Spanish Validation of the Long and Short Versions of the Problematic Pornography Consumption Scale (PPCS and PPCS-6) in Adolescents.

Although 1-14% of adolescents may experience problematic pornography use (PPU), psychometrically sound instruments for assessing PPU in Spanish-speaking adolescents are scarce. Given the advantages of the different forms of the Problematic Pornography Consumption Scale (PPCS), the aim of the present study was to assess the psychometric properties of the PPCS and PPCS-6, and to examine associations between PPU and age among boys and girls. Two school-based adolescent samples were recruited in Spain (n = 650; Mage = 16.0 [SD = 1.1]; 50% girls and 50% boys) and Mexico (n1, 160; Mage = 15.8 [SD = 1.1]; 68% girls) to assess the psychometric properties of the PPCS and PPCS-6. Confirmatory factor analysis was applied and convergent and discriminant validity with other measures related to PPU was also tested. The results provided empirical support for the six-factor structure of the PPCS and the one-factor structure of the PPCS-6. Boys with older age showed higher levels of tolerance than girls on the PPCS in both countries. Both the PPCS and the PPCS-6 may be considered valid psychometric instruments for the assessment of PPU in Spanish-speaking adolescents from Spain and Mexico.

Eating disorders during lockdown: the transcultural influence on eating and mood disturbances in Ibero-Brazilian population.

BACKGROUND: COVID-19 pandemic has implied exceptional restrictive measures to contain its widespread, with adverse consequences on mental health, especially for those people with a background of mental illness, such as eating disorders (EDs). In this population, the influence of socio-cultural aspects on mental health has been still underexplored. Then, the main aim of this study was to assess changes in eating and general psychopathology in people with EDs during lockdown regarding the ED subtype, age, and provenance, and considering socio-cultural aspects (e.g., socioeconomical factors such as work and financial losses, social support, restrictive measures, or health accessibility, among others). METHODS: The clinical sample was composed of 264 female participants with EDs (74 anorexia nervosa (AN), 44 bulimia nervosa (BN), 81 binge eating disorder (BED), and 65 other specified feeding and eating disorder (OSFED)), with a mean age of 33.49 years old (SD = 12.54), from specialized ED units in Brazil, Portugal, and Spain. The participants were evaluated using the COVID-19 Isolation Eating Scale (CIES). RESULTS: A global impairment in mood symptoms and emotion regulation was reported in all the ED subtypes, groups of age, and countries. Spanish and Portuguese individuals seemed more resilient than Brazilian ones (p < .05), who reported a more adverse socio-cultural context (i.e., physical health, socio-familial, occupational, and economic status) (p < .001). A global trend to eating symptoms worsening during lockdown was observed, regardless of the ED subtype, group of age, and country, but without reaching statistical significance. However, the AN and BED groups described the highest worsening of the eating habits during lockdown. Moreover, individuals with BED significantly increased their weight and body mass index, similarly to BN, and in contrast to the AN and OSFED groups. Finally, we failed to find significant differences between groups of age although the younger group described a significant worsening of the eating symptoms during lockdown. CONCLUSIONS: This study reports a psychopathological impairment in patients with EDs during lockdown, being socio-cultural aspects potential modulatory factors. Individualized approaches to detect special vulnerable groups and long-term follow-ups are still needed.

Risk patterns in food addiction: a Mexican population approach.

BACKGROUND: Food addiction (FA) is a construct that has gained interest in recent years but its relevance in Mexican population is still unexplored. AIMS: The present study has the aims of explore FA in a community of Mexican population, as well as identifying the risk patterns associated with it, in relation to the different etiological factors that have been described such as impulsivity, emotional regulation and eating styles. Furthermore, to identify a predictive model of FA severity. METHODS: The sample consisted of 160 female and male university students of Pachuca city in México, who volunteered to participate in the study. Assessment included multidimensional measures for FA, eating disorder severity, eating disorder styles, emotional regulation and impulsivity. RESULTS: A screening of FA-probable was registered for 13.8% of the sample, while 8.1% met criteria for FA-present. The FA-present group differed from FA-absent in the impulsivity levels and in emotional eating style. Patients with FA-present differed from FA-probable in the impulsivity levels. Differences between FA-probable versus FA-absent were found in the restrained eating style. Path analysis evidenced that FA severity was directly associated with older age, worse eating style profile and higher impulsivity levels, and indirectly related with the ED symptom levels. CONCLUSIONS: Our findings suggest that it is possible to establish a specific predictive model of the development of FA and its severity in Mexican population to implement adequate prevention and treatment strategies. EVIDENCE LEVEL: Level III: evidence obtained from well-designed cohort or case-control analytic studies.

