Sex and adrenal hormones in association with insecticide biomarkers among adolescents living in ecuadorian agricultural communities.

BACKGROUND: Organophosphate, pyrethroid, and neonicotinoid insecticides have resulted in adrenal and gonadal hormone disruption in animal and in vitro studies; limited epidemiologic evidence exists in humans. We assessed relationships of urinary insecticide metabolite concentrations with adrenal and gonadal hormones in adolescents living in Ecuadorean agricultural communities. METHODS: In 2016, we examined 522 Ecuadorian adolescents (11-17y, 50.7% female, 22% Indigenous; ESPINA study). We measured urinary insecticide metabolites, blood acetylcholinesterase activity (AChE), and salivary testosterone, dehydroepiandrosterone (DHEA), 17ß-estradiol, and cortisol. We used general linear models to assess linear (ß = % hormone difference per 50% increase of metabolite concentration) and curvilinear relationships (ß2 = hormone difference per unit increase in squared ln-metabolite) between ln-metabolite or AChE and ln-hormone concentrations, stratified by sex, adjusting for anthropometric, demographic, and awakening response variables. Bayesian Kernel Machine Regression was used to assess non-linear associations and interactions. RESULTS: The organophosphate metabolite malathion dicarboxylic acid (MDA) had positive associations with testosterone (ßboys = 5.88% [1.21%, 10.78%], ßgirls = 4.10% [-0.02%, 8.39%]), and cortisol (ßboys = 6.06 [-0.23%, 12.75%]. Para-nitrophenol (organophosphate) had negatively-trending curvilinear associations, with testosterone (ß2boys = -0.17 (-0.33, -0.003), p = 0.04) and DHEA (ß2boys = -0.49 (-0.80, -0.19), p = 0.001) in boys. The neonicotinoid summary score (ßboys = 5.60% [0.14%, 11.36%]) and the neonicotinoid acetamiprid-N-desmethyl (ßboys = 3.90% [1.28%, 6.58%]) were positively associated with 17ß-estradiol, measured in boys only. No associations between the pyrethroid 3-phenoxybenzoic acid and hormones were observed. In girls, bivariate response associations identified interactions of MDA, Para-nitrophenol, and 3,5,6-trichloro-2-pyridinol (organophosphates) with testosterone and DHEA concentrations. In boys, we observed an interaction of MDA and Para-nitrophenol with DHEA. No associations were identified for AChE. CONCLUSIONS: We observed evidence of endocrine disruption for specific organophosphate and neonicotinoid metabolite exposures in adolescents. Urinary organophosphate metabolites were associated with testosterone and DHEA concentrations, with stronger associations in boys than girls. Urinary neonicotinoids were positively associated with 17ß-estradiol. Longitudinal repeat-measures analyses would be beneficial for causal inference.

Urinary Glyphosate, 2,4-D and DEET Biomarkers in Relation to Neurobehavioral Performance in Ecuadorian Adolescents in the ESPINA Cohort.

