Concomitant human papillomavirus (HPV) vaccination and screening for elimination of HPV and cervical cancer.

HPV vaccination with concomitant HPV-based screening of young women has been proposed for faster cervical cancer elimination. We describe the baseline results of a population-based trial of this strategy to reduce the incidence of HPV. All 89,547 women born 1994-1999 and resident in the capital region of Sweden were personally invited to concomitant HPV vaccination and HPV screening with 26,125 women (29.2%) enrolled between 2021-05-03 and 2022-12-31. Baseline HPV genotyping of cervical samples from the study participants finds, compared to pre-vaccination prevalences, a strong decline of HPV16 and 18 in birth cohorts previously offered vaccination, some decline for cross-protected HPV types but no decline for HPV types not targeted by vaccines. Our dynamic transmission modelling predicts that the trial could reduce the incidence of high-risk HPV infections among the 1994-1998 cohorts by 62-64% in 3 years. Baseline results are prevalences of HPV infection, validated transmission model projections, and power estimates for evaluating HPV incidence reductions at follow-up (+/-0.1% with 99.9% confidence). In conclusion, concomitant HPV vaccination and HPV screening appears to be a realistic option for faster cervical cancer elimination. Clinicaltrials.gov identifier: NCT04910802; EudraCT number: 2020-001169-34.

Estudio observacional prospectivo del impacto de los problemas de acceso al tratamiento como factores de riesgo de la adherencia y persistencia. Estudio piloto / Prospective observational study of the impact of problems accessing treatment such as risk factors for adherence and persistence. Pilot study

Introducción: se han realizado algunos estudios preliminares que muestran la aparición de factores de riesgo no investigados previamente relativos al sistema sanitario que pueden reducir la adherencia y/o persistencia de los tratamientos farmacológicos. De su conocimiento se pueden explorar posibles soluciones. Objetivo: estimar la incidencia de los factores de riesgo relativos al sistema sanitario que pueden reducir la adherencia/persistencia a los tratamientos asociados a problemas de acceso a los mismos en farmacia comunitaria. Método: estudio prospectivo aleatorizado transversal en farmacias comunitarias del Principado de Asturias y Aragón. La variable principal es la incidencia de nuevos factores de riesgo que hacen que la prescripción sea inadecuada para su dispensación. Se analizan diferentes subgrupos en función de tipo de factor de riesgo, tipo de población y tipo de prescripción.Resultados: el paciente tipo es una persona vulnerable en función de su edad (65,4 años), pluripatología y polifarmacia (6,8 medicamentos). Tras la evaluación de 138.697 dispensaciones en 98 farmacias comunitarias se detectaron 2.009 pacientes con 2.221 dispensaciones con factores de riesgo frente a la adherencia y/o persistencia (1,6  % de del total de dispensaciones). El tipo de incidencia más frecuentemente observado fue caducidad de la receta (54,7 %; IC95 %=52,6-56,8), seguido de ausencia de receta (18,7 %; IC95 %: 17,1-20,3). Por su parte los problemas de suministro alcanzaron el 10,2 % (IC95 %= 10,6 %-10,9 %). Los grupos terapéuticos más comprometidos fueron los grupos N-Sistema Nervioso (27,6 %), C-Aparato Cardiovascular (20,3 %) y A-Aparato Digestivo (15,3 %) (AU)

Measuring symptoms of obsessive-compulsive and related disorders using a single dimensional self-report scale.

Background: Obsessions and compulsions are heterogenous but can be classified into obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD), hair-pulling disorder (HPD), and skin-picking disorder (SPD). OCD is in itself heterogenous, with symptoms clustering around four major symptom dimensions: contamination/cleaning, symmetry/ordering, taboo obsessions, and harm/checking. No single self-report scale captures the full heterogeneity of OCD and related disorders, limiting assessment in clinical practice and research on nosological relations among the disorders. Methods: To provide a single self-report scale of OCD and related disorders that respects the heterogeneity of OCD, we expanded the DSM-5-based Obsessive-Compulsive and Related Disorders-Dimensional Scales (OCRD-D) so that is also includes the four major symptom dimensions of OCD. A psychometric evaluation and an exploration of the overarching relations among the dimensions were conducted using an online survey which was completed by 1,454 Spanish adolescents and adults (age span = 15-74 years). Approximately 8 months after the initial survey, 416 participants completed the scale again. Results: The expanded scale showed excellent internal psychometric properties, adequate test-retest correlations, known groups validity, and correlations in the expected directions with well-being, depression/anxiety symptoms, and satisfaction with life. The higher-order structure of the measure indicated that harm/checking and taboo obsessions formed a common disturbing thoughts factor and that HPD and SPD formed a common body-focused repetitive behaviors factor. Conclusion: The expanded OCRD-D (OCRD-D-E) shows promise as a unified way to assess symptoms across the major symptom dimensions of OCD and related disorders. The measure may be useful in clinical practice (e.g., screening) and research, but more research on construct validity, incremental validity, and clinical utility is needed.

