Near infrared spectroscopy (NIRS) and machine learning as a promising tandem for fast viral detection in serum microsamples: A preclinical proof of concept.

Fast detection of viral infections is a key factor in the strategy for the prevention of epidemics expansion and follow-up. Hepatitis C is paradigmatic within viral infectious diseases and major challenges to elimination still remain. Near infrared spectroscopy (NIRS) is an inexpensive, clean, safe method for quickly detecting viral infection in transmission vectors, aiding epidemic prevention. Our objective is to evaluate the combined potential of machine learning and NIRS global molecular fingerprint (GMF) from biobank sera as an efficient method for HCV activity discrimination in serum. GMF of 151 serum biobank microsamples from hepatitis C patients were obtained with a FT-NIR spectrophotometer in reflectance mode. Multiple scatter correction, smoothing and Saviztsky-Golay second derivative were applied. Spectral analysis included Principal Component Analysis (PCA), Bootstrap and L1-penalized classification. Microsamples of 70 µl were sufficient for GMF acquisition. Bootstrap evidenced significant difference between HCV PCR positive and negative sera. PCA renders a neat discrimination between HCV PCR-positive and negative samples. PCA loadings together with L1-penalized classification allow the identification of discriminative bands. Active virus positive sera are associated to free molecular water, whereas water in solvation shells is associated to HCV negative samples. Divergences in the water matrix structure and the lipidome between HCV negative and positive sera, as well as the relevance of prooxidants and glucose metabolism are reported as potential biomarkers of viral activity. Our proof of concept demonstrates that NIRS GMF of hepatitis C patients' sera aided by machine learning allows for efficient discrimination of viral presence and simultaneous potential biomarker identification.

Alternativas al encarcelamiento de las personas con problemas de salud mental: experiencias internacionales / Alternatives to incarceration for people with mental health problems: international experiences

Partiendo de la realidad de la plétora de personas con trastorno mental que pueblan las cárceles de países occidentales, la precaria atención clínica que reciben y el consiguiente efecto negativo que la estancia en prisión tiene para su porvenir, abordamos en este artículo los datos más relevantes de la relación entre delito y trastorno mental, y revisamos las experiencias más actuales en lo que se refiere a medidas alternativas a la prisión para personas con trastorno mental. Entre todas ellas nos ocupamos de revisar la experiencia de los tribunales especializados en EE. UU. que, desde la perspectiva de la Justicia Terapéutica, ofrecen programas alternativos a la prisión, con el objetivo de buscar una oportunidad para la recuperación de los pacientes. (AU)

Starting from the reality of the plethora of people with mental disorders that populate the prisons of Western countries, the precarious clinical care they receive, and the consequent negative effects that the stay in prison have on their future, in this article we review the most relevant aspects of the relationship between crime and mental disorder, and the newest experiences regarding alternative measures to prison for people with mental disorders. Among all of them, we examine the experience of specialized courts in the US, which, from the perspective of Therapeutic Justice, offer alternative programs to prison, aiming at offering an opportunity for the recovery of patients. (AU)

Calidad del Sueño, Estrés Percibido y Desórdenes Temporomandibulares Dolorosos en Adultos Jóvenes de Dos Comunidades Mexicanas