BACKGROUND: Herbicides are the most used class of pesticides worldwide, and insect repellents are widely used globally. Yet, there is a dearth of studies characterizing the associations between these chemical groups and human neurobehavior. Experimental studies suggest that glyphosate and 2,4-dichlorophenoxyacetic acid (2,4-D) herbicides can affect neurobehavior and the cholinergic and glutamatergic pathways in the brain. We aim to assess whether herbicides and insect repellents are associated with neurobehavioral performance in adolescents. METHODS: We assessed 519 participants (11-17 years of age) living in agricultural communities in Ecuador. We quantified urinary concentrations of glyphosate, 2,4-D, and two N,N-diethyl-meta-toluamide (DEET) insect repellent metabolites [3-(diethylcarbamoyl)benzoic acid (DCBA) and 3-(ethylcarbamoyl)benzoic acid (ECBA)] using isotope-dilution mass spectrometry. We assessed neurobehavioral performance using 9 subtests across 5 domains (attention/inhibitory control, memory/learning, language, visuospatial processing, and social perception). We characterized the associations using generalized estimating equations and multiple imputation for metabolites below detection limits. Models were adjusted for demographic and anthropometric characteristics, urinary creatinine, and sexual maturation. Mediation by salivary cortisol, dehydroepiandrosterone, 17ß-estradiol, and testosterone was assessed using structural equation modeling. RESULTS: The mean of each neurobehavioral domain score was between 7.0 and 8.7 [standard deviation (SD) range: 2.0-2.3]. Glyphosate was detected in 98.3% of participants, 2,4-D in 66.2%, DCBA in 63.3%, and ECBA in 33.4%. 2,4-D was negatively associated with all neurobehavioral domains, but statistically significant associations were observed with attention/inhibition [score difference per 50% higher metabolite concentration (ß)=-0.19 95% confidence interval (CI): -0.31, -0.07], language [ß=-0.12 (95% CI: -0.23, -0.01)], and memory/learning [ß=-0.11 (95% CI: -0.22, 0.01)]. Glyphosate had a statistically significant negative association only with social perception [ß=-0.08 (95% CI: -0.14, -0.01)]. DEET metabolites were not associated with neurobehavioral performance. Mediation by gender and adrenal hormones was not observed. CONCLUSION: This study describes worse neurobehavioral performance associated with herbicide exposures in adolescents, particularly with 2,4-D. Replication of these findings among other pediatric and adult populations is needed. https://doi.org/10.1289/EHP11383.

Depression, perceived stress, and distress during pregnancy and EV-associated miRNA profiles in MADRES.

BACKGROUND: MicroRNA (miRNA) circulating in plasma has been proposed as biomarkers for a variety of diseases and stress measures, including depression, stress, and trauma. However, few studies have examined the relationship between stress and miRNA during pregnancy. METHODS: In this study, we examined associations between measures of stress and depression during pregnancy with miRNA in early and late pregnancy from the MADRES cohort of primarily low-income Hispanic women based in Los Angeles, California. Extracellular-vesicle- (EV-) associated miRNA were isolated from maternal plasma and quantified using the Nanostring nCounter platform. Correlations for stress-associated miRNA were also calculated for 89 matching cord blood samples. RESULTS: Fifty miRNA were nominally associated with depression, perceived stress, and prenatal distress (raw p < 0.05) with 17 miRNA shared between two or more stress measures. Two miRNA (miR-150-5p and miR-148b-3p) remained marginally significant after FDR adjustment (p < 0.10). Fifteen PANTHER pathways were enriched for predicted gene targets of the 50 miRNA associated with stress. Clusters of maternal and neonate miRNA expression suggest a link between maternal and child profiles. LIMITATIONS: The study evaluated 142 miRNA and was not an exhaustive analysis of all discovered miRNA. Evaluations for stress, depression and trauma were based on self-reported instruments, rather than diagnostic tools. CONCLUSIONS: Depression and stress during pregnancy are associated with some circulating EV miRNA. Given that EV miRNA play important roles in maternal-fetal communication, this may have downstream consequences for maternal and child health, and underscore the importance of addressing mental health during pregnancy, especially in health disparities populations.

Evaluación de riesgos psicosociales y su influencia en el desarrollo de burnout en el personal de emergencias del Hospital General Docente Calderón / Evaluation of psychosocial risks and their influence on the development of burnout in emergency personnel of the Hospital General Docente Calderón

