Patient-doctor interactions around alternative and complementary medicine in the context of oncology care in a Latin American country.

OBJECTIVE: To characterize doctor-patient communication patterns around the use of complementary and alternative medicines (CAM) in the context of oncology care in Colombia. METHODS: A qualitative study was conducted using snowball sampling until data saturation was reached. We included oncology specialists and cancer patients who were in active treatment. Semi-structured interviews were conducted following a guide designed for each group of participants. An analysis based on open coding was performed to identify thematic areas. The coherence of emerging categories was verified by contrasting the data set within the content of the participants' reports and existing literature. RESULTS: In total, 10 oncologists and 16 cancer patients were included, representing diverse professional fields and cancer diagnoses, respectively. Communication patterns comprise themes regarding the beginning of the interaction (i.e., patient's anticipations), the patient-doctor relationship (i.e., confidence), the characteristics of the message (i.e., synthetic vs explanatory), the communication styles (i.e., confrontational vs conciliatory), and the closing of the interaction (i.e., continuity vs. end of communication). In addition, extrinsic factors influencing communication were found to be related to participants (i.e., knowledge, cultural background) and context (i.e., institutional procedures). CONCLUSIONS: The low frequency of communication contrasts to the increasing use of CAM. Divergent perspectives between doctors and patients could limit shared decision-making on the use of CAM. Enhanced knowledge and education on CAM for both actors is fundamental to improve their interaction and to move away from paternalistic and confrontational communication, particularly in a world region with cultural backgrounds that influence the use of CAM.

Exploring Links Between Psychosis and Frontotemporal Dementia Using Multimodal Machine Learning: Dementia Praecox Revisited.

Importance: The behavioral and cognitive symptoms of severe psychotic disorders overlap with those seen in dementia. However, shared brain alterations remain disputed, and their relevance for patients in at-risk disease stages has not been explored so far. Objective: To use machine learning to compare the expression of structural magnetic resonance imaging (MRI) patterns of behavioral-variant frontotemporal dementia (bvFTD), Alzheimer disease (AD), and schizophrenia; estimate predictability in patients with bvFTD and schizophrenia based on sociodemographic, clinical, and biological data; and examine prognostic value, genetic underpinnings, and progression in patients with clinical high-risk (CHR) states for psychosis or recent-onset depression (ROD). Design, Setting, and Participants: This study included 1870 individuals from 5 cohorts, including (1) patients with bvFTD (n = 108), established AD (n = 44), mild cognitive impairment or early-stage AD (n = 96), schizophrenia (n = 157), or major depression (n = 102) to derive and compare diagnostic patterns and (2) patients with CHR (n = 160) or ROD (n = 161) to test patterns' prognostic relevance and progression. Healthy individuals (n = 1042) were used for age-related and cohort-related data calibration. Data were collected from January 1996 to July 2019 and analyzed between April 2020 and April 2022. Main Outcomes and Measures: Case assignments based on diagnostic patterns; sociodemographic, clinical, and biological data; 2-year functional outcomes and genetic separability of patients with CHR and ROD with high vs low pattern expression; and pattern progression from baseline to follow-up MRI scans in patients with nonrecovery vs preserved recovery. Results: Of 1870 included patients, 902 (48.2%) were female, and the mean (SD) age was 38.0 (19.3) years. The bvFTD pattern comprising prefrontal, insular, and limbic volume reductions was more expressed in patients with schizophrenia (65 of 157 [41.2%]) and major depression (22 of 102 [21.6%]) than the temporo-limbic AD patterns (28 of 157 [17.8%] and 3 of 102 [2.9%], respectively). bvFTD expression was predicted by high body mass index, psychomotor slowing, affective disinhibition, and paranoid ideation (R2 = 0.11). The schizophrenia pattern was expressed in 92 of 108 patients (85.5%) with bvFTD and was linked to the C9orf72 variant, oligoclonal banding in the cerebrospinal fluid, cognitive impairment, and younger age (R2 = 0.29). bvFTD and schizophrenia pattern expressions forecasted 2-year psychosocial impairments in patients with CHR and were predicted by polygenic risk scores for frontotemporal dementia, AD, and schizophrenia. Findings were not associated with AD or accelerated brain aging. Finally, 1-year bvFTD/schizophrenia pattern progression distinguished patients with nonrecovery from those with preserved recovery. Conclusions and Relevance: Neurobiological links may exist between bvFTD and psychosis focusing on prefrontal and salience system alterations. Further transdiagnostic investigations are needed to identify shared pathophysiological processes underlying the neuroanatomical interface between the 2 disease spectra.

