se han estudiado los efectos de los fármacos antidepresivos siguiendo las indicaciones generales para el tratamiento de la depresión, se recomienda el uso de fármacos antidepresivos para los casos más severos. Con el conocimiento disponible se podría con cautela utilizar sertralina o nortriptilina, sin necesidad de suspender la lactancia materna. Se hacen necesarias investigaciones bien diseñadas para evaluar diferentes componentes del tratamiento además de combinaciones y programas de tratamiento que sean costo efectivos.