Efficacy of methadone for the management of postoperative pain in laparoscopic cholecystectomy: A randomized clinical trial. / Eficacia de la metadona para el tratamiento del dolor postoperatorio en colecistectomía laparoscópica: ensayo clínico aleatorizado.

BACKGROUND: Postoperative pain management contributes to reducing postoperative morbidity and unscheduled readmission. Compared to other opioids that manage postoperative pain like morphine, few randomized trials have tested the efficacy of intraoperatively administered methadone to provide evidence for its regular use or be included in clinical guidelines. METHODS: We conducted a randomized clinical trial comparing the use of intraoperative methadone to assess its impact on postoperative pain. Eighty-six patients undergoing elective laparoscopic cholecystectomy were allocated to receive either methadone (0.08 mg/kg) or morphine (0.08 mg/kg). RESULTS: Individuals who received methadone required less rescue morphine in the Post Anesthesia Care Unit for postoperative pain than those who received morphine (p = 0.0078). The patients from the methadone group reported less pain at 5 and 15 minutes and 12 and 24 hours following Post Anesthesia Care Unit discharge, exhibiting fewer episodes of nausea. Time to eye-opening was equivalent between the two groups. CONCLUSION: Intraoperative use of methadone resulted in better management of postoperative pain, supporting its use as part of a multimodal pain management strategy for laparoscopic cholecystectomy under remifentanil-based anesthesia.

INTRODUCCIÓN: El manejo del dolor postoperatorio contribuye a reducir la morbilidad postoperatoria y los reingresos no programados. Pocos ensayos clínicos aleatorizados han evaluado la eficacia de la administración intraoperatoria de metadona en comparación con otros opioides como morfina, para el tratamiento del dolor postoperatorio, como para proporcionar evidencia de su uso regular o incluirse en guías clínicas. MÉTODOS: Realizamos un ensayo clínico aleatorizado comparando el uso de metadona intraoperatoria para evaluar su impacto sobre el dolor postoperatorio. Ochenta y seis pacientes sometidos a colecistectomía laparoscópica electiva fueron asignados para recibir metadona (0,08 mg/kg) o morfina (0,08 mg/kg). RESULTADOS: El grupo de pacientes que recibió metadona requirió menos morfina de rescate en la unidad de cuidados post-anestésicos para el manejo del dolor posoperatorio, en comparación con el grupo morfina (p = 0,0078). Los pacientes del grupo metadona reportaron menos dolor a los 5 y 15 minutos, y a las 12 y 24 horas postoperatorias, además de presentar menos episodios de náuseas. El tiempo de despertar entre ambos grupos fue equivalente. CONCLUSIÓN: El uso intraoperatorio de metadona es superior a morfina en el manejo del dolor postoperatorio, apoyando su uso como parte de la estrategia de manejo multimodal del dolor para colecistectomía laparoscópica bajo anestesia total endovenosa con remifentanilo.

Miocardiopatía de y movimiento sistólico anterior de válvula mitral / Myocardiopaty and sistolic anterior movement of mitral valve

Tako tsubo cardiomyopathy associated with left ventricular outflow tract obstruction (LVOT) is a rare cause of persistent perioperative hypotension. One of the causes of this association is the systolic anterior motion (SAM) of the mitral valve. We report a case of a 67-year-old woman who, after undergoing liver segmentectomy because of metastasis, presents post-operative hypotension that is difficult to manage. Upon evaluation with a transthoracic echocardiogram, the diagnostic suspicion of Tako tsubo syndrome associated with LVOT obstruction secondary to SAM was raised. As initial therapy, a volume expander, in association with propanolol and phenylephrine were administred, achieving partial hemodynamic response. Later, she evolved with signs of heart failure and was transferred to the intensive care unit for management. In this unit, non-invasive ventilatory support, diuretic and vasopressor therapy were required, achieving favorable results on the second post-operative day. Echocardiography was essential to make the differential diagnosis against a persistent post-operative hypotension