Clinical, Brain, and Multilevel Clustering in Early Psychosis and Affective Stages.

Importance: Approaches are needed to stratify individuals in early psychosis stages beyond positive symptom severity to investigate specificity related to affective and normative variation and to validate solutions with premorbid, longitudinal, and genetic risk measures. Objective: To use machine learning techniques to cluster, compare, and combine subgroup solutions using clinical and brain structural imaging data from early psychosis and depression stages. Design, Setting, and Participants: A multisite, naturalistic, longitudinal cohort study (10 sites in 5 European countries; including major follow-up intervals at 9 and 18 months) with a referred patient sample of those with clinical high risk for psychosis (CHR-P), recent-onset psychosis (ROP), recent-onset depression (ROD), and healthy controls were recruited between February 1, 2014, to July 1, 2019. Data were analyzed between January 2020 and January 2022. Main Outcomes and Measures: A nonnegative matrix factorization technique separately decomposed clinical (287 variables) and parcellated brain structural volume (204 gray, white, and cerebrospinal fluid regions) data across CHR-P, ROP, ROD, and healthy controls study groups. Stability criteria determined cluster number using nested cross-validation. Validation targets were compared across subgroup solutions (premorbid, longitudinal, and schizophrenia polygenic risk scores). Multiclass supervised machine learning produced a transferable solution to the validation sample. Results: There were a total of 749 individuals in the discovery group and 610 individuals in the validation group. Individuals included those with CHR-P (n = 287), ROP (n = 323), ROD (n = 285), and healthy controls (n = 464), The mean (SD) age was 25.1 (5.9) years, and 702 (51.7%) were female. A clinical 4-dimensional solution separated individuals based on positive symptoms, negative symptoms, depression, and functioning, demonstrating associations with all validation targets. Brain clustering revealed a subgroup with distributed brain volume reductions associated with negative symptoms, reduced performance IQ, and increased schizophrenia polygenic risk scores. Multilevel results distinguished between normative and illness-related brain differences. Subgroup results were largely validated in the external sample. Conclusions and Relevance: The results of this longitudinal cohort study provide stratifications beyond the expression of positive symptoms that cut across illness stages and diagnoses. Clinical results suggest the importance of negative symptoms, depression, and functioning. Brain results suggest substantial overlap across illness stages and normative variation, which may highlight a vulnerability signature independent from specific presentations. Premorbid, longitudinal, and genetic risk validation suggested clinical importance of the subgroups to preventive treatments.

Avances recientes en el diagnóstico imagenológico de la hidrocefalia en niños. Revisión de la literatura de los últimos seis años / Recent advances of the imagological diagnosis of hydrocephalus in children. Review of the literature of the last six years

Resumen La hidrocefalia es un problema de salud frecuente en pediatría, en particular durante el primer mes de vida. La incidencia en América Latina es una de las más altas del mundo. En Colombia no existen datos representativos sobre la incidencia real de esta enfermedad. Recientes hallazgos relacionados con la dinámica del líquido cefalorraquídeo permitieron proponer nuevos modelos sobre la fisiopatología de la hidrocefalia que, junto con los hallazgos en la Resonancia Magnética, han llevado a tener una mejor comprensión de la enfermedad. El objetivo de este articulo es realizar una revisión de la información disponible en la literatura sobre los avances en la fisiopatología de la enfermedad y los hallazgos en neuroimágenes, además de realizar una breve revisión sobre el papel de estas en el diagnóstico y seguimiento de los pacientes. Se realizó una revisión bibliográfica con términos MeSH, en las bases de datos de PUBMED, OVID y SCOPUS con artículos publicados en los últimos 6 años, seleccionado un total de 30 artículos que abordaron el tema de forma integral. Los nuevos hallazgos descritos como lo son el sistema glinfático y el papel de las AQP4 y los avances en las neuroimágenes, sobre todo de la resonancia magnética, han ayudado a comprender mejor esta entidad, apoyando el desarrollo de un nuevo modelo de la dinámica del líquido cefalorraquídeo y a partir de él diferentes explicaciones sobre la fisiopatología. MÉD.UIS.2022;35(1): 17-29.