RESUMEN: Una mala calidad del sueño y estrés, pueden ser la génesis de anomalías temporomandibulares que consisten en una familia heterogénea de desórdenes músculoesqueletales que representan la afección de dolor orofacial crónica más común. El objetivo de este trabajo fue relacionar la calidad del sueño, estrés percibido y desórdenes temporomandibulares dolorosos en adultos jóvenes de dos comunidades mexicanas (Puebla y Yucatán). Material y Métodos: estudio de tipo correlacional, analítico, prospectivo, de corte transversal. Se obtuvo consentimiento informado y voluntario por medio de firmas de 552 sujetos adultos jóvenes: 276 de Puebla (P), 53 % (n=147) mujeres, 47 % (n= 129) hombres, con un promedio de 28 años (± 4,5); y 276 sujetos de Yucatán (Y), 58 % (n=161) mujeres, 42 % (n= 115) hombres, con un promedio de 27 años (±4,9). Se les realizó entrevistas con base a tres cuestionarios: Índice de Calidad de Sueño de Pittsburg (ICSP), Escala de Estrés Percibido de Cohen (EEP) e Instrumento de Examinación de Desórdenes Temporomandibulares Doloroso de González (IEDTD). Para el análisis estadístico se utilizó estadística descriptiva (frecuencias y porcentajes), regresión logística y correlación de Pearson. Puebla presenta un porcentaje mayor de individuos con calidad de sueño pobre 83 %, comparado con Yucatán, 56 %. De la misma forma, Puebla muestra un porcentaje mayor de individuos con estrés alto, 82 %, comparado con Yucatán, 74 %. Por otro lado, Puebla presenta un porcentaje mayor de individuos con DTM dolorosos, 33 %, comparado con Yucatán, 11 %. Asimismo, existe una correlación moderada general entre el estrés percibido y la calidad del sueño en mujeres (0,335) y edades de 30 a 35 años (0,383) ambas con una significancia de p <0,001. La calidad de sueño pobre aumenta 4 veces la posibilidad de padecer un DTM doloroso. Vivir en Puebla aumenta hasta 3.1 veces la posibilidad de un DTM doloroso.

ABSTRACT: Por sleep quality and stress may be the génesis of temporomandibular disorders that consist of a heterogeneous family of musculoskeletal disorders that represent the most common chronic orofacial pain condition. The objective of the study was to relate sleep quality, perceived stress, and painful temporomandibular disorders in Young adults from two Mexican communities (Puebla and Yucatán). a correlational, analytical, prospective, cross- sectional study. Informed and voluntary consent was obtained through the signatures of 552 young adult subjects: 276 from Puebla (P), 53 % (n = 147) women, 47 % (n = 129) men, with an average of 28 years (± 4.5); and 276 subjects from Yucatán (Y), 58 % (n = 161) women, 42 % (n = 115) men, with an average age of 27 years (±4.9). Interviews were conducted based on three questionnaires: Pittsburg Sleep Quality Index (ICSP), Cohen's Perceived Stress Scale (EEP) and González's Painful Temporomandibular Disorders Examination Instrument (IEDTD). Descriptive statistics (frequencies and percentages), logistic regression and Pearson's correlation were used for statistical analysis. Puebla has a higher percentage of individuals with por sleep quality, 83 %, compared to Yucatán, 56 %. In the same way, Puebla shows a higher percentage of individuals with high stress, 82 %, compared to Yucatán, 74 %. On the other hand, Puebla has a higher percentage of individuals with painful TMD, 33 %, compared to Yucatán, 11 %. Likewise, there is a general moderate correlation between perceived stress and sleep quality in women (0.335) and ages 30 to 35 years (0.383), both with a significance of p <.001. Poor sleep quality increases the chance of painful TMD by 4 times. Living in Puebla increases the possibility of painful TMD up to 3.1 times.

Impact of COVID-19 on the Anxiety Perceived by Healthcare Professionals: Differences between Primary Care and Hospital Care.

The COVID-19 pandemic has had an emotional impact on healthcare professionals at different levels of care, and it is important to understand the levels of anxiety of hospital personnel (HP) compared to those of primary care personnel (PCP). The objectives herein were to assess the differences in anxiety levels between these populations and to detect factors that may influence them. The anxiety levels (measured using the Hospital Anxiety and Depression (HAD) scale) of the HP and PCP groups were compared using data collected from a cross-sectional study. The secondary variables included demographic and health data, confinement factors, contact with COVID-19 patients, having suffered from COVID-19, perceptions of protection, caregiver overload, threat, and satisfaction with management. We found anxiety "case" (35.6%) and "at-risk" (21%), with statistically significant differences in the group "at risk", and higher scores in the PCP group. The factors associated with the perception of threat and protection were significant determinants of an increase in anxiety, with all of them showing statistically significant differences. There were greater symptoms of anxiety in the PCP group than the HP group (32% vs. 18%). The factors associated with the prevalence of anxiety symptoms were the perceptions of threat, protection, management, caregiver overload, and perceived degree of threat associated with COVID-19.

Clinical evolution of patients treated with aripiprazole long-acting injectable: a preliminary, prospective, observational study.

