Psychedelic Therapy: A Primer for Primary Care Clinicians-The Strengths, Weaknesses, Opportunities, and Threats of Psychedelic Therapeutics.

The reviews in this special edition have presented a primer on the state of the literature for 7 different psychedelic compounds and their plausible roles in medicine. In a common format underscoring strengths, weakness, opportunities, and threats (SWOT), this article addresses how psychedelic compounds fit into the broader health care landscape for indicated conditions. Historically, psychiatric pathologies have been treated with small-molecule compounds that have limited effect sizes and carry a variety of adverse effect profiles. Psychedelic medicines offer the opportunity to provide more potent and rapidly acting treatments. It is crucial to note that this is an emerging field of medicine, and only one of these compounds (esketamine) is currently Food and Drug Administration-approved for depression. The other compounds discussed are investigational, and this discussion is both imaginative and prospective in nature.

Psychedelic Therapy: A Primer for Primary Care Clinicians-Ketamine.

BACKGROUND: Ketamine, an arylcyclohexylamine dissociative anesthetic agent, has evolved into a versatile therapeutic. It has a rapid-onset, well-understood cardiovascular effects and a favorable safety profile in clinical use. Its enantiomeric compound, esketamine, was approved by the Food and Drug Administration in 2019 for both treatment-resistant depression and major depressive disorder with suicidal ideation. AREAS OF UNCERTAINTY: Research indicates dose-dependent impacts on cognition, particularly affecting episodic and working memory following both acute administration and chronic use, albeit temporarily for the former and potentially persistent for the latter. Alongside acute risks to cardiovascular stability, ketamine use poses potential liver toxicity concerns, especially with prolonged or repeated exposure within short time frames. The drug's association with "ketamine cystitis," characterized by bladder inflammation, adds to its profile of physiological risks. THERAPEUTIC ADVANCES: Data demonstrate a single intravenous infusion of ketamine exhibits antidepressant effects within hours (weighted effect size averages of depression scores (N = 518) following a single 0.5 mg/kg infusion of ketamine is d = 0.96 at 24 hours). Ketamine is also effective at reducing posttraumatic stress disorder (PTSD) symptom severity following repeated infusions (Clinician-Administered PTSD Scale scores: -11.88 points compared with midazolam control). Ketamine also decreased suicidal ideation in emergency settings (Scale for Suicidal Ideation scores: -4.96 compared with midazolam control). Through its opioid-sparing effect, ketamine has revolutionized postoperative pain management by reducing analgesic consumption and enhancing recovery. LIMITATIONS: Many studies indicate that ketamine's therapeutic effects may subside within weeks. Repeated administrations, given multiple times per week, are often required to sustain decreases in suicidality and depressive symptoms. CONCLUSIONS: Ketamine's comprehensive clinical profile, combined with its robust effects on depression, suicidal ideation, PTSD, chronic pain, and other psychiatric conditions, positions it as a substantial contender for transformative therapeutic application.

Psychedelic Therapy: A Primer for Primary Care Clinicians-Historical Perspective and Overview.

BACKGROUND: Psychedelic drugs have recently emerged as plausibly effective pharmacological agents for the management of depression, anxiety, and other neuropsychiatric conditions, including those that are treatment-resistent. The latter half of the 20th century marked a revolution in the treatment of mental illnesses, exemplified by the introduction of selective serotonin reuptake inhibitors and other pharmacological agents. Nevertheless, mental illness remains a major public health crisis, affecting nearly one billion individuals worldwide. AREAS OF UNCERTAINTY: Because of the decades-long status of several psychedelics as Schedule I drugs, there have not been very many large, double-blind, randomized controlled trials of psychedelics. Owing to small sample sizes, there may be rare yet serious adverse events that have not been reported in the clinical trials thus far. THERAPEUTIC ADVANCES: Esketamine, a dissociative hallucinogen drug, was approved for the management of major depressive disorder by the Food and Drug Administration in 2019. As of January 2024, two Phase III trials of 3,4-methylenedioxymethamphetamine (MDMA), a synthetic drug that inhibits the serotonin transporter, have been completed; the results indicate that MDMA is superior to existing pharmacological treatments for post-traumatic stress disorder. A phase III trial of psilocybin, a naturally occurring serotonin receptor partial agonist, is currently underway. The following series details the current state of research in psychedelic therapeutics, including lysergic acid diethylamide (LSD), N-N-dimethyltryptamine (DMT) and ayahuasca, psilocybin, ibogaine, MDMA, and ketamine. LIMITATIONS: While initial clinical trials of psychedelics for depression were very promising, trials of psilocybin with larger sample sizes (100+ participants) suggest that its remission rate is 25%-29%. This is about the same as the remission rate of antidepressants, which is roughly 30% according to the landmark STAR*D trial. CONCLUSIONS: Psychedelic drugs and structural derivatives offer a great deal of promise for the management of a wide range of psychiatric morbidities. It is imperative that clinicians become familiar with these novel agents and learn how to integrate psychedelic therapy with the rest of their care through open communication and referral.