La cardiomiopatía de Tako tsubo asociada a obstrucción del tracto de salida del ventrículo izquierdo (TSVI) es una causa poco frecuente de hipotensión persistente en el perioperatorio. Uno de los motivos de esta asociación es el movimiento anormal sistólico (SAM) de la válvula mitral. A continuación, presentamos el caso de una mujer de 67 años que, tras ser sometida a segmentectomía hepática por metástasis, presenta cuadro de hipotensión postoperatoria de difícil manejo. Al ser evaluada con ecocardiograma transtorácico se plantea la sospecha diagnóstica de síndrome de Tako tsubo asociado a obstrucción del TSVI secundario a SAM. Como terapia inicial se realizó aporte de volumen, en asociación con propanolol y fenilefrina, logrando parcial respuesta hemodinámica. Posteriormente, evolucionó con signos de insuficiencia cardiaca y fue trasladada a unidad de cuidados intensivos para su manejo. En esta unidad requirió apoyo ventilatorio no invasivo, terapia diurética y vasopresora, logrando resultados favorables al segundo día postoperatorio. La ecocardiografía fue fundamental para realizar el diagnóstico diferencial frente a un cuadro de hipotensión postoperatoria persistente.

Milrinona inhalada en hipertensión pulmonar: A propósito de un caso / Case Report: Inhaled milrinone in pulmonary hypertension

INTRODUCCIÓN: Pulmonary hypertension (PH) is a disease that is characterized for an elevated pressure in the pulmonary artery and an increased pulmonary vascular resistance (PVR). Inhaled milrinone has demonstrated acting as a selective pulmonary vasodilator, being a useful tool for the treatment of patients with PH in the perioperative. MATERIALS AND METHODS: We report a successful case of inhaled milrinone in PH in cardiovascular surgery. The patient signed the informed consent for this report. DISCUSSION: Patients with PH has increased risk of perioperative complications (mortality as far as 37-90%) The management with intravenous vasodilators is frequently limited because of secondary effects of vasodilation and hypotension affecting the myocardial perfusion pressure. Milrinone is an inodilator that acts as an inhibitor of the phosphodiesterase III. Wang et al., and posterior studies have demonstrated that administered by inhalation it acts as a selective pulmonary vasodilator and inotrope, with a minor systemic effect. CONCLUSION: Inhaled milrinone have demonstrated to be a useful drug to lower PH, PVR and to enhance inotropism without deleterious systemic effects. Wide availability, lower costs and ease of administration make you think as it could be an ideal tool for perioperative management in patients with PH. There are still more studies to define it´s potentials.

INTRODUCCIÓN: La hipertensión pulmonar (HTP) es una enfermedad caracterizada por la elevación de las presiones de arteria pulmonar (PAP) y un aumento de la resistencia vascular pulmonar (RVP). La milrinona inhalada ha demostrado actuar como un vasodilatador pulmonar selectivo siendo una herramienta útil en el manejo de los pacientes con HTP en el perioperatorio. MATERIALES Y MÉTODOS: Reportamos un caso exitoso de milrinona inhalada en HTP en cirugía cardiovascular. La paciente firmó el consentimiento informado para este reporte. DISCUSIÓN: Pacientes con HTP tienen mayor riesgo de complicaciones perioperatorias (mortalidad hasta 37-90%). Su manejo con vasodilatadores intravenosos es frecuentemente limitado por sus efectos secundarios de vasodilatación e hipotensión, perjudicando la presión de perfusión miocárdica. La milrinona es un inodilatador que actúa como inhibidor de la fosfodiesterasa III. Wang et al., y estudios posteriores, han demostrado que administrada por vía inhalatoria actúa como un vasodilatador pulmonar selectivo e inótropo, con menor efecto sistémico. CONCLUSIÓN: La milrinona inhalada ha demostrado ser una herramienta útil para la disminución de la PAP, RVP y mejoría del inotropismo, sin efectos sistémicos deletéreos. Su amplia disponibilidad, menor costo y facilidad de administración, hacen pensar que podría ser una herramienta útil para el manejo perioperatorio de los pacientes con HTP. Hacen falta más trabajos para definir sus potencialidades.