Objective: To evaluate the effectiveness of 6-month treatment with aripiprazole long-acting injectable (LAI) in improving psychotic symptoms, social functioning and side effects and reducing co-administered antipsychotic drugs.Methods: Multicentre, observational, prospective study that enrolled 53 patients with diagnosis of schizophrenia spectrum disorders who initiated or switched to aripiprazole LAI. The effectiveness of aripiprazole LAI was assessed through the Positive and Negative Syndrome Scale (PANSS), the Udvalg for Kliniske Undersogelser scale for side effects, the Global Assessment of Functioning and the Clinical Global Impression-Schizophrenia (CGI-SCH).Results: Upon treatment with aripiprazole LAI, patients significantly improved all the domains of PANSS (p < .05). Adverse event severity significantly improved after a 6-month aripiprazole LAI treatment (p < .05). Differences from baseline to month 6 in Global Assessment of Functioning score were significant (p = .0002). The proportion of severely ill patients decreased upon treatment with aripiprazole LAI (CGI-SCH scale). Prolactin levels were normalised after a 6-month treatment (from 43.0 to 14.7 ng/mL). Co-administered antipsychotic drugs significantly decreased after a 6-month treatment with aripiprazole LAI.Conclusion: A 6-month treatment with aripiprazole LAI improved the clinical status of our patients without modifying their metabolic profile, and allowed the reduction of co-administered antipsychotic drugs.Practice implicationsLong-acting injectable antipsychotics are effective treatment options for the maintenance of patients with schizophrenia and related disorders, and to ensure treatment adherence. This study describes the evolution of patients over six months of treatment with aripiprazole long-acting injectable. The results from this study support previous data on the efficacy and safety of this atypical antipsychotic. This study may be of wide interest to the community of psychiatrists and may help clinicians optimise treatment adherence in patients with schizophrenia spectrum disorders.Key pointsAripiprazole long-acting injectable is an atypical antipsychotic intended to improve treatment adherence and prevent relapses.This multicentre prospective study evaluated the effectiveness of aripiprazole long-acting injectable over six months of treatment on the control of a comprehensive set of clinical variables.Clinical rating scales showed that treatment with aripiprazole long-acting injectable improved clinical symptoms and social functioning, and reduced the severity of adverse events.Aripiprazole long-acting injectable contributed to the maintenance of adequate metabolic profiles and the normalisation of prolactin levels.Patients significantly decreased co-administered antipsychotic drugs after 6-month treatment with aripiprazole.

Síndrome d'activació macrofàgica com a forma de debut d'una artritis idiopàtica juvenil sistèmica / Síndrome de activación macrofágica como debut de una artritis idiopática juvenil sistémica / Juvenile systemic rheumatoid arthritis presenting as macrophage activation syndrome

INTRODUCCIÓ: La síndrome d'activació macrofàgica (SAM) és una limfohistiocitosi hemofagocítica que apareix en el context d'una malaltia reumatològica I típicament s'associa a l'artritis idiopàtica juvenil sistèmica (AIJS). CAS CLÍNIC: Es presenta el cas d'una nena de 23 mesos amb febre de 6 dies, hiperèmia conjuntival, exantema I edema al dors de mans I peus. Inicialment es va descartar una malaltia infecciosa I posteriorment es va orientar com a malaltia de Kawasaki. Se li va fer una ecocardiografia, amb resultat normal, I es va iniciar gammaglobulina endovenosa I ibuprofèn; no es va objectivar resposta clínica. L'estudi d'autoanticossos va ser negatiu. La pacient va presentar de manera progressiva artràlgies, hepatosplenomegàlia I embassament pleural. En l'analítica destacava anèmia, trombocitopènia, leucocitosi I elevació dels reactants de fase aguda (RFA). Davant la sospita clínica I analítica de SAM es va fer un aspirat de medul·la òssia, I no es van objectivar signes d'hemofagocitosi ni malignitat. Es va iniciar tractament amb corticosteroides a dosis altes; l'estat general va millorar, però van persistir la febre, les artràlgies, la leucocitosi I els RFA augmentats. Es va orientar com a debut d'AIJS associat a SAM, motiu pel qual es va afegir al tractament l'anti-IL-1 (anakinra). Al cap de 48 hores la febre va desaparèixer I la pacient ja presentava millora clínica I dels paràmetres inflamatoris I d'activació macrofàgica. COMENTARIS: La SAM és una malaltia potencialment mortal I pot ser el debut d'una malaltia sistèmica, com l'AIJS. Conèixer els criteris clínics I analítics de totes dues entitats és fonamental per al diagnòstic precoç. El tractament amb corticosteroides I amb anti-IL-1 sol ser molt eficaç