Introducción: Los riesgos psicosociales son factores que pueden afectar el bienestar psi-cológico y emocional de una persona en el entorno laboral, como el estrés laboral, la falta de apoyo social y la falta de autonomía en el trabajo. Estos riesgos pueden tener una gran influencia en el desarrollo del síndrome de burnout, una afección psicológica que se carac-teriza por agotamiento emocional, despersonalización y disminución del rendimiento laboral. Objetivo: Identificar los factores psicosociales de riesgo que puedan afectar de manera considerable al desarrollo del síndrome de burnout, planteando medidas preventivas que ayudaran a aplacar los riesgos evidenciados.Material y Métodos: Estudio descriptivo - transversal, con diseño no experimental, se uti-lizó 2 instrumentos: 1) Factores Psicosociales (FPSICO3.0), el cual está compuesto por 44 preguntas con su subdivisión de 89 sub preguntas, mide 9 factores de riesgo psicosocial (intra laborales); 2) Factores de riesgo Psicosociales (MBI-HSS) contiene 22 preguntas, mide 3 factores para burnout: baja realización personal del trabajo, agotamiento emocional y des-personalización. Resultados: Según la correlación de Spearman (Rho) manejado con margen de error del 0.05, los factores de riesgo psicosocial (intra laborales) tiempo de trabajo, demanda psicológica, participación/supervisión; interés por el trabajador y compensación; son directamente propor-cionales al nivel de burnout. Los resultados muestran que el 7% de personal presenta burnout y el 51% indicios del mismo, a mayor edad hay mayor prevalencia de burnout y el puesto de trabajo con mayor vulnerabilidad es el de médico general en funciones hospitalarias. Discusión: Los instrumentos (MBI-HSS y Fpsico 3.0) utilizados en la presenteb investiga-ción, fueron desarrollados para la población hospitalaria dentro de condiciones laborales, mismos que también han sido utilizados por varias investigaciones previas en el Ecuador y en diferentes países, por lo que el análisis de los estudios previos similares reflejan sobre los factores psicosociales que más inciden en el personal sanitario de las áreas de emergencias tanto ecuatorianas como extranjeras y son similares a los resultados del presente estudio, enfatizando además que el factor carga de trabajo en todas las investigación comparativas, a pesar de ser un factor de riesgo alto, no incide en la nuestra, al ser susceptible de buen manejo y adaptación ante la demanda de pacientes.

Introduction: Psychosocial risks can affect the psychological and emotional well-being of a person in the work environment, aspects such as work stress, lack of social support and autonomy at work. These risks may cause the appearance of Burnout syndrome, a psycho-logical condition characterized by emotional exhaustion, depersonalization, and work perfor-mance decrease. Objective:Identify the psychosocial risk factors that can significantly lead to the development of Burnout syndrome; propose preventive measures that will help mitigate the risks evidenced.Materials and Methods:Descriptive - cross-sectional study, with a non-experimental de-sign, 2 instruments were used: 1) Psychosocial Factors (FPSICO3.0), which is made up of 44 questions with their subdivision of 89 sub-questions, measures 9 psychosocial risk factors (in-tra-work); 2) Psychosocial Risk Factors (MBI-HSS) contains 22 questions, measures 3 factors for burnout: low personal performance at work, emotional exhaustion and depersonalization. Outcome: According to Spearman's correlation (Rho) managed with a margin of error of 0.05, psychosocial risk factors (intra-work) work time, psychological demand, participation/supervision; worker interest and compensation; are directly proportional to the level of bur-nout. The results show that 7% of the staff have burnout and 51% have signs of it. The older, the higher the prevalence of burnout; The profession with the greatest vulnerability to Bur-nout syndrome are doctors and nurses working in hospitals.Discussion: The instruments (MBI-HSS and Fpsico 3.0) used in the present research were developed for the hospital employees within working conditions, which have also been used by previous researches in Ecuador as well as in different countries, so the similar previous studies reflect on the psychosocial factors that most affect health workers in both Ecuadorian and foreign emergency areas and are similar to the results of the present study, which empha-sizes the workload factor in all comparative research, despite being a high risk factor, it does not affect ours, as it is susceptible to good management and adaptation to patient demand.

Concurrent urinary organophosphate metabolites and acetylcholinesterase activity in Ecuadorian adolescents.