Left ventricular assist device (LVAD) program in Chile: first successful experience in South America.

BACKGROUND: The need to have a variety of tools to deal with end-stage heart failure (ES-HF), along with the limited heart transplantation availability encouraged us to create a pilot Left ventricular assist device (LVAD) program in a public health care system hospital in Chile. METHODS: A retrospective analysis of the first nine patients of an ongoing LVAD program initiated on August 2013 was performed, completing an average of 30 months of follow-up. The most important events regarding to morbidity and mortality are described. RESULTS: Nine patients with ES-HF underwent LVAD implantation surgery; one of them died 23 days after surgery and another died after 11 months. One patient successfully underwent heart transplantation after 16 months of HeartWare ventricular assist device (HVAD) support; the other six patients remain in the program and have an average follow-up of 846 days at the time of this study (range, 23-1,481 days). The survival rate at 6, 12 and 18 months follow-up was 89%, 78% and 78% respectively. CONCLUSIONS: This new pioneering LVAD program in Chile has been successful and now constitutes a vital adjunct to all who work in heart transplantation and ES-HF programs. It offers an effective therapeutic alternative when there is a severe donor shortage, in cases of atypical blood types, emergencies, exceptional cases with contraindication for heart transplantation or when there is important donor-receiver size mismatch.

Síndrome de infusión por propofol en el adulto / Propofol infusion syndrome

Propofol infusion syndrome is a rare but lethal complication of propofol administration. The most common clinical presentation is high anion-gap metabolic acidosis, heart failure, rhabdomyolysis and hyperkalemia in patients receiving a prolonged propofol infusion. It has an estimated incidence of 1,1% in patients receiving propofol and its mortality varies between 18 and 81%. The most important risk factor is an infusion over 4 mg/kg/h of propofol and a critically sick patient. Management of a diagnosed PRIS is based on immediate discontinuation of propofol and support therapy.

El síndrome de infusión de propofol es una complicación rara, pero posiblemente letal de la administración de propofol (Propofol Infusion Syndrome, PRIS) Generalmente, se presenta como una acidosis metabólica con anion Gap aumentado, falla cardiaca rápidamente progresiva, rabdomiólisis e hiperkalemia, junto con el antecedente claro de una infusión prolongada de la droga. La incidencia se estima en un 1,1% en los pacientes que reciben propofol y su mortalidad varía entre el 18 al 81%. Los factores de riesgo son: una infusión de propofol mayor a 4 mg/kg/h y pacientes críticos. El tratamiento se basa en la suspensión de la droga y medidas de soporte hemodinámico.

[Left ventricular assistant devices for end-stage heart failure: report of two cases]. / Asistencia ventricular intracorpórea en falla cardiaca terminal

In the last 2 decades, there have been significant advances in medical treatment of heart failure. However, there is a group of patients who are refractory to the available medical therapy and progress inevitably to a state of end-stage heart failure, whose only therapeutic alternative is cardiac transplantation. But this is an option limited by the scarce availability of donors. Therefore many patients die waiting for an organ. Recently, extra or intracorporeal left ventricular devices have emerged as a viable alternative for patients with end-stage heart failure waiting for a heart transplant. These devices discharge the left ventricle, increasing cardiac output and improving systemic perfusion. This year, in our hospital we began a left ventricular device implantation program for the most severely ill patients on the waiting list for cardiac transplantation. We report two males aged 30 and 53 years, in whom a left ventricular device was successfully implanted, using a minimally invasive surgical technique developed at the University of Hannover in Germany.

Asistencia ventricular intracorpórea en falla cardiaca terminal / Left ventricular assistant devices for end-stage heart failure: report of two cases

In the last 2 decades, there have been significant advances in medical treatment of heart failure. However, there is a group of patients who are refractory to the available medical therapy and progress inevitably to a state of end-stage heart failure, whose only therapeutic alternative is cardiac transplantation. But this is an option limited by the scarce availability of donors. Therefore many patients die waiting for an organ. Recently, extra or intracorporeal left ventricular devices have emerged as a viable alternative for patients with end-stage heart failure waiting for a heart transplant. These devices discharge the left ventricle, increasing cardiac output and improving systemic perfusion. This year, in our hospital we began a left ventricular device implantation program for the most severely ill patients on the waiting list for cardiac transplantation. We report two males aged 30 and 53 years, in whom a left ventricular device was successfully implanted, using a minimally invasive surgical technique developed at the University of Hannover in Germany.