Psychedelic Therapy: A Primer for Primary Care Clinicians-Lysergic Acid Diethylamide (LSD).

BACKGROUND: Lysergic acid diethylamide (LSD) is a hallucinogenic agent. In the mid-20th century, it was used to augment psychoanalysis and to treat alcohol use disorder. However, LSD was banned in 1970 in part because of concerns that it could bring about or exacerbate mental illness. Its therapeutic potential remains incompletely understood. AREAS OF UNCERTAINTY: While uncontrolled recreational use of LSD can, in rare instances, lead to long-term psychosis, adverse events in clinical trials of LSD, such as anxiety, headache, and nausea, have almost always been mild and transient. Serious adverse events, such as intense panic, suicidal ideation, and psychosis, were reported in either none or very few of the participants. However, patient selection criteria, optimal dosing strategy, and appropriate clinical follow-up guidelines remain to be established. THERAPEUTIC ADVANCES: Preliminary data suggest that LSD may be effective for the management of alcohol use disorder, anxiety, and depression. In trials of LSD for treating anxiety and depression associated with life-threatening illnesses, 77% of participants demonstrate durable relief at 1 year post-treatment. Top-line data from a large-scale phase IIb trial (n = 198) indicate that 50% of participants experience remission from generalized anxiety disorder after a single 100 µg dose of LSD. According to a meta-analysis of RCTs on LSD from the mid-20th century, single-dose regimens of LSD significantly improve alcohol use disorder (P < 0.0003) with an odds ratio (OR) of 1.96. LIMITATIONS: Only one large-scale clinical trial (>50 participants) has been conducted on LSD in the contemporary era of psychedelic research. Further studies with large sample sizes are needed to explore potential clinical applications. CONCLUSIONS: Preliminary data suggest that LSD may be one of the most potent treatments for anxiety in patients both with and without a life-threatening illness. LSD may also be beneficial for treating depression and substance use disorders.

Psychedelic Therapy: A Primer for Primary Care Clinicians-Ibogaine.

BACKGROUND: Ibogaine is a plant-derived alkaloid that has been used for thousands of years in rites of passage and spiritual ceremonies in West-Central Africa. In the West, it has primarily been used and studied for its anti-addictive properties and more recently for other neuropsychiatric indications, including post-traumatic stress disorder, depression, anxiety, and traumatic brain injury. AREAS OF UNCERTAINTY: Ibogaine requires careful patient screening and monitoring because of significant safety issues. There is potential for cardiotoxicity (prolonged QT interval); without rigorous screening, fatal arrhythmias may occur. However, preliminary research suggests that co-administration of ibogaine with magnesium may mitigate cardiotoxicity. Additionally, ibogaine may have dangerous interactions with opiates, so patients who receive ibogaine treatment for opioid use disorder must withdraw from long-acting opioids. Other potential concerning effects of ibogaine include rare incidences of mania or psychosis. Anticipated transient effects during ibogaine treatment can include ataxia, tremors, and gastrointestinal symptoms. THERAPEUTIC ADVANCES: Robust effects after a single treatment with ibogaine have been reported. In open-label and randomized controlled trials (RCTs), ibogaine reduces heroin and opioid cravings by upwards of 50%, up to 24 weeks after the treatment. An observational study of 30 Special Operations Forces veterans with mild traumatic brain injury reported that 86% were in remission from post-traumatic stress disorder, 83% from depression, and 83% from anxiety, one month after a single-dose ibogaine treatment. LIMITATIONS: Although there are several observational and open-label studies, there is only a single double-blind, placebo-controlled RCT on ibogaine. More RCTs with large sample sizes must be conducted to support ibogaine's safety and efficacy. CONCLUSIONS: Given the promising preliminary findings, ibogaine could potentially fill a much-needed gap in treatments for challenging conditions, including opioid dependence. Ibogaine's remarkable effects in traditionally treatment-resistant, combat-exposed individuals hints at its potential in broader populations with physical and psychological trauma.