BACKGROUND: Organophosphates are insecticides that inhibit the enzymatic activity of acetylcholinesterase (AChE). Because of this, AChE is considered a physiological marker of organophosphate exposure in agricultural settings. However, limited research exists on the associations between urinary organophosphate metabolites and AChE activity in children. METHODS: This study included 526 participants from 2 exams (April and July-October 2016) of ages 12-17 years living in agricultural communities in Ecuador. AChE activity was measured at both examinations, and organophosphate metabolites, including para-nitrophenol (PNP), 3,5,6-trichloro-2-pyridinol (TCPy), and malathion dicarboxylic acid (MDA) were measured in urine collected in July-October. We used generalized estimating equation generalized linear model (GEEGLM), adjusting for hemoglobin, creatinine, and other demographic and anthropometric covariates, to estimate associations of urinary metabolite concentrations with AChE activity (July-October) and AChE% change between April and July-October. RESULTS: The mean (SD) of AChE and AChE% change (April vs July-October) were 3.67 U/mL (0.54) and -2.5% (15.4%), respectively. AChE activity was inversely associated with PNP concentration, whereas AChE% change was inversely associated with PNP and MDA. There was evidence of a threshold: difference was only significant above the 80th percentile of PNP concentration (AChE difference per SD increase of metabolite = -0.12 U/mL [95%CI: 0.20, -0.04]). Likewise, associations with AChE% change were significant only above the 80th percentile of TCPy (AChE % change per SD increase of metabolite = -1.38% [95%CI: 2.43%, -0.32%]) and PNP -2.47% [95%CI: 4.45%, -0.50%]). PNP concentration at ≥80th percentile was associated with elevated ORs for low AChE activity of 2.9 (95% CI: 1.5, 5.7) and for AChE inhibition of ≤ -10% of 3.7 (95% CI: 1.4, 9.8). CONCLUSIONS: Urinary organophosphate metabolites, including PNP, TCPy and MDA, particularly at concentrations above the 80th percentile, were associated with lower AChE activity among adolescents. These findings bring attention to the value of using multiple constructs of pesticide exposure in epidemiologic studies.

Testosterone, estradiol, DHEA and cortisol in relation to anxiety and depression scores in adolescents.

Background Adrenal and sex hormone dysregulation have been independently associated with increased depression and anxiety. Cortisol can modify production of sex hormones and hormone-mood associations. This study evaluated associations and interplay of sex and adrenal hormones with depression and anxiety. Methods We assessed 545 Ecuadorian adolescents (11-17y, 50.4% female, ESPINA) for depression and anxiety symptoms using standardized scales. Testosterone, cortisol, dehydroepiandrosterone (DHEA), and estradiol (boys only) were measured in saliva. We performed logistic regression modeling to calculate odds ratios (OR) of elevated depression or anxiety (scores ≥60) comparing participants with low (<10th percentile) and elevated hormones (≥90th percentile) to normal concentrations (10th-90th percentile). Effect modification by cortisol and testosterone was assessed. Models adjusted for demographic, anthropometric, and circadian measures. Results In all participants, elevated testosterone (OR [95%CI:]=1.78 [0.98, 3.23]) and cortisol (OR=1.69 [0.95, 2.99]) were marginally associated with elevated anxiety scores. In boys, elevated estradiol was associated with elevated depression (OR=4.75 [1.95, 11.56]) and anxiety scores (OR=2.43 [1.01, 5.84]). In linear regression, estradiol was positively associated with depression (difference/10% hormone increase (ß=0.45 [0.15, 0.75]) and anxiety scores (ß=0.42 [0.13, 0.72]). Higher cortisol levels strengthened the depression association with estradiol in boys (ß=0.54 [0.12, 0.96]), and with testosterone (ß= -0.19 [-0.35, -0.03]) and DHEA (ß= -0.12 [-0.22, -0.02]) in girls. Testosterone also modified associations. Limitations This was a cross-sectional analysis. Discussion Elevated testosterone, cortisol, and estradiol (≥90th percentile) were associated with altered mood. Cortisol and testosterone were considerable effect modifiers to the associations of most hormones with depression and anxiety.

Extracellular vesicle-enriched miRNA profiles across pregnancy in the MADRES cohort.

MicroRNA (miRNA) circulating in plasma have been proposed as biomarkers for a variety of conditions and diseases, including complications during pregnancy. During pregnancy, about 15-25% of maternal plasma exosomes, a small size-class of EVs, are hypothesized to originate in the placenta, and may play a role in communication between the fetus and mother. However, few studies have addressed changes in miRNA over the course of pregnancy with repeated measures, nor focused on diverse populations. We describe changes in miRNA in early and late pregnancy from the MADRES cohort of primarily low-income Hispanic women based in Los Angeles, CA. miRNA derived from extracellular-vesicles (EVs) were isolated from maternal blood plasma samples collected in early and late pregnancy. In this study, we identified 64 of 130 detectable miRNA which significantly increased with gestational age at the time of collection (GA), and 26 which decreased with GA. Possible fetal sex-specific associations were observed for 30 of these 90 significant miRNA. Predicted gene targets for miRNA significantly associated with GA were identified using MirDIP and were found to be enriched for Gene Ontology categories that included energetic and metabolic processes but were underrepresented in immune-related categories. Circulating EV-associated miRNA during pregnancy are likely important for maternal-fetal communication, and may play roles in supporting and maintaining a healthy pregnancy, given the changing needs of the fetus.