Proyecto sobre dispensación excepcional en el Principado de Asturias / Project on exceptional dispensation in the Principality of Asturias

La farmacia comunitaria (FC) se enfrenta a diario con situaciones que impiden la dispensación adecuada del medicamento, poniendo en riesgo la continuidad de los tratamientos por parte de los pacientes, lo cual se traduce en problemas relacionados con los medicamentos (PRM). A través de este estudio piloto realizado en el Principado de Asturias, se ha querido cuantificar el número de incidencias de este tipo relacionadas con aquellos aspectos de la prescripción que podrían ser fácilmente subsanadas por el farmacéutico comunitario a través de intervenciones sencillas en el momento de la dispensación. Se llevó a cabo un estudio en diez farmacias de esta comunidad autónoma en el horario de apertura habitual a lo largo de quince días laborables. La muestra incluyó un total de 32.331 envases dispensados. En él se registraron 406 incidencias susceptibles de dispensación excepcional. La tasa de incidencia total alcanza el 1,26 % de las dispensaciones, lo que extrapolando al total de dispensaciones realizadas en Asturias durante el mes de octubre de 2020 daría una cifra de 27.030 dispensaciones totales susceptibles de dispensación excepcional.La tasa de incidencia total fue inferior en la farmacia urbana (1,03 %) frente a la semiurbana y rural (1,37 % y 1,39 %). La mayor parte de los casos (59,4 %) afectó a pacientes con aportación individual a la Seguridad Social correspondiente al 10 % (TSI2) y la edad media del paciente fue de 60,8 años. En cuanto al nivel asistencial, el 79 % de los casos corresponde a recetas de atención primaria (AP). El tipo más habitual de incidencia es “potencial interrupción por prescripción no activa en el momento de la dispensación (superado el margen de 10 días)” con una tasa de incidencia del 0,61 % de las dispensaciones, lo que supondría un total de 13.181 prescripciones susceptibles de dispensación excepcional por este tipo de incidencia...(AU)

Socio-emotional strengths against psychopathology and suicidal ideation in fear of COVID-19.

Coronavirus disease (COVID-19) has caused a global health crisis. It also leads to different types of psychosocial problems in society as a result of preventive health measures and the disease itself. Among others, psychopathological symptoms and suicide behaviors have increased. The PsicorecurSOS COVID-19 online protocol was designed. At baseline, 1020 Spanish adults were assessed, during confinement, for sociodemographics, fear of COVID-19, anxious-depressive symptoms, covitality, and suicidal ideation. Reliability, descriptive, and frequency analyses were carried out, and the computer tool SPSS PROCESS was used to carry out a conditional process analysis (model 59). A total of 595 participants were included (58.30% response rate from baseline; mean age = 37.18 [SD = 13.30]; 72.44% female). Regarding suicidal ideation, 12% responded differently to "never," 19.3% exceeded the cutoff point on the anxiety scale, and 24% on the depression scale. Moderate mediation analysis explained 27% of the variance in suicidal ideation. In addition, the indirect effect of moderate mediation was significant (b = -.004, SE = .002 with the presence of covitality; and b = .01, SE = .003 absence of covitality). Sex and age did not influence the overall outcome of the model. The data from this study can serve as a starting point for generating social and health treatment initiatives based on self-examination of anxiety-depressive symptoms and increasing socio-emotional skills in order to prevent and alleviate the psychosocial effects of the pandemic.