Psychedelic Therapy: A Primer for Primary Care Clinicians-N,N-Dimethyltryptamine and Ayahuasca.

BACKGROUND: N,N-dimethyltryptamine (DMT) is a naturally occurring serotonergic psychedelic found in natural plants around the globe. As the main psychoactive component in ayahuasca, which also contains monoamine oxidase inhibitors, DMT has been consumed as plant-based brew by indigenous peoples for centuries. Further research is required to delineate the therapeutic utility of DMT. AREAS OF UNCERTAINTY: Although previous research has shown that DMT is synthesized endogenously, it may not be produced at physiologically relevant concentrations. Additionally, the phenomenological similarities between the DMT-induced state and near-death experiences led to the popular hypothesis that endogenous DMT is released during the dying process. However, this hypothesis continues to be debated. Generally, DMT and ayahuasca seem to be physiologically and psychiatrically safe, although ayahuasca is known to cause transient vomiting. THERAPEUTIC ADVANCES: A double-blind, randomized controlled trial showed that, within 1 week, ayahuasca causes remission in 36% of patients with treatment-resistant depression. According to top-line results from a recent phase IIa trial, 57% of patients with major depressive disorder experienced remission 12 weeks after receiving a single intravenous dose of DMT. LIMITATIONS: There has only been a single published double-blind randomized controlled trial on ayahuasca and 2 on DMT. All clinical trials have had small sample sizes (≤34 participants). DMT requires further research to understand its therapeutic and clinical potential as a psychedelic. CONCLUSIONS: Preliminary evidence indicates that ayahuasca and DMT may be more effective than existing antidepressants for treating major depressive disorder and treatment-resistant depression.

Psychedelic Therapy: A Primer for Primary Care Clinicians-3,4-Methylenedioxy-methamphetamine (MDMA).

BACKGROUND: After becoming notorious for its use as a party drug in the 1980s, 3,4-methylenedioxy-methampetamine (MDMA), also known by its street names "molly" and "ecstasy," has emerged as a powerful treatment for post-traumatic stress disorder (PTSD). AREAS OF UNCERTAINTY: There are extensive data about the risk profile of MDMA. However, the literature is significantly biased. Animal models demonstrating neurotoxic or adverse effects used doses well beyond the range that would be expected in humans (up to 40 mg/kg in rats compared with roughly 1-2 mg/kg in humans). Furthermore, human samples often comprise recreational users who took other substances in addition to MDMA, in uncontrolled settings. THERAPEUTIC ADVANCES: Phase III clinical trials led by the Multidisciplinary Association for Psychedelic Studies (MAPS) have shown that MDMA-assisted psychotherapy has an effect size of d = 0.7-0.91, up to 2-3 times higher than the effect sizes of existing antidepressant treatments. 67%-71% of patients who undergo MDMA-assisted psychotherapy no longer meet the diagnostic criteria for PTSD within 18 weeks. We also describe other promising applications of MDMA-assisted psychotherapy for treating alcohol use disorder, social anxiety, and other psychiatric conditions. LIMITATIONS: Thus far, almost all clinical trials on MDMA have been sponsored by a single organization, MAPS. More work is needed to determine whether MDMA-assisted therapy is more effective than existing nonpharmacological treatments such as cognitive behavioral therapy. CONCLUSIONS: Phase III trials suggest that MDMA is superior to antidepressant medications for treating PTSD. Now that MAPS has officially requested the Food and Drug Administration to approve MDMA as a treatment for PTSD, legal MDMA-assisted therapy may become available as soon as 2024.

Psychedelic Therapy: A Primer for Primary Care Clinicians-Psilocybin.

BACKGROUND: The primary psychoactive drug in magic mushrooms, psilocybin, induces profound alterations in consciousness through the 5-HT2A receptor. This review consolidates current research findings to elucidate the pharmacology, safety profile, and clinical applications of psilocybin. AREAS OF UNCERTAINTY: Despite initial concerns that psilocybin could cause psychosis, contemporary research has demonstrated that psilocybin is generally safe. The most common adverse effects are nausea and headache, yet both tend to be transient. Serious adverse events can generally be avoided in controlled settings such as clinical trials. However, in the largest clinical trial to date, there were a total of 7 reported cases of suicidal ideation, up to 12 weeks after receiving a single 25 mg dose of psilocybin. That being said, all 7 cases did not respond to the treatment. Although selective serotonin reuptake inhibitors may blunt the hallucinogenic qualities of psilocybin, preliminary research suggests that they may enhance its antidepressant effects. THERAPEUTIC ADVANCES: In clinical trials, psilocybin has shown promise for treating major depressive disorder and treatment-resistant depression. Initial studies indicated that 42%-57% of patients underwent remission after psilocybin-assisted therapy, which suggests that psilocybin is more effective than existing antidepressant medications. Clinical data have also demonstrated that psilocybin can manage substance use disorders and end-of-life anxiety with clinical outcomes that are sustained for months and sometimes years after 1 or 2 doses. LIMITATIONS: However, larger Phase II trials with more than 100 depressed participants have shown a much smaller remission rate of 25%-29%, though these studies still observed that psilocybin causes a significant reduction in depressive symptoms. CONCLUSIONS: Aside from ketamine, psilocybin is the most clinically well-researched psychedelic drug, with trials that have enrolled hundreds of participants and multiple therapeutic applications. Phase III trials will determine whether psilocybin lives up to the promise that it showed in previous clinical trials.