Baseline urinalysis results in 32 healthy Antillean manatees (Trichechus manatus manatus).

OBJECTIVE: To describe results of analysis of free-catch urine samples collected from Antillean manatees (Trichechus manatus manatus) under human care in the Caribbean. ANIMALS: 32 Antillean manatees in 5 Caribbean oceanaria and rescue centers. PROCEDURES: Urine samples were obtained by opportunistic free catch during physical examination or through the use of operant conditioning procedures. Urinalyses consisted of macro- and microscopic evaluations, biochemical analyses with test strips, and refractometry. Results were compared for manatees grouped on the basis of age, sex, and habitat. RESULTS: Urine samples were typically clear, straw colored, and alkaline (mean pH, 8.0); had a urinoid odor and low specific gravity (mean, 1.010); and had results on qualitative test strips that were consistently negative for the presence of glucose, bilirubin, ketones, proteins, nitrites, RBCs, and WBCs. Microscopically, the mean ± SD number of RBCs and WBCs/hpf was 0.5 ± 0.3 RBCs/hpf and 1.1 ± 1.5 WBCs/hpf. The presence of some epithelial cells and crystals was typical. Spermatozoa were found in urine from 1 of 15 sexually mature males, and parasite larvae and eggs were found in urine from 2 manatees. CONCLUSIONS AND CLINICAL RELEVANCE: Results of the present study yielded the first compilation of baseline urinalysis values in healthy Antillean manatees under human care, which, when combined with physical examination and other diagnostic procedures, can help in monitoring the health of these animals. We encourage the use of free-catch urine collection methods, as used in the present study, for routine urinalyses of manatees under human care in zoos, aquaria, or rescue centers.

Hepatitis E virus in bottlenose dolphins Tursiops truncatus.

Hepatitis E virus (HEV) infects several animal species that act as zoonotic reservoirs for viral transmission. Solid and liquid residues from infected animals could lead to HEV contamination of food and surface waters. Evidence of human HEV infection through ingestion of seafood (shellfish, mussels) has been reported. Dolphins generally feed on fish and squid but are able to adapt to an environment and consume whatever prey is available. Clinical signs of infected dolphins include lethargy, inappetence, behavioral aberrations and increased serum alanine aminotransferase (ALT). The dolphins examined in this study were maintained at the National Aquarium, Havana, Cuba. A total of 31 dolphins were evaluated for HEV markers. Sera were collected and screened for total immunoglobin (Ig) anti-HEV. Sera and liver homogenate were tested for HEV RNA by nested RT-PCR using primers targeting the open reading frame 1. Phylogenetic analysis was performed using partial nucleotide sequences at the amplified RNA-dependent RNA polymerase gene. Total anti-HEV Ig was detected in 32.2% (10 of 31), and 16.1% (5 of 31) of these dolphins were positive by both serology and HEV RNA testing. Nucleotide sequence analyses revealed that HEV strains identified in dolphins were genotype 3. This virus may represent an environmental contamination of food or wastewater as a source of HEV exposure and infection. Our findings provide evidence that HEV is associated with liver disorders in cetaceans and that it is advisable to screen for exposure of this virus in captive dolphins, particularly animals with elevated serum ALT or compromised liver function test results of undetermined cause.