Síndrome de Rapunzel: hallazgos y sus complicaciones

Se reporta el caso de una niña de 10 años que acude al cuarto de urgencias con historia de tricofagia de 3 años de evolución, dolor abdominal y datos de abdomen agudo al examen físico. En la radiografía de abdomen se reconoce la cámara gástrica distendida con un patrón de gas moteado intragástrico, delineado por gas y en la tomografía de abdomen y pelvis, se visualiza masa intragástrica bien circunscrita heterogénea en patrón de gas moteado y datos de pancreatitis necrotizante. Se requirió manejo quirúrgico encontrándose tricobezoar que se extendía hasta la segunda porción del duodeno. (provisto por Infomedic International)

We report the case of a 10-year-old girl who came to the emergency room with a history of trichophagia of 3 years of evolution, abdominal pain and data of acute abdomen on physical examination. The abdominal X-ray showed a distended gastric chamber with an intragastric speckled gas pattern, delineated by gas, and the CT scan of the abdomen and pelvis showed a well-circumscribed heterogeneous intragastric mass with a speckled gas pattern and evidence of necrotizing pancreatitis. Surgical management was required and trichobezoar was found extending to the second portion of the duodenum. (provided by Infomedic International)

Acute lymphoblastic leukemia necessitates GSH-dependent ferroptosis defenses to overcome FSP1-epigenetic silencing.

Ferroptosis is a form of cell death triggered by phospholipid hydroperoxides (PLOOH) generated from the iron-dependent oxidation of polyunsaturated fatty acids (PUFAs). To prevent ferroptosis, cells rely on the antioxidant glutathione (GSH), which serves as cofactor of the glutathione peroxidase 4 (GPX4) for the neutralization of PLOOHs. Some cancer cells can also limit ferroptosis through a GSH-independent axis, centered mainly on the ferroptosis suppressor protein 1 (FSP1). The significance of these two anti-ferroptosis pathways is still poorly understood in cancers from hematopoietic origin. Here, we report that blood-derived cancer cells are selectively sensitive to compounds that block the GSH-dependent anti-ferroptosis axis. In T- and B- acute lymphoblastic leukemia (ALL) cell lines and patient biopsies, the promoter of the gene coding for FSP1 is hypermethylated, silencing the expression of FSP1 and creating a selective dependency on GSH-centered anti-ferroptosis defenses. In-trans expression of FSP1 increases the resistance of leukemic cells to compounds targeting the GSH-dependent anti-ferroptosis pathway. FSP1 over-expression also favors ALL-tumor growth in an in vivo chick chorioallantoic membrane (CAM) model. Hence, our results reveal a metabolic vulnerability of ALL that might be of therapeutic interest.

Resultados según comunidad autónoma del proyecto de dispensación excepcional / Results according to autonomous community of the exceptional dispensation project

INTRODUCCIÓN: el paciente se enfrenta a diario con situaciones que impiden la dispensación de sus medicamentos y que están causadas por problemas de inadecuación en el documento de la prescripción médica, lo que constituye un factor de riesgo de interrupción temporal o definitiva del tratamiento, que probablemente pueda empeorar los resultados en salud esperados. No se han llevado a cabo suficientes estudios que evalúen los efectos que tendría permitir al farmacéutico comunitario intervenir en estos supuestos concretos donde el acceso al medicamento esté comprometido.OBJETIVOS: estimar la incidencia de los factores de riesgo de interrupción de los tratamientos. Tipos de FR: A-desabastecimiento del medicamento prescrito: B-caducidad de la receta. C- prescripción con ausencia de receta. D-receta con forma farmacéutica (FF) inadecuada para el paciente-insuficientes dosis prescritas para finalizar el tratamiento.MATERIAL Y MÉTODOS: estudio descriptivo observacional transversal prospectivo, multicéntrico. Se ha registrado mediante un cuestionario alojado en una plataforma web, aquellas incidencias detectadas según los FR, en horario habitual de la farmacia, durante el periodo del 8-21 noviembre 2021, en FC de Aragón y Asturias. Para calcular el tamaño muestral se partió de los resultados del piloto realizado en Asturias en octubre de 2020.Utilizando las tasas de incidencia de cada tipo de dispensación excepcional (DE) se calculó por muestreo inverso mediante el programa de cálculo muestral Ene 3.0 (4) el número de casos necesarios para ajustar la amplitud de los intervalos de confianza (i.c. 95 %).Se han clasificado en farmacias: rurales (menos de 5000 habitantes), semiurbana (entre 5000-50.000) y urbana (más de 50.000). (AU)

Dispensación excepcional. Resultados según tipo de farmacia / Exceptional dispensing. Results by type of pharmacy