Adaptation and validation of content of the sedentary behavior questionnaire / Adaptación y validación de contenido del Sedentary behavior questionnaire / Adaptação e validação de conteúdo do Sedentary behavior questionnaire

Abstract Objective: to validate and adapt the Sedentary Behavior Questionnaire. Materials and methods: content adaptation and validation study, the Delphi technique was used, 18 experts evaluated the items of the questionnaire on a Likert scale regarding their relevance, utility, clarity, written form and length. Results: the questionnaire through its items assesses sedentary activity, the qualitative evaluation showed the need to adapt some questions regarding semantic to the Colombian context, the only item with an alpha lower than 0.70 was 7, the item with the highest Cronbach alpha was 10, the general Cronbach alpha of the instrument was 0.963, which is considered to be of optimal reliability. Conclusions: The content validation process showed that the Sedentary Behavior Questionnaire is a valid instrument in its content that is easy to apply and fill out, it allows a first approach to the sedentary behaviors of the subjects that can be complemented with physical tests to define the level of sedentary lifestyle, the foregoing enables the structuring of promotion and prevention programs by applying an instrument adapted and validated to the Colombian context.

Resumen Objetivo: adaptar y realizar la validación de contenido del Sedentary Behaviour Questionnaire. Materiales y métodos: estudio de adaptación y validación de contenido, se utilizó la técnica Delphi, participaron 18 expertos quienes evaluaron los ítems del cuestionario en una escala likert en cuanto a su pertinencia, relevancia, utilidad, claridad, redacción y extensión Resultados: El cuestionario a través de sus ítems evalúa la conducta sedentaria, la evaluación cualitativa mostró aspectos semánticos a tener en cuenta en algunas preguntas para realizar la adaptación al contexto colombiano, el único ítem con un alfa menor a 0,70 fue el 7, el ítem con mayor alfa de cronbach fue el 10, el alfa de cronbach general del instrumento fue de 0,963 este valor es considerado como de óptimo valor de confiabilidad; la versión definitiva incluye 3 nuevos ítems que complementan la valoración de la variable de interés. Conclusiones: el proceso de validación de contenido evidenció que el Sedentary Behaviour Questionnaire, es un instrumento válido en su contenido de fácil aplicación y diligenciamiento, permite una primera aproximación a las conductas sedentarias de los sujetos, este puede ser complementado con pruebas físicas para definir el nivel de sedentarismo, lo anterior posibilita la estructuración de programas de promoción y prevención, al aplicar un instrumento adaptado y validado al contexto colombiano.

Resumo Objetivo: validar e adaptar o Sedentary Behavior Questionnaire. Materiais e métodos: estudo de adaptação e validação de conteúdo, foi utilizada a técnica Delphi, 18 especialistas avaliaram os itens do questionário em uma escala Likert quanto à relevância, utilidade, clareza, forma escrita e extensão. Resultados: o questionário por meio de seus itens avalia a atividade sedentária, a avaliação qualitativa mostrou a necessidade de adequação de algumas questões semânticas ao contexto colombiano, o único item com alfa inferior a 0,70 foi 7, o item com maior alfa de Cronbach foi 10, o alfa de Cronbach geral do instrumento foi de 0,963, considerado de confiabilidade ótima. Conclusões: O processo de validação de conteúdo mostrou que o Sedentary Behavior Questionnaire é um instrumento válido em seu conteúdo, de fácil aplicação e preenchimento, pois permite uma primeira abordagem dos comportamentos sedentários dos sujeitos que podem ser complementados com testes físicos para definir os nível de sedentarismo, o anterior permite a estruturação de programas de promoção e prevenção por meio da aplicação de um instrumento adaptado e validado para o contexto colombiano.