INTRODUCCIÓN: El síndrome de activación macrofágica (SAM) es una linfohistiocitosis hemofagocítica que aparece en el contexto de una enfermedad reumatológica y típicamente se asocia a la artritis idiopática juvenil sistémica (AIJS). CASO CLÍNICO: Se presenta el caso de una niña de 23 meses con fiebre de 6 días de evolución, hiperemia conjuntival, exantema y edema en el dorso de manos y pies. Inicialmente se descartó una enfermedad infecciosa y posteriormente se orientó como enfermedad de Kawasaki. Se realizó ecocardiografía, que resultó normal, y se iniciaron gammaglobulinas endovenosas e ibuprofeno, sin objetivarse una respuesta clínica. El estudio de autoanticuerpos resultó negativo. Progresivamente presentó artralgias, hepatoesplenomegalia y derrame pleural. Analíticamente destacaba anemia, trombocitopenia, leucocitosis y elevación de los reactantes de fase aguda (RFA). Bajo la sospecha de SAM se realizó aspirado de médula ósea sin objetivarse signos de hemofagocitosis ni malignidad. Se inició tratamiento con corticosteroides a dosis altas con mejoría del estado general, pero persistiendo fiebre, artralgias, leucocitosis y RFA aumentados. Se orientó como debut de AIJS asociado a SAM, por lo que se añadió al tratamiento la anti-IL-1 (anakinra). A las 48 horas desapareció la fiebre y presentó mejoría clínica y de los parámetros inflamatorios y de activación macrofágica. COMENTARIOS: El SAM es una enfermedad potencialmente mortal y puede ser el debut de una enfermedad sistémica como la AIJS. Conocer los criterios clínicos y analíticos de las dos entidades es fundamental para su diagnóstico precoz. El tratamiento con corticosteroides y con anti-IL-1 suele ser muy eficaz

INTRODUCTION: The macrophage activation syndrome (MAS) is a hemophagocytic lymphohystiocytosis developing in the context of a rheumatologic disease and it is commonly associated to systemic juvenile idiopathic arthritis (sJIA). CASE REPORT: A 23-month-old child was admitted with a six-day history of fever, conjunctival hyperemia, rash, and hand and foot edema. An infectious disease process was first ruled out, and Kawasaki disease was then suspected. The echocardiogram did not show abnormalities, and intravenous gamma globulin and ibuprofen were administered, without clinical response. The autoantibody screening was negative. The patient progressively developed arthralgias, hepatosplenomegaly and pleural effusion. Blood tests showed anemia, thrombocytopenia, leukocytosis, and elevated inflammatory markers. MAS was suspected, and bone marrow aspirate was performed, which showed no signs of hemophagocytosis or malignancy. Treatment with high-dose corticosteroids was started, resulting in improvement of the general condition of the patient, but with persistence of fever, joint pain, leukocytosis, and elevated inflammatory markers. sJIA-associated MAS was suspected, and interleukin-1-receptor antagonist (anakinra) was started, with significant clinical improvement, decrease in inflammatory markers, and resolution of the fever in 48 hours. COMMENTS: MAS is a life-threatening illness that can present as the first sign of sJIA. It is important to know the diagnostic criteria of both entities for early diagnosis. Treatment with corticosteroids and anti-IL-1 is very effective

Detección del consumo de alcohol inmediatamente antes del trasplante hepático, ¿recaída o continuidad del consumo? / Detection of alcohol prior to liver transplant, recurrence or continued use?