Análise do conhecimento de profissionais de Educação Física referente à prescrição de exercícios físicos para portadores de condromalácia patelar / Knowledge analysis of physical education professionals regarding exercise prescription for patients with chondromalacia patellae

Este trabalho buscou verificar a conduta profissional que professores de Educação Física (PEFs) possui na utilização do exercício de extensão de joelhos na cadeira extensora e no leg press em pessoas sofrendo de condromalácia da patela. Dois experimentos foram feitos, utilizando questionários aplicados em academias do Rio de Janeiro. O primeiro estudo foi dividido nas seguintes opções: “cadeira extensora”, “leg press”, “ambos” e “nenhum” e foi aplicado em 18 PEFs. O segundo estudo foi relacionado com a utilização de ângulos específicos na máquina de extensão de pernas que foi dividido em: “0°-30°”, “60°-90°”, “ambos” e “nenhum” que foi aplicado em 24 PEFs. Adicionalmente ambos os questionários possuíam seções específicas onde informação complementar poderia ser escrita para justificar as respostas. As justificativas foram nomeadas (JT+) quando satisfatória e (JT-) na ausência de argumentos baseados em dados científicos. A análise estatística foi feita com o teste qui-quadrado e a significância foi considerada quando o valor de p era menor do que 0,05. No primeiro estudo nós observamos que a utilização do leg press foi menor do que as outras opções. Além disso, o percentual de JT+ foi maior nas opções “cadeira extensora”, “leg press” e “nenhum”. No segundo estudo nós observamos que o percentual de PEFs que escolheram a opção “0°-30°” foi maior em relação a opção “ambos”. Quando as justificativas foram analisadas, nós observamos que todas as opções tiveram um maior percentual de JT-, com exceção da opção “ambos” que não mostrou diferenças (p>0,05). Nós concluímos que os PEFs possuem uma adequada conduta quando escolhem os exercícios para pessoas com condromalácia patelar, porém existe uma necessidade de melhor sustentar as argumentações relacionadas com a utilização de ângulos no exercício de cadeira extensora.

This work aimed to verify which professional conduct Physical Education teachers (PETs) have when using knee extension exercise with leg extension machines and leg presses in people suffering from chondromalacia patellae. Two experiments were done using questionnaires applied in Rio de Janeiro gyms. The first study was divided in the following options: “leg extension”, “leg presses”, “both” or “none” and was applied in 18 PETs. The second study was related to the utilization of specific angles in leg extension machines that were divided in: “0°-30°”, “60°-90°”, “both” and “none” that was applied to 24 PETs. Additionally both questionnaires have specific sections where complementary information could be written to justify the answers. The explanations was named (JT+) when satisfactory and (JT-) in the absence of arguments based in scientific data. Statistical analysis was done by chi square test and significance was considered when p value was lower than 0.05. In first study we observed that leg press utilization was lower than the other options. Besides that JT+ percent was higher in options “leg extension”, “leg press” and “none” but had no significant alterations in “both”. In second study we observed that the percent of PETs that chose option “0-30°” was higher in relation to the option “both”. When the explanations were analyzed, we observed that all the options had a higher percentage of JT- with exception of option “both” that showed no differences (p>0.05). We conclude that PETs have an adequate conduct when choosing exercises for people with chondromalacia patellae, however there is a need to better sustain the argumentations relating to angle utilization in leg extension exercises.

Analgesia intraarticular posoperatoria en cirugía artroscópica de rodilla / Postoperative intraarticular analgesia in arthroscopic knee surgery

Se realizó un estudio descriptivo y transversal de 100 pacientes que acudieron a la consulta especializada de artroscopia de la rodilla del Hospital Clinicoquirúrgico Docente Dr Joaquín Castillo Duany de Santiago de Cuba (enero de 2007-diciembre del 2008), a fin de evaluar la efectividad de la inyección intraarticular de bupivacaína al 0,25 por ciento como método analgésico, antes de comenzar la cirugía o después de finalizarla. Los integrantes de la casuística se distribuyeron en 2 grupos de igual número; a los de un grupo se les administraron 30 mL de bupivacaína con epinefrina, 20 minutos previos a la operación, y a los del otro se les aplicó lo mismo, pero al concluir la intervención. Quedó demostrada la efectividad de la citada inyección después de la artroscopia, pues redujo la intensidad del dolor posoperatorio y el consumo de analgésicos con un mínimo de complicaciones; en cambio, su uso preventivo no fue efectivo