Densidad mineral osea en escolares colombianos entre 8 y 16 años / Bone mineral density in colombian schools between 8 and 16 years old

INTRODUCCIÓN: La salud ósea está dada por un adecuado desarrollo del contenido mineral óseo en edades tempranas. OBJETIVO: Determinar la relación de la Densidad Mineral Ósea (DMO) con las variables sociodemográficas, antropométricas y práctica de actividad física en escolares colombianos. MÉTODOS: Estudio descriptivo transversal correlacional, participaron 1.940 escolares entre 8 y 16 años de diferentes ciudades colombianas, se realizó un muestreo aleatorio Se aplicó el cuestionario de actividad física PAQ-C versión colombiana y la medición de variables antropométricas las cuales sirvieron para determinar la DMO con el apoyo de fórmulas de predicción establecidas. A partir de la distribución normal de las variables mediante el estadístico de Pearson se establecieron las relaciones del estudio. RESULTADOS: Las medias de la DMO fueron superiores para las ciudades de Popayán, Pasto y Villavicencio, en los hombres, en los estratos 3,2,4 y 5, para quienes habían tenido fractura, y realizaban actividad física. La DMO presenta un incremento progresivo a medida que se aumenta la edad, siendo mayor el incremento en los hombres a partir de los 13 años. Al relacionar la DMO con la edad y el sexo se encontraron diferencias estadísticamente significativas para ambas variables p < 0,05. Se encontró una correlación directa y significativa entre la DMO, la edad, el índice de Masa Corporal (IMC) y la velocidad pico de crecimiento (APHV) de los escolares evaluados y en ciudades como Manizales, Neiva, Pasto y Villavicencio no hay correlación entre la DMO y la actividad física. CONCLUSIONES: Conocer la relación entre la DMO y variables como la edad, sexo, IMC y Actividad física permite establecer un diagnóstico del estado de salud ósea de los escolares con la intencionalidad de establecer acciones de promoción en salud que favorezcan el proceso de desarrollo y crecimiento de los escolares

INTRODUCTION: Bone health is given by an adequate development of bone mineral content at an early age. OBJECTIVE: To determine the relationship of the Bone Mineral Density (BMD) with the sociodemographic, anthropometric variables and the practice of physical activity in Colombian schoolchildren. METHODS: Descriptive cross-sectional correlational study, 1,940 schoolchildren between 8 and 16 years old from different Colombian cities participated, a random sampling was carried out The PAQ-C physical activity questionnaire was applied in the Colombian version and the measurement of anthropometric variables which served to determine BMD supported by established prediction formulas. From the normal distribution of the variables using the Pearson statistic, the study relationships were established. RESULTS: The means of BMD were higher for the cities of Popayán, Pasto and Villavicencio, in men, in strata 3,2,4 and 5, for those who had had a fracture, and carried out physical activity. BMD shows a progressive increase as age increases, the increase being greater in men from 13 years of age. When relating BMD to age and sex, statistically significant differences were found for both variables, p <0.05. A direct and significant correlation was found between BMD, age, Body Mass Index (BMI) and peak growth rate (APHV) of the evaluated schoolchildren and in cities such as Manizales, Neiva, Pasto and Villavicencio there is no correlation between BMD and physical activity. CONCLUSIONS: Knowing the relationship between BMD and variables such as age, sex, BMI and Physical activity allows establishing a diagnosis of the state of bone health of schoolchildren with the intention of establishing health promotion actions that favor the development and growth process of the schoolchildren

Composición corporal en escolares colombianos: Diferenciaspor sexo y edad / Body composition in Colombian schoolchildren: differences by sex and age