Comparación de rasgos de personalidad entre pacientes con trastorno de la conducta alimentaria y sus hermanas sanas / Personality traits comparison between eating disorder patients and their healthy siblings

Los objetivos del presente estudio con pacientes-hermanas fueron: 1) Analizar diferencias existentes en sintomatología alimentaria y psicopatología general entre pacientes con trastorno alimentario (TCA) y hermanas discordantes para el trastorno, 2) Identificar en qué medida pacientes y hermanas presentan vulnerabilidades de personalidad diferenciales; 3) Identificar factores predictores de aparición de un trastorno alimentario. La muestra estuvo formada por 92 participantes mujeres (46 pacientes TCA vs 46 hermanas sanas). Todos los pacientes cumplían criterios DSM-IV-TR para el TCA. Los resultados mostraron diferencias significativas en todas las escalas de sintomatología alimentaria y psicopatología general entre ambos grupos. En términos de rasgos de personalidad, las pacientes con TCA presentaban una mayor evitación del daño (p<.001) y menor autodirección (p<.001) al ser comparadas con sus hermanas discordantes para el trastorno. Finalmente, los resultados mostraron que haber tenido historia previa de obesidad o sobrepeso (p=.027) y rasgos específicos de temperamento (elevada evitación al daño; p=.025) y carácter (baja autodirección; p=.009) se asociaban al posterior desarrollo de un TCA. La combinación de factores ambientales no compartidos, tales como obesidad con vulnerabilidades específicas de personalidad, influyen en la posterior aparición de un trastorno de la conducta alimentaria.

The aims of the study were threefold: 1) analyze differences in symptomatology and general psychopathology among eating disorder (ED) patients and their sisters discordant for eating disorders, 2) identify differential personality vulnerabilities between ED patients and their healthy sisters and 3) identify predictors of developing an eating disorder. The sample consisted of 92 female participants (46 ED patients fulfilling DSM-IV-TR criteria for eating disorders vs 46 healthy sisters). The results showed significant differences in eating symptomatology and general psychopathology. In terms of personality traits, ED patients had higher harm avoidance (p<.001) and lower self-directedness (p<.001) compared with their discordant sister. Finally, the results showed that having a history of obesity or overweight (p=.027), and specific traits of temperament (high scores on harm avoidance; p=.025) and character (low self-directedness; p=.009) were associated with the development of an ED. These findings allow to conclude that the combination of non-shared environmental factors such as obesity with specific vulnerabilities of personality, influence the subsequent emergence of an eating disorder.

Caracterización del material forestal de reproducción de cinco procedencias de nothofagus alessandrii espinosa, una especie en peligro de extinción / Characterization of forest reproductive material from five provenances of nothofagus alessandrii espinosa, an endangered species / Caracterização do material florestal de reprodução de cinco procedências de nothofagus alessandrii espinosa, uma espécie em perigo de extinção

Nothofagus alessandrii es una especie endémica de la zona mesomórfica de Chile que se encuentra en peligro de extinción y de la cual existe aún información insuficiente respecto de las diferencias entre sus poblaciones. Por ello, en este trabajo se analizan y caracterizan parámetros cualitativos y cuantitativos del material germinativo y el comportamiento en vivero de cinco procedencias representativas del área de distribución natural de la especie. Se colectaron semillas de estas procedencias en febrero 2000 y se determinó su tamaño, forma, peso y capacidad germinativa. En septiembre del mismo año se cultivaron plantas en vivero y se evaluó su crecimiento diametral y en altura. Los resultados indican que el tamaño de las semillas es, en general, homogéneo y solo se observan diferencias estadísticas en la longitud de las dímeras y ancho de las trímeras. El peso de 1000 semillas y la capacidad germinativa varió significativamente entre las procedencias. El desarrollo de las plantas en vivero fue homogéneo y no hubo diferencias en el diámetro de cuello de la raíz ni en la altura que alcanzaron las plantas después de una temporada de cultivo. N. alessandrii tiene un comportamiento diferente al de otras especies del mismo género, sin que se observe una variación de tipo clinal. Sin embargo, la procedencia más austral tiende a diferenciarse de las otras y, probablemente, corresponda a un ecotipo diferente.