A cross-sectional and descriptive study was carried out in 100 patients attending the specialized outpatient department of knee arthroscopy at Dr Joaquín Castillo Duany Teaching Clinical Surgical Hospital of Santiago de Cuba (January 2007-December 2008) to evaluate the effectiveness of 0,25 per cent bupivacaine intraarticular injection as analgesic method before or after surgery. Patients of the case material were distributed in 2 equal groups; one group received 30 mL of bupivacaine with epinephrine 20 minutes before surgery, and the other received the same but after the intervention. The effectiveness of this injection was demonstrated after the arthroscopy as it reduced intensity of the postoperative pain and the use of analgesics with minimal complications; however their preventive use was not effective

Analgesia intraarticular posoperatoria en cirugía artroscópica de rodilla / Postoperative intraarticular analgesia in arthroscopic knee surgery

Se realizó un estudio descriptivo y transversal de 100 pacientes que acudieron a la consulta especializada de artroscopia de la rodilla del Hospital Clinicoquirúrgico Docente Dr Joaquín Castillo Duany de Santiago de Cuba (enero de 2007-diciembre del 2008), a fin de evaluar la efectividad de la inyección intraarticular de bupivacaína al 0,25 por ciento como método analgésico, antes de comenzar la cirugía o después de finalizarla. Los integrantes de la casuística se distribuyeron en 2 grupos de igual número; a los de un grupo se les administraron 30 mL de bupivacaína con epinefrina, 20 minutos previos a la operación, y a los del otro se les aplicó lo mismo, pero al concluir la intervención. Quedó demostrada la efectividad de la citada inyección después de la artroscopia, pues redujo la intensidad del dolor posoperatorio y el consumo de analgésicos con un mínimo de complicaciones; en cambio, su uso preventivo no fue efectivo(AU)

A cross-sectional and descriptive study was carried out in 100 patients attending the specialized outpatient department of knee arthroscopy at Dr Joaquín Castillo Duany Teaching Clinical Surgical Hospital of Santiago de Cuba (January 2007-December 2008) to evaluate the effectiveness of 0,25 per cent bupivacaine intraarticular injection as analgesic method before or after surgery. Patients of the case material were distributed in 2 equal groups; one group received 30 mL of bupivacaine with epinephrine 20 minutes before surgery, and the other received the same but after the intervention. The effectiveness of this injection was demonstrated after the arthroscopy as it reduced intensity of the postoperative pain and the use of analgesics with minimal complications; however their preventive use was not effective(AU)

Eficacia, tolerabilidad y seguridad de mirtazapina en pacientes con depresión mayor moderada y severa / Efficacy tolerability and safety of mirtazapine in patients with moderate and severe major depression

Evaluar la eficacia, seguridad y tolerancia de mirtazapina como tratamiento antidepresivo, en un estudio fase III, abierto no comparativo, en pacientes con depresión mayor moderada y severa (DSM-IV) Métodos: 31 pacientes de ambos sexos, en edades comprendidas entre los 18 y 65 años completaron el estudio. Se les administró mirtazapina en dosis de 15 a 45 mg durante 8 semanas. La eficacia fue evaluada utilizando CGI, HAMD-17 y BDI. La tolerabilidad y seguridad se evaluó con el reporte espontáneo de eventos adversos los treinta y un (100 por ciento) pacientes incluidos en el estudio respondieron a la modificación en estudio y 24 (77,41 por ciento) de los mismos cumplieron criterios de remisión en las ocho semanas de tratamiento. No se registraron abandonos debido a eventos adversos, 5 pacientes (16,12 por ciento) reportaron eventos adversos, estos fueron ansiedad, somnolencia, hipertensión arterial, boca seca, aumento del apetito y síndrome de piernas inquietas, no se reportaron eventos adversos severos. En los pacientes evaluados, mirtazapina, mostró ser un tratamiento eficaz, bien tolerado y seguro para la depresión mayor

Trastorno border de la personalidad, comorbilidad con trastornos del humor (episodio maníaco con síntomas psicóticos) y tratamiento con diferentes antipsicóticos de nueva generación: a propósito de un caso / I overtum border of the personality, comorbilitidad with dysfunctions of the humor maniac episode with symptoms psicoticos and treatment with different antipsicoticos of new generation to purpose of a case