JUSTIFICACIÓN: la farmacia comunitaria (FC) se enfrenta a diario con situaciones que impiden la dispensación adecuada del medicamento y que están relacionadas con la forma farmacéutica, el tamaño del envase, la idoneidad de una presentación determinada, el extravío de la medicación por parte del paciente, etc. en las que el farmacéutico se ve obligado a derivar al médico de Atención Primaria (AP) debido a que su intervención, si hiciera esa dispensación, superaría sus competencias profesionales.OBJETIVOS: estimar el número de incidencias que impiden dispensar el fármaco adecuado y que podrían ser susceptibles de resolución por parte del farmacéutico comunitario, pero que por la normativa actual precisan obligatoriamente de la intervención del médico prescriptor.Material y Métodos se han clasificado las FC en función del número de habitantes que contiene la localidad en la que se encuentran, y son:-Urbana: más de 50.000-Semiurbana: entre 5.000-50.000 -Rural: menos de 5000 Se ha registrado mediante un cuestionario alojado en una plataforma web, aquellas incidencias detectadas según los FR, en horario habitual de la farmacia, durante el periodo del 8-21 noviembre 2021, en FC de Aragón y Asturias. Para calcular el tamaño muestral se partió de los resultados del piloto realizado en Asturias en octubre de 2020.RESULTADOS: una vez depurada la base de datos se incorporaron al estudio 138.697 dispensaciones, correspondientes a 87 FC, que cumplimentaron adecuadamente los registros. Un 44,37 % proceden de farmacias urbanas, 39,94 % farmacias semiurbanas y 15,69 % rurales. (AU)

Proyecto dispensación excepcional. Resultados según edad, sexo, duración del tratamiento prescrito y nivel asistencial / Exceptional dispensation project. Results according to age, sex, duration of prescribed treatment and level of care

INTRODUCCIÓN: la farmacia comunitaria (FC) se encuentra en una situación de cambio y evolución hacia un modelo de prestación de servicios profesionales farmacéuticos asistenciales. La dispensación excepcional, como complemento de la prescripción médica, constituye un campo de actuación fundamental.OBJETIVOS: estimar el número de incidencias que impiden dispensar el fármaco adecuado y que podrían ser susceptibles de resolución por parte del farmacéutico comunitario, pero que por la normativa actual precisan obligatoriamente de la intervención del médico prescriptor. Además, se busca segmentar esos resultados según edad, sexo, duración del tratamiento prescrito (crónico o agudo) y nivel asistencial del médico prescriptor (primaria u otra especialidad).MATERIAL Y MÉTODOS: estudio descriptivo observacional transversal prospectivo, multicéntrico de incidencia de los casos potenciales de dispensación excepcional. Se ha registrado mediante un cuestionario alojado en una plataforma web, aquellas incidencias detectadas según los FR, en horario habitual de la farmacia, durante el periodo del 8-21 noviembre 2021, en FC de Aragón y Asturias. Para calcular el tamaño muestral se partió de los resultados del piloto realizado en Asturias en octubre de 2020.Se han clasificado en farmacias: rurales (menos de 5000 habitantes), semiurbana (entre 5000-50.000) y urbana (más de 50.000).RESULTADOS: las características basales de la muestra a estudio son las siguientes, la población en la que se han presentado incidencias es mayor de 65 años (edad media: 65,4 años; DE: 19,2), predominantemente mujeres (59,7 %; IC95 %:57,5-61,8) con prescripciones para tratamientos crónicos (79,9 %; IC95 %=78,1-81,2) provenientes del ámbito de la atención primaria (90,6 %; IC95 %=89,4-91,9) Dentro de los resultados obtenidos, la población fue mayor de 65 años, en la que predominaban las mujeres. Los tipos de tratamientos crónicos y provenían del ámbito de la atención primaria. (AU)

A multi-group confirmatory factor analysis of the revised children's anxiety and depression scale (RCADS) in Spain, Chile and Sweden.