INTRODUCCIÓN: La composición corporal en escolares, se convierte en un aporte significativo para reorientación de programas en salud y educación, debido a que el incremento de índice de masa corporal, alto porcentaje graso y alto nivel de masa muscular puede asociarse con el aumento de enfermedades crónicas trasmisibles, primeras causas de muerte a nivel mundial. OBJETIVO: analizar las diferencias por sexo y edad de las variables de la composición corporal en escolares de diez ciudades colombianas. MÉTODO: estudio descriptivo transversal con una fase correlacional. Participaron 3458 escolares entre 12 y 18 años de edad, se realizó un muestreo aleatorio simple probabilístico, con un nivel de significancia de 5% y un poder de 80%, los escolares se seleccionaron aleatoriamente de los establecimientos públicos y privados de las ciudades seleccionadas. Se calcularon centiles a partir de la regresión Least Mean square por edad y sexo p3, p25, p50, p75, p90 y p97 con el método de los Least Mean squares (LMS, 'mínimos cuadrados') por curvas centiles que representan la asimetría, la mediana y la variabilidad se usó el paquete estadístico SPSS licenciado por la Universidad Autónoma de Manizales. RESULTADOS: Se encontraron correlaciones directas y significativas entre el %grasa y perímetro cintura, índice de masa corporal y edad tanto en hombres como en mujeres, en el grupo de mujeres él % grasa no mostró correlación con la edad. DISCUSIÓN: por edad y sexo se encontró como la media del índice de masa corporal y el porcentaje graso aumenta con la edad siendo mayor en mujeres, lo cual ha sido confirmado en otros estudios realizados en esta población. CONCLUSIÓN: las mujeres muestran valores más altos que los hombres, por edad, a medida que los escolares aumentan en edad la composición corporal cambia

INTRODUCTION: The study of body composition in schoolchildren, becomes a significant contribution to reorientation of programs in health and education, because the increase in body mass index, high percentage of fat and high level of muscle mass can be associated with the increase in chronic diseases transmissible, the leading causes of death worldwide. OBJECTIVE: to analyze the differences by sex and age of the variables Body Mass Index, percentage of fat and percentage of muscle mass in schoolchildren in ten Colombian cities. METHOD: cross-sectional descriptive study with a correlational phase.3458 schoolchildren between 12 and 18 years of age participated, a simple probabilistic random sampling was carried out, with a significance level of 5% and a power of 80%, schoolchildren were randomly selected from public and private establishments in the selected cities. Centiles were calculated from the Least Mean square regression by age and sex p3, p25, p50, p75, p90 and p97 with the Least method. Mean squares (LMS, 'least squares') by centile curves representing asymmetry, median and variability were used the statistical package SPSS licensed by the Autonomous University of Manizales. RESULTS: direct and significant correlations were found between % fat and waist circumference, body mass index and age in both men and women, in the group of women % fat showed no correlation with age. DISCUSSION: by age and sex was found as the mean body mass index and the fat percentage increases with age being higher in women, which has been confirmed in other studies conducted in this population. CONCLUSION: women show higher values than men, by age, as schoolchildren increase in age body composition changes

Exposure of Brazilian soil and groundwater to pollution by coccidiostats and antimicrobial agents used as growth promoters.

The World Health Organization has identified antimicrobial resistance as one of the most important threats to global health. Brazil is one of the world's leading meat producers and the Brazilian use of veterinary antimicrobials as therapeutic agents and prophylactic or growth promoters in animal production remains problematic. Many antimicrobials are not completely metabolized and their excretion represents a significant source of environmental exposure. The aim of this work was to estimate the exposure risk of soil and groundwater to pollution by growth promoters (GPs) and anticoccidial additives (AAs) in Brazil by using a method based on a geographical information system (GIS). The principle adopted is that the greater the amount of animals, the greater the quantity of antimicrobials present, and the greater the soil vulnerability to pollution. Our research showed that GPs and AAs are extensively used in the Brazilian animal production system. An analysis of market data showed that zinc bacitracin, monensin, salinomycin, colistin and tylosin are representative GPs and AAs. This study presents a qualitative approach for risk assessment based on worst-case scenarios. First, the probable environmental concentration was estimated using a correlation between the number of heads of the herds of poultry and cattle, and the amounts of drug released. The leaching risk potential was characterized for each compound, as proposed in ISO 15175. The potential of soil pollution was evaluated for each antimicrobial as a function of its binding and dissipation rates. These rates were calculated using georeferenced data of organic carbon, average temperature, water balance and hydro-geological parameters. The consequences were modeled based on Brazilian soil usage. Finally, the risk was calculated by combining the different maps generated using spatial multi-criteria decision analysis. Higher risk was found for the midwest, southeast and south regions of Brazil. Groundwater was found to be more vulnerable than soil.