El propósito de la descripción de este caso es la contribución al cúmulo de experiencias que se necesitan cuando se desarrolla una nueva línea de tratamiento psicofarmacológico y las interrogantes que surgen a través de la misma. Se describe el caso de un paciente masculino de 30 años con antecedentes de enfermedad mental de larga data, presentando en este ingreso clínica compatible con episodio maníaco con síntomas psicóticos, se recogen datos premórbidos de la personalidad que orientan hacia comorbilidad con trastorno border de la personalidad. Muestra exacerbación de los síntomas maníacos con el uso de Olanzapina (10-30 mgr/día) y remisión con el uso de Risperidona (6 mgr/día); su suspensión por la aparición de distonias y posterior reaparición de los síntomas . Finalmente, una buena respuesta al iniciar Clozapina (50-300 mgr/día). Se evidencia en este caso en particular la diferencia en los efectos clínicamente observables de estas moléculas, a pesar de sus similitudes en los perfiles químicos y/o farmacológicos. Se describe el caso de un paciente masculino, de 34 años de edad, con antecedentes de enfermedad mental de larga data (12 años aproximadamente) y tres hospitalizaciones previas. La última, el primer trimestre de este año, de 22 días de duración, egreso con diagnóstico de trastorno esquizoafectivo. El tratamiento ambulatorio indicado consistía en una sesión de psicoterapia de corte cognitivo=conductual, junto a los siguientes psicofármacos: riperidona 3 mgs BID, carbonato de litio 300 mgs TID y flurazepan 30 mgs HS; dos semanas después de iniciado, el paciente se muestra renuente al cumplimiento, en aparente relación con la aparición de distonía, lo suspende en forma definitiva unos días después. La primera semana desarrolla insomnio, luce intranquilo, y deambula sin objetivo fijo, se agrega la semana subsiguiente logorrea, irritabilidad ideación delirante de tipo místico religioso referidoda a la propia identidad, hétero agresividad verbal y am...

Percepción de la imagen corporal en portadores asintomáticos de la infección por el virus de inmunodeficiencia humana / Perception of corporal image in non-symptomatic carries of HIV infection

La aparición de pruebas serológicas, capaces de diagnosticar la presencia del Virus de Inmunodeficiencia Humana, mucho antes de la aparición de los síntomas de dicha infección, produjo una población de portadores asintomáticos, quienes debían afrontar una serie de cambios a nivel psicológico. Dado que la imagen corporal presenta una relación directa con diversos aspectos psicológicos del sujeto, y de la presencia de pruebas psicológicas capaces de reflejar a los mismos es que se realizó la presente investigación, en la cual, si bien no se encontraron hallazgos significativos en cuanto a alteraciones psicológicas, fue posible establecer que en los portadores asintomáticos de la infección por el Virus de Inmunodeficiencia Humana, sí existe una gran preocupación por el cuerpo al igual que dificultades en sus relaciones interpersonales

Prevalencia de la obesidad en los pacientes del Hospital Universitarios "Dr. Angel Larralde" / Incidence obesity in patients of the Universitary Hospital \"Dr. Angel Larralde\"

En esta investigación se estudiaron 337 pacientes de los Servicios de Medicina y Cirugía del HUAL, tanto de consulta externa como hospitalización, en un lapso de 30 días; obteniendo que un porcentaje del 36,79 del total eran considerados como obesos según el IMC, con un marcado predominio del sexo femenino del 44,4%, sobre el sexo masculino de un 27%. Además se estableció una relación entre un 97,7% a un 100%, entre Indice de Masa Corporal y Circunferencia Braquial para sexo femenino y masculino respectivamente

Cuando un recién nacido muere

En esta revisión bibliográfica se hace una aproximación a las manifestaciones emocionales y clínicas de la aflicción en los padres, en el entorno familiar y en el personal que trató, en último término, a un recién nacido que ha fallecido. Se describen algunos de los fenómenos psicológicos que explican los intrincados mecanismos internos del duelo, así como algunas de sus expresiones externas, tanto en los afectados directamente como en quienes estuvieron relacionados de algún modo con los dolientes y con los sucesos. También se proporcionan algunas sugerencias para el seguimiento individual de estas familias, se dan orientaciones a los padres con respecto a la planificación de sus vidas a partir de ese fallecimiento...