BACKGROUND: There is a need for a measure that can be used across countries and cultures to advance cross-cultural research about internalizing mental health symptoms in children and adolescents. The Revised Children's Anxiety and Depression Scale (RCADS) is a potential candidate, but no study has examined whether its scales are measured similarly in youth populations from different countries. METHODS: In this study, we use confirmatory factor analysis (CFA) and multi-group CFA to examine the cross-cultural properties of a short and free to use 30-item version of RCADS that assesses social, generalized, panic, and separation anxiety alongside depression and obsessive-compulsive symptoms. We tested the factor structure of RCADS in children and adolescents from Chile, Spain, and Sweden, recruited using different research designs (i.e., school-based studies and an anonymous web survey), and whether the factor structure showed measurement invariance across the three countries. RESULTS: The proposed factor structure of RCADS showed good model/data fit in all three countries and was superior to a unidimensional model in which correlations among scale items were explained by a single broad internalizing factor. Each RCADS subscale showed adequate to excellent internal consistency in all three countries and multi-group CFA supported scalar invariance across the three countries. LIMITATIONS: No clinical sample was included. CONCLUSIONS: This study provides an important first step in supporting the use of RCADS in cross-cultural research on depression, anxiety and obsessive-compulsive symptoms in children and adolescents, but more work on validity aspects of the scale across cultures is needed.

Honey bees can store and retrieve independent memory traces after complex experiences that combine appetitive and aversive associations.

Real-world experiences often mix appetitive and aversive events. Understanding the ability of animals to extract, store and use this information is an important issue in neurobiology. We used honey bees as model organism to study learning and memory after a differential conditioning paradigm that combines appetitive and aversive training trials. First, we used an aversive conditioning paradigm that constitutes a clear opposite of the well-known appetitive olfactory conditioning of the proboscis extension response. A neutral odour is presented paired with the bitter substance quinine. Aversive memory is evidenced later as an odour-specific impairment in appetitive conditioning. Then, we tested the effect of mixing appetitive and aversive conditioning trials distributed along the same training session. Differential conditioning protocols like this were used previously to study the ability to discriminate odours; however, they were not focused on whether appetitive and aversive memories are formed. We found that after differential conditioning, honey bees establish independent appetitive and aversive memories that do not interfere with each other during acquisition or storage. Finally, we moved the question forward to retrieval and memory expression to evaluate what happens when appetitive and the aversive learned odours are mixed during a test. Interestingly, opposite memories compete in such a way that they do not cancel each other out. Honey bees showed the ability to switch from expressing appetitive to aversive memory depending on their satiation level.

Late Outcomes of Transcatheter Coarctation Intervention in Infants with Biventricular Anatomy.

Determine outcomes of catheter intervention for aortic coarctation in infants. Aortic coarctation in infants following surgical repair and in high surgical risk native cases remains a challenging problem. Catheter intervention is an alternative to surgical intervention. Single-center, chart review of infants with biventricular anatomy who underwent coarctation stent placement or balloon angioplasty between 04/2004 and 04/2020. Outcomes of interest included change in aortic lumen diameter, peak gradient, number of re-interventions, time to re-intervention, and adverse events. Thirty-four patients were included in analysis, of those 16 underwent stent placement. Patients' mean age was 4.0 ± 3.0 months and weight of 5.3 ± 1.9 kg. Follow-up interval was 5.4 ± 5.1 years (0.2-16.1 years). Twelve (35%) patients underwent procedure due to ventricular dysfunction; the rest were for high resting gradient. Coarctation diameter increased from 2.4 ± 1.0 to 4.5 ± 1.3 (p < 0.01) and gradient decreased from 32.0 ± 18.4 mmHg to 9.2 ± 8.8 mmHg (p < 0.01). Thirteen (81%) of the stented patients required at least one re-intervention, at an average of 1.7 ± 3.2 years from the index procedure. Five (28%) of those undergoing balloon angioplasty required repeat intervention. There was no mortality due to the procedure and one late mortality. One patient had a serious procedural adverse event. On follow-up, 12 (35%) were on anti-hypertensive medications. Catheter intervention, including stent placement, for aortic coarctation in infants is feasible with an acceptable adverse event profile. Repeat interventions are common.

Endogenous formaldehyde scavenges cellular glutathione resulting in redox disruption and cytotoxicity.

Formaldehyde (FA) is a ubiquitous endogenous and environmental metabolite that is thought to exert cytotoxicity through DNA and DNA-protein crosslinking, likely contributing to the onset of the human DNA repair condition Fanconi Anaemia. Mutations in the genes coding for FA detoxifying enzymes underlie a human inherited bone marrow failure syndrome (IBMFS), even in the presence of functional DNA repair, raising the question of whether FA causes relevant cellular damage beyond genotoxicity. Here, we report that FA triggers cellular redox imbalance in human cells and in Caenorhabditis elegans. Mechanistically, FA reacts with the redox-active thiol group of glutathione (GSH), altering the GSH:GSSG ratio and causing oxidative stress. FA cytotoxicity is prevented by the enzyme alcohol dehydrogenase 5 (ADH5/GSNOR), which metabolizes FA-GSH products, lastly yielding reduced GSH. Furthermore, we show that GSH synthesis protects human cells from FA, indicating an active role of GSH in preventing FA toxicity. These findings might be relevant for patients carrying mutations in FA-detoxification systems and could suggest therapeutic benefits from thiol-rich antioxidants like N-acetyl-L-cysteine.