No neurocognitive advantage for immediate antiretroviral treatment in adults with greater than 500 CD4+ T-cell counts

OBJECTIVE: To compare the effect of immediate versus deferred antiretroviral treatment (ART) on neuropsychological test performance in treatment-naive HIV-positive adults with more than 500 CD4 cells/µl. DESIGN: Randomized trial. METHODS: The START parent study randomized participants to commence immediate versus deferred ART until CD4 less than 350 cells/µl. The START Neurology substudy used eight neuropsychological tests, at baseline, months 4, 8, 12 and annually, to compare groups for changes in test performance. Test results were internally standardized to z-scores. The primary outcome was the average of the eight test z-scores (QNPZ-8). Mean changes in QNPZ-8 from baseline were compared by intent-to-treat using longitudinal mixed models. Changes from baseline to specific time points were compared using ANCOVA models. RESULTS: The 592 participants had a median age of 34 years; median baseline CD4 count was 629 cells/µl; the mean follow-up was 3.4 years. ART was used for 94 and 32% of accrued person-years in the immediate and deferred groups, respectively. There was no difference between the immediate and deferred ART groups in QNPZ-8 change through follow-up [-0.018 (95% CI -0.062 to 0.027, P = 0.44)], or at any visit. However, QNPZ-8 scores increased in both arms during the first year, by 0.22 and 0.24, respectively (P < 0.001 for increase from baseline). CONCLUSION: We observed substantial improvement in neurocognitive test performance during the first year in both study arms, underlining the importance of using a control group in studies assessing neurocognitive performance over time. Immediate ART neither benefitted nor harmed neurocognitive performance in individuals with CD4 cell counts above 500 cells/µl

Mobility of polivinylpyrrolidone coated silver nanoparticles in tropical soils.

Experiments in saturated soil columns were performed to investigate the transport and retention of 25 nm and 75 nm silver nanoparticles stabilized with polyvinylpyrrolidone (PVP-AgNPs) in two Brazilian soils (sandy and sandy-clay). The normalized concentration of the PVP-AgNPs was obtained through a flow injection analysis method based on the surface plasmon ressonance effect of the metallic nanoparticles. The use of the ultraviolet-visible spectroscopy (UV-Vis) allows a rapid and low-cost analysis. The obtained breakthrough curves (BCs) were modeled with a deterministic model of solute transport in steady conditions of water flow and considering two regions of non-physical equilibrium; this model allowed the determination of the hydrodynamic parameters. It was found that the process occurs in condition of non-equilibrium, with a low mass transfer for larger NP, and that the process is predominantly advective and affected by the pore size of the soil packed in the columns. The BCs for PVP-AgNPs obtained by UV-Vis spectroscopy were compared with the BCs obtained by ICP-MS and with BCs of the bromide anion, confirming that the nanoparticles have a low retention and few modifications when transported through the soil column. These PVP-AgNPs are highly mobile and can be transported through the studied tropical soils, representing a potential environmental problem, due to the possibility of these materials reaching groundwater. On the contrary, the conservative behavior of PVP-AgNPs in the studied tropical soils, indicates its potential use as tracers, substituting the bromide anion which has been demonstrated to be not a good tracer in the same conditions.

Estrongiloidiasis en inmunosuprimidos

Strongyloides stercoralis es el único helminto con reproducción intracorpórea, en inmunosuprimidos acelera la producción larvaria y propicia desenlaces fatales. Objetivo: Comparar el comportamiento clínico y de laboratorio de la infección por S. stercoralis en inmunosuprimidos con y sin VIH. Métodos: Estudio restrospectivo (1984 a 2005). Se evaluaron 328 pacientes inmunosuprimidos con estrongiloidiasis, VIH+ (n=99) y VIH- con neoplasias, tratamiento esteroideo o desnutridos (n=229). Se realizó hematología con fórmula leucocitaria, cuantificación de inmunoglobulinas séricas y exámenes de heces seriados con métodos directo, Kato, Kinyoun y Baermann; se incluyó cultivo en agar modificado a partir del 2000. Resultados: Los hombres prevalecieron en ambos grupos, VIH+ 88 % y VIH- 63 %. La edad promedio fue 44 años en VIH- y 37 años en VIH+. Recuento normal de leucocitos se demostró en 50 % de los pacientes de ambos grupos; cifras menores de 5 000 leucocitos predominaron en VIH+ (34 %, 20 %) y por encima de 10 000 en VIH- (31 %, 14 %). Menos de 500 eosinófilos/mm3 se detectaron en 60 % de los VIH+ y 25 % de los VIH-. La diarrea, común en ambos grupos, afectó más a VIH+ (86%) que a VIH- (62 %), tendencia a la consistencia líquida (VIH+ 90 %, VIH- 77 %), cronicidad (VIH+ 76%, VIH- 65 %) y pérdida de peso (VIH+ 72 %, VIH- 48 %). Conclusiones: La infección por S. stercoralis ocasiona gastroenteropatías más severas en pacientes VIH+ que en otros inmunosuprimidos, contribuyendo al desgaste orgánico. La eosinofilia es un indicador confiable de infección pero su ausencia no la excluye. En inmunosuprimidos, su despistaje debe ser rutinario.