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Manía inducida por el tratamiento con corticoesteroides: revisión a partir de un caso clínico / Corticosteroid-induced mania: a case study and review

Los corticoides son fármacos muy usados en la práctica clínica habitual que, sin embargo, se asocian a frecuentes efectos adversos neuropsiquiátricos. Se describe el caso clínico de un varón de setenta y un años que desarrolló síntomas maníacos tras toma de corticoides y que fue tratado de forma satisfactoria con quetiapina. A partir de este caso, se realiza una revisión de la manía inducida por corticoides (AU)

Corticosteroids are drugs widely used in routine clinical practice that are however associated with neuropsychiatric adverse effects. This paper describes the case of a seventy-one- year man who developed manic symptoms after taking with corticosteroids and was successfully treated with quetiapine and, on the other hand, reviews corticosteroid-induced mania (AU)

Efectos psicológicos de un programa estructurado para preparación de pacientes a cirugía bariátrica / Psychological effects of a structured programme for preparing surgery patients

Se ha diseñado y aplicado un programa de tratamiento cognitivo-conductual para pacientes que van a ser sometidos a cirugía bariátrica. Se presentan los resultados referidos a la ansiedad y la depresión, tres meses después de su aplicación. Cincuenta candidatos a cirugía bariátrica completaron los cuestionarios BDI y STAI (E-R) antes y después de la implementación del programa (grupos 1 y 2), y nuevamente después de tres meses (grupo 2). Se han encontrado diferencias significativas en depresión y en ansiedad-rasgo antes y después de la aplicación del programa en ambos grupos. Asimismo, el Grupo 2 mostró también diferencias significativas entre el pre-programa y el seguimiento, pero no entre el post-programa y el seguimiento. Respecto de la ansiedad-estado, el Grupo 2 sólo mostró diferencias entre el pre-programa y el seguimiento con un tamaño del efecto muy alto. Los resultados muestran una reducción significativa en los niveles de ansiedad y depresión en los pacientes después del tratamiento y antes de ser sometidos a la cirugía bariátrica. Estos resultados no se mantienen estables durante el seguimiento y no se ha podido establecer una relación causal (AU)

A bariatric surgery preparation programme based on cognitive behavioural techniques was designed and implemented in a sample of 50 candidates for bariatric surgery. All participants completed the BDI short-form and STAI (E-R) questionnaires before and after the programme implementation (Groups 1 and 2) and again after a three-month follow-up (Group 2). The programme’s results are presented in terms of its effect on anxiety and depression levels three months after surgery. We found significant differences in depression and trait anxiety between pre- and post-treatment measures in both groups. Group 2 also showed significant differences between the pre-treatment and follow-up measures, but not between the post-treatment and follow-up measures. In the case of state anxiety, Group 2 showed differences between pre-programme implementation and follow-up with a large effect size, but not in the other comparisons. Conclusion: The results show a significant post-treatment reduction of anxiety and depression in bariatric surgery patients before surgery. These results do not remain stable during the follow-up and the authors are not able to establish a causal relationship (AU)

Trazodona combinada con ISRS e ISRN en pacientes deprimidos que presentan ansiedad e insomnio / Trazadone associated with SSRIs and SNRIs in depressed patients with anxiety and insomnia

Introducción: El clorhidrato de trazodona (TZD) es el primer miembro del grupo SARI. Combina la capacidad de bloqueo de la serotonina con su poder antagonista de los receptores 5-HT2A, sin estimular áreas del sistema nervioso central habitualmente relacionadas con la agitación, la ansiedad y los trastornos del sueño. La TZD ha mostrado ser una molécula eficaz y segura para el tratamiento de la depresión con efectos beneficiosos en el sueño y la ansiedad. Objetivo: Con frecuencia los pacientes deprimidos presentan, entre otros síntomas, problemas de sueño. Se ha publicado que la TZD sola o combinada con otros antidepresivos parece mejorar el insomnio. El objetivo del estudio fue evaluar, mediante escalas específicas, varios parámetros clínicos de la asociación. Material y método: Se ha incluido con intención de tratar a 50 pacientes depresivos, de edad entre 24 y 70 años, en tratamiento con ISRS o ISRN que presentaban trastornos del sueño. La administración simultánea de TZD se llevó a cabo desde el día 0 a dosis variable. Los días 0, 7, 21 y 42 se utilizaron: Calidad de Sueño, HAM-A, SF-12 y ZUNG-D. El día 42 se añadió ICG. La evaluación estadística se llevó a cabo con un programa SPSS. Resultados: Finalizaron el estudio y se evaluó a 38 pacientes. Añadir TZD parece haber resultado beneficioso para la calidad de vida del paciente, pues ha mejorado el sueño, la ansiedad y la depresión. Aumentó el número de horas de sueño, la calidad del sueño inicial, de mantenimiento y la sensación de sueño profundo, reparador y el descanso. La calidad de vida en su subescala mental mejoró ostensiblemente, mientras que la física no presentó variaciones significativas. En determinados casos fue necesario ajustar las dosis a lo largo del estudio. Sólo 4 de los 50 pacientes incluidos con intención de tratar abandonaron por efectos adversos leves. Conclusiones: Al agregar TZD al tratamiento con ISRS o ISRN de pacientes deprimidos que presentaban problemas residuales de sueño, mejoraron tanto la depresión como el insomnio y la ansiedad. Estos beneficios se acompañaron de una mejor situación emocional y vitalidad que afectaron positivamente a la calidad de vida del paciente. Sin embargo, son necesarios estudios que incluyan a más pacientes y puedan aportar datos estratificados. Por el momento, los disponibles apuntan a un uso beneficioso de la combinación (AU)