The incidence of recurrent laryngeal nerve injury resulting in vocal cord paralysis following interventional congenital catheterisation procedures.

BACKGROUND: Recurrent laryngeal nerve injury leading to vocal cord paralysis is a known complication of cardiothoracic surgery. Its occurrence during interventional catheterisation procedures has been documented in case reports, but there have been no studies to determine an incidence. OBJECTIVE: To establish the incidence of left recurrent laryngeal nerve injury leading to vocal cord paralysis after left pulmonary artery stenting, patent ductus arteriosus device closure and the combination of the procedures either consecutively or simultaneously. METHODS: Members of the Congenital Cardiovascular Interventional Study Consortium were asked to perform a retrospective analysis to identify cases of recurrent laryngeal nerve injury after the aforementioned procedures. Twelve institutions participated in the analysis. They also contributed the total number of each procedure performed at their respective institutions for statistical purposes. RESULTS: Of the 1337 patients who underwent left pulmonary artery stent placement, six patients (0.45%) had confirmed vocal cord paralysis. 4001 patients underwent patent ductus arteriosus device closure, and two patients (0.05%) developed left vocal cord paralysis. Patients who underwent both left pulmonary artery stent placement and patent ductus arteriosus device closure had the highest incidence of vocal cord paralysis which occurred in 4 of the 26 patients (15.4%). Overall, 92% of affected patients in our study population had resolution of symptoms. CONCLUSION: Recurrent laryngeal nerve injury is a rare complication of left pulmonary artery stent placement or patent ductus arteriosus device closure. However, the incidence is highest in patients undergoing both procedures either consecutively or simultaneously. Additional research is necessary to determine contributing factors that might reduce the risk of recurrent laryngeal nerve injury.

Relationships Between Emotion Regulation, Social Communication and Repetitive Behaviors in Autism Spectrum Disorder.

The relationship between emotion regulation, social interaction and different types of restricted and repetitive behaviors is poorly understood. In the present study, structural equation modeling based on information about 239 individuals with autism was used to examine whether emotion regulation and social communication were associated with self-injury and stereotyped behaviors. Results showed that poor emotion regulation had a unique association with self-injury while difficulties with social communication was uniquely associated with stereotyped behaviors. Emotion regulation and social communication were strongly associated and self-injury and stereotyped behaviors moderately associated. This implies that these types of behaviors are often expressions of broader negative emotional states in autism. Treatments that help improve coping and social communication strategies may benefit individuals with autism.

Differences in emotional state and autistic symptoms before and during confinement due to the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic has generated a global crisis that has affected the emotional health of both the general and the clinical population. METHOD: The present study aimed to analyze the differences between the emotional states of a group of individuals with ASD and a neurotypical group both during and after the COVID-19 confinement. The study also examined the changes in autistic symptoms between a group of individuals with ASD who were confined during the COVID-19 pandemic and another group of individuals with ASD who were studied prior to the COVID-19 pandemic period. RESULTS: Higher levels of aggression, irritability, hyperactivity and impulsivity, lack of attention and anxiety, among other symptoms, were found in individuals with ASD during confinement when compared to healthy controls (p < .05; p < .01). Higher levels of repetitive, restrictive, and stereotyped behaviors were also found in pandemic-era ASD individuals when compared to the group of individuals with ASD who were assessed prior to the pandemic (p < .01). CONCLUSIONS: the confinement is related to an increase in symptomatology and dysfunctional behaviours characteristic of ASD, and therefore it is necessary to implement actions that help to reduce this impact now, as well as in future crisis events.

Complex giant incisional hernia repair with intraperitoneal mesh: A case report.