Nothofagus alessandrii is an endemic and endangered species from the mesomorphic zone of Chile. Currently, differences across populations are not well known. To this end, quantitative and qualitative parameters pertaining to germinative material and nursery performance of seedlings from five provenances representing the natural distribution of the species were analyzed and characterized. Seeds were collected in February 2000 and size, form, weight, and germination capacity were determined. Seedlings were then cultivated in nursery in September of the same year, and basal diameter and height growth were quantified. Results indicate that seed size is generally homogeneous across sites, and statistical differences were limited to length of dimerous seeds and width of trimerous seeds. Seed weight and germination capacity varied significantly among the provenances. After one cultivation season, the development of the nursery plants was homogenous across provenances, with no differences in basal diameter or height. N. alessandrii differs, in relation to the variation among the studied provenances, from that of other species of the same genus, with the exception of a pronounced clinal type. However, the southern-most provenance tended, in general, to differ from the other ones and likely represents a different ecotype.

Nothofagus alessandrii é uma espécie endêmica da zona mesomórfica do Chile que se encontra em perigo de extinção e da qual existe ainda informação insuficiente em relação às diferenças entre suas populações. Por isto, neste trabalho se analisam e caracterizam parâmetros qualitativos e quantitativos do material germinativo e o comportamento em viveiro de cinco procedências representativas da área de distribuição natural da espécie. Recolheram-se sementes destas procedências em fevereiro de 2000 e se determinou seu tamanho, forma, peso e capacidade germinativa. Em setembro do mesmo ano se cultivaram plantas em viveiro e se avaliou seu crescimento diametral e em altura. Os resultados indicam que o tamanho das sementes é, em geral, homogêneo e somente se observam diferenças estatísticas no comprimento das dímeras e largura das trímeras. O peso de 1.000 sementes e a capacidade germinativa variou significativamente em relação às procedências. O desenvolvimento das plantas em viveiro foi homogêneo e não houve diferenças no diâmetro do colo da raíz nem na altura que alcançaram as plantas depois de uma temporada de cultivo. N. alessandrii tem um comportamento diferente ao de outras espécies do mesmo gênero, sem que se observe uma variação do tipo clinal. No entanto, a procedência mais austral tende a diferenciar-se das outras e, provavelmente, corresponda a um ecótipo diferente.

Oximetría cerebral durante paro circulatorio hipotérmico y perfusión cerebral retrógrada / Cerebral oximetry during hypothermic circulatory arrest with retrograde cerebral perfusion

Se presenta el caso de una paciente de 54 años que ingresa con el diagnóstico de disección aórtica tipo A. La reparación del defecto y reemplazo se realiza con paro circulatorio hipotérmico profundo por comprometer el nacimiento del tronco braquiocefálico y perfusión cerebral retrógrada como método de protección cerebral. Durante todo el procedimiento se monitorizó la oximetría cerebral regional para evaluar disminuciones de la saturación y riesgo de isquemia en relación a cambios en la hemodinamia asociados al paro circulatorio, a la perfusión cerebral retrógrada y a las distintas medidas tomadas para aumentar el periodo libre de isquemia durante el paro. La disminución de la oximetría se relaciona a disminución del aporte de oxígeno, y por lo tanto, a un mayor riesgo de isquemia. En el presente caso, se observó el beneficio del uso de perfusión cerebral retrógrada como método de protección cerebral.

A case report of a 54 year patient with a type A aortic disecction is presented. Because of braquiocephalic compromise, the surgery was performed under deep hypotermic circulatory arrest. Retrograde cerebral perfusion was used for cerebral protection. Regional cerebral oxymetry was monitored during the entire procedure in order to correlate hemodynamic changes associated to circulatory arrest with reduction of saturation, risk of ischemia and therapeutics used for augmenting ischemic free periods. The reduction of oxygen supply correlates with low oxygen deliver and with high risk of ischemia. Benefits in cerebral protection were seen with the use of retrograde cerebral perfusion.