Introduction: Trazodone hydrochloride (TZD) is the first member of the group of serotonin-2 antagonists/reuptake inhibitors (SARI) antidepressants. This drug combines the ability to block serotonin with antagonistic action on the 5-HT2A receptors without stimulating the areas of the central nervous system usually associated with agitation, anxiety and sleep disturbances. TZD has been shown to be effective and safe in the treatment of depression, with beneficial effects on sleep and anxiety. Objective: Depressed patients often have sleep disorders, among other symptoms. TZD alone or in combination with other antidepressants has been reported to improve insomnia. The aim of the present study was to evaluate a number of clinical parameters of these associations, using specific scales. Material and method: Fifty depressed patients with sleep disturbances aged 24-70 years old and treated with selective serotonin reuptake inhibitors (SSRIs) or selective norepinephrine reuptake inhibitors (SNRIs) were enrolled in this study. The coadministration of TZD was carried out from day 0 at a variable dose. On days 0, 7, 21 and 42, Sleep Quality, the Hamilton Rating Scale for Anxiety (HAM-A), the 12-Item Short Form Health Survey (SF-12) and the Zung Self-Rating Depression Scale (ZUNG-D) were applied. On day 42, the clinical global impression (CGI) scale was added. The statistical analysis was performed using the SPSS package. Results: Thirty-eight patients completed the study and were analyzed. The addition of TZD appeared to enhance quality of life, improving sleep, anxiety and depression. The number of hours of sleep, the quality of initial and maintenance sleep, and the sensation of deep, reparatory sleep and rest all increased. The mental subscale of quality of life improved considerably, while the physical subscale showed no significant variations. In certain cases dose adjustment proved necessary during the study. Only 4 of the 50 patients included on an intent-to-treat basis dropped out because of mild or moderate adverse effects. Conclusions: In depressed patients with residual sleep disorders treated with SSRIs or SNRIs, the addition of TZD improved depression, insomnia and anxiety. These benefits were accompanied by an improved emotional state and vitality that positively influenced the patients' quality of life. However, studies involving a larger number of patients that could contribute stratified data are required. For the time being, the available information suggests that the above-mentioned drug combinations are beneficial (AU)

Acute cholestatic hepatitis probably associated with risperidone.

OBJECTIVE: Risperidone is an atypical neuroleptic drug widely used due to the lower incidence and severity of hepatic adverse effects in comparison to phenothiazines. Although idiosyncratic reversible hepatotoxicity may occur in association with risperidone, the interaction with fluoxetine might increase the risk of toxic liver injury in a vulnerable patient. METHODS AND RESULTS: We present a case of acute cholestatic hepatitis probably associated with the use of risperidone after only a few days of therapy in a patient also treated with fluoxetine. The patient, a 64-year-old male, developed a rapid increase in liver enzymes after starting treatment with only four doses of risperidone 2 mg/day. CONCLUSIONS: We recommend obtaining baseline liver function tests before starting risperidone and regular monitoring to screen patients for liver damage during therapy whenever a patient is also receiving fluoxetine.