INTRODUCTION AND IMPORTANCE: An incisional hernia is one of the most frequent complications after abdominal surgery, with an estimated incidence of 2-20% after midline laparotomy. They are often caused by poor wound healing. We present the case of a complex giant incisional hernia that was repaired by implanting an intraperitoneal mesh. CASE PRESENTATION: A 63-year-old man with obesity, hypertension, and multiple previous laparotomies, who developed a complex giant incisional hernia (xipho-pubic > 10 cm wide). An open technique repair was decided with the introduction of a large mesh (Parietex ™ Composite) in an intraperitoneal position, covering a 25 × 16 cm hernial ring. After two years, the patient continues to be followed due to a low-output distal enterocutaneous fistula. CLINICAL DISCUSSION: Currently, there is no technique or approach that has become a gold standard for ventral incisional hernia repair. The introduction of an intraperitoneal mesh with two surfaces by laparotomy is recommended when there are contraindications for laparoscopic surgery, for example in obese patients, and patients with multiple previous laparotomies. However, it has been reported to be a complex technique with an enterocutaneous fistula rate of 0.3-4%. CONCLUSION: The introduction of a composite mesh represents an alternative surgical technique for the repair of giant incisional hernias.

Neutrophil-to-lymphocyte ratio as a predictor of complicated acute diverticulitis: A retrospective cohort study.

INTRODUCTION: Currently, the debate on the usefulness of Neutrophil to Lymphocyte Ratio (NLR) as a predictor of complications in acute diverticulitis (AD) remains open, especially, the relation to the severity of the disease, the clinical impact, and the necessity of minimally invasive or emergency surgical procedures. On the other hand, its diagnostic efficacy has not been studied even in our field. The objective of the present study was to determine the utility and diagnostic precision of NLR in complicated acute diverticulitis (cAD). METHODS: Descriptive, retrospective cohort and analytical study. Patients older than 18 years with a diagnosis of AD were included, from 2013 to 2018. Demographic variables, days of hospitalization, leukocyte count, neutrophils, lymphocytes, ESR, CRP, and NLR were analyzed. The sensitivity and specificity for the diagnosis of cAD were determined using ROC curves. RESULTS: 325 patients were included. Of these 196 (60%) were men. The median age was 52 years. A total of 30 (9%) were categorized as cAD. The patients with cAD presented mean values in the leukocyte count (14.02 ± 4.49 × 109/l; p < 0.01), CRP (119.60 ± 87.67; p < 0.01) and NLR (7.61 ± 4.03; p < 0.01). An NLR cutoff value ≥ 4.2 was identified as the most appropriate to distinguish cAD, with a sensitivity of 80%, a specificity of 64%, NPV of 96%, and PPV of 18%. CONCLUSION: NLR is a predictive marker of cAD, with a cut-off point of 4.2 being the best diagnostic approach.

DetectaWeb-Distress Scale: A Global and Multidimensional Web-Based Screener for Emotional Disorder Symptoms in Children and Adolescents.

Emotional disorder symptoms are highly prevalent and a common cause of disability among children and adolescents. Screening and early detection are needed to identify those who need help and to improve treatment outcomes. Nowadays, especially with the arrival of the COVID-19 outbreak, assessment is increasingly conducted online, resulting in the need for brief online screening measures. The aim of the current study was to examine the reliability and different sources of validity evidence of a new web-based screening questionnaire for emotional disorder symptoms, the DetectaWeb-Distress Scale, which assesses mood (major depression and dysthymic disorder), anxiety (separation anxiety, generalized anxiety, social phobia, panic disorder/agoraphobia, and specific phobia), obsessive-compulsive disorder, post-traumatic stress disorder, suicidality (suicidal ideation, plans, and attempts), and global distress. A total of 1,499 participants (aged 8-18) completed the DetectaWeb-Distress Scale and specific questionnaires for emotional disorder symptoms, suicidal behaviors, and well-being through a web-based survey. Results indicated that a structural model of 10 correlated factors fits reasonably better in comparison to the remaining models; measurement invariance for age and gender; good internal consistency (McDonald's ω ranging from 0.65 to 0.94); and significant positive correlation with other measures of anxiety, depression, PTSD, or distress, and negative correlation with well-being measures, displaying support for convergent-discriminant validity. We also found that girls scored higher than boys on most of the subscales, and children had higher scores for social anxiety, specific phobia, panic disorder, and obsessive-compulsive symptoms, whereas adolescents scored higher on depressive symptoms, suicidality, and generalized anxiety, but the effect sizes were small to medium for all comparisons. The DetectaWeb-Distress Scale is a valid, innovative, and useful online tool for the screening and evaluation of preventive programs for mental health in children and adolescents.