Strongyloides stercoralis is the only intestinal helminth with intracorporeal reproduction, in immunosuppressed patients accelerates larval production and promotes fatal outcomes. Objective: To identify the symptoms and lab hematological values during S. stercoralis infection in immunosuppressed patients with or without HIV. Methods: retrospective study (1984-2005). We evaluated 328 immunosuppressed patients with strongyloidiasis, infected with HIV (n=99) and not infected with HIV, with neoplasms, under steroid treatment and undernourished (n=229). Hematology exam with leukocyte formula, quantification of serum immunoglobulins and stool tests with the direct methods, Kato, Kinyoun and Baermann were performed. Modified agar culture was included since the year 2000. Results: Male sex prevailed in both groups, 88 % (HIV+) and 63 % (VIH-). The average age was 44 years in VIH- and 37 years in HIV+. Normal leukocyte count was demonstrated in 50 % of patients in both groups; figures below 5 000 leukocytes predominated in HIV+ (34 %, HIV- 20 %) and above 10 000 in VIH- (31 %, HIV+ 14 %). Less than 500 eosinophils were detected in 60 % of HIV+ and 25 % of VIH-. Diarrhea, common in both groups, affected HIV+ more than VIH- (HIV+ 86%, VIH- 62 %), with a tendency to liquid consistency (HIV+ 90 %, VIH- 77 %), chronicity (HIV+ 76%, VIH- 65 %) and greater weight loss (HIV+ 72 %, VIH- 48 %). Conclusions: The infection by S. stercoralis causes more severe gastroenteropathies in HIV+ patients than in other immunosuppressed patients, contributing to a greater weight loss. Eosinophilia is a reliable indicator of infection but its absence does not exclude it. In immunosuppressed patients, screening should be routine.

Sorption of thiabendazole in sub-tropical Brazilian soils.

Thiabendazole (TBZ) is an ionizable anthelmintic agent that belongs to the class of benzimidazoles. It is widely used in veterinary medicine and as a fungicide in agriculture. Sorption and desorption are important processes influencing transport, transformation, and bioavailability of xenobiotic compounds in soils; data related to sorption capacity are therefore needed for environmental risk assessments. The aim of this work was to assess the sorption potential of TBZ in four Brazilians soils (sandy, sandy-clay, and clay soils), using batch equilibrium experiments at three pH ranges (2.3-3.0, 3.8-4.2, and 5.5-5.7). The Freundlich sorption coefficient (K F) ranged from 9.0 to 58 µg1-1/n  (mL) 1/n  g-1, with higher values generally observed at the lower pH ranges (2.3-3.0 and 3.8-4.2) and for clay soils. The highest organic carbon-normalized sorption coefficients (KOC) obtained at pH 3.8-5.7 (around the natural pH range of 4.1-5.0) for both clay soils and sandy-clay soil were 3255 and 2015 mL g-1, respectively. The highest correlations K F vs SOM (r = 0.70) and K F vs clay content (r = 0.91) were observed at pH 3.8-4.2. Our results suggest that TBZ sorption/desorption is strongly pH dependent and that its mobility could be higher in the studied soils than previously reported in soils from temperate regions.

Undivided attention improves postoperative anesthesia handover recall.

BACKGROUND: For years, undivided attention during the presurgical "timeout" has been utilized as a precaution to ensure patient safety. The information relayed during the timeout is presented in a confirmatory nature rather than a delegation of new information. However, it is a standard of practice in which all members of the operating theater provide their full and undivided attention. Standards of patient care should be contiguous throughout the preoperative, perioperative, and postoperative stages of surgery. In this manner, it is expected that the same undivided attention afforded during the timeout should be maintained when transferring the patient to the postanesthesia care unit. METHODS: In this study, information was collected regarding handover of information during the transfer status postsurgical procedures. Data were collected via observing interactions between the anesthesiologist and the nurse during verbal patient transfers. RESULTS: This study demonstrated that the presence of undivided attention during the handover of a surgical patient in the postanesthesia care unit has a direct correlation with improved recall of the information discussed during handover. CONCLUSION: Focus is on the quantity of information that can be recalled by the transferring nurse, and whether or not undivided attention affects the outcome. Analysis focuses on suggestions to better improve patient safety and recovery when being transferred in an anesthetic setting. The practice of patient handover should be standardized to better improve the safety and quality of medical care.