Abstract Hydrocephalus is a frequent health problem in pediatrics, particularly during the first month of life. The incidence in Latin America is one of the highest in the world. In Colombia there are no representative data. Recent findings related to the dynamics of cerebrospinal fluid allowed proposals of new models on the pathophysiology of hydrocephalus that, along with new findings on MRI, have led to a better understanding of the disease. The aim of this work is to review the information available in the literature about the progress in the pathophysiology of the disease and neuroimaging findings, in addition to conducting a brief review on the role of these in the diagnosis and follow-up of patients. A bibliographic review with MeSH terms was carried out in PUBMED, OVID and SCOPUS databases, with articles published in the last 6 years. 30 articles that dealt with the theme in a comprehensive way were included. New findings described as the glymphatic system and the role of AQP4, along with advances in neuroimaging, especially MRI, have helped to better understand hydrocephalus, supporting the development of a new model of cerebrospinal fluid dynamics, and based on it, different explanations regarding its pathophysiology. MÉD.UIS.2022;35(1): 17-29.

Impact of anthropogenic activities on an urban river through a comprehensive analysis of water and sediments.

The aim of this study was to assess the impact of urban and industrial areas on an urban river through a comprehensive analysis of water and sediments. Six different sites along the San Luis River, Argentina, were characterized by measuring 12 physical-chemical parameters and nine heavy metals according to standard protocols. Metal pollution in sediment samples was evaluated with several indices. Cluster analysis was applied to standardized experimental data in order to study spatial variability. As, Cu, Cr, Mn, Pb, and Zn were the main contributors to sediment pollution, and the industrial zone studied showed moderate enrichment of Co, Cu, and Zn, probably due to anthropogenic activities. Cluster analysis allowed the grouping of the sites: sediment samples were classified into two clusters according to the metal content; water samples were arranged into three groups according to organic matter content. The results were compared with sediment and water quality guidelines. They indicated progressive deterioration of water and sediment quality compared with the background area, mainly in the sites following the industrial park and domestic discharge areas. Moreover, the results showed that the analysis of both water and sediment should be considered to achieve a watershed contamination profile.

Multimodal Machine Learning Workflows for Prediction of Psychosis in Patients With Clinical High-Risk Syndromes and Recent-Onset Depression.

Importance: Diverse models have been developed to predict psychosis in patients with clinical high-risk (CHR) states. Whether prediction can be improved by efficiently combining clinical and biological models and by broadening the risk spectrum to young patients with depressive syndromes remains unclear. Objectives: To evaluate whether psychosis transition can be predicted in patients with CHR or recent-onset depression (ROD) using multimodal machine learning that optimally integrates clinical and neurocognitive data, structural magnetic resonance imaging (sMRI), and polygenic risk scores (PRS) for schizophrenia; to assess models' geographic generalizability; to test and integrate clinicians' predictions; and to maximize clinical utility by building a sequential prognostic system. Design, Setting, and Participants: This multisite, longitudinal prognostic study performed in 7 academic early recognition services in 5 European countries followed up patients with CHR syndromes or ROD and healthy volunteers. The referred sample of 167 patients with CHR syndromes and 167 with ROD was recruited from February 1, 2014, to May 31, 2017, of whom 26 (23 with CHR syndromes and 3 with ROD) developed psychosis. Patients with 18-month follow-up (n = 246) were used for model training and leave-one-site-out cross-validation. The remaining 88 patients with nontransition served as the validation of model specificity. Three hundred thirty-four healthy volunteers provided a normative sample for prognostic signature evaluation. Three independent Swiss projects contributed a further 45 cases with psychosis transition and 600 with nontransition for the external validation of clinical-neurocognitive, sMRI-based, and combined models. Data were analyzed from January 1, 2019, to March 31, 2020. Main Outcomes and Measures: Accuracy and generalizability of prognostic systems. Results: A total of 668 individuals (334 patients and 334 controls) were included in the analysis (mean [SD] age, 25.1 [5.8] years; 354 [53.0%] female and 314 [47.0%] male). Clinicians attained a balanced accuracy of 73.2% by effectively ruling out (specificity, 84.9%) but ineffectively ruling in (sensitivity, 61.5%) psychosis transition. In contrast, algorithms showed high sensitivity (76.0%-88.0%) but low specificity (53.5%-66.8%). A cybernetic risk calculator combining all algorithmic and human components predicted psychosis with a balanced accuracy of 85.5% (sensitivity, 84.6%; specificity, 86.4%). In comparison, an optimal prognostic workflow produced a balanced accuracy of 85.9% (sensitivity, 84.6%; specificity, 87.3%) at a much lower diagnostic burden by sequentially integrating clinical-neurocognitive, expert-based, PRS-based, and sMRI-based risk estimates as needed for the given patient. Findings were supported by good external validation results. Conclusions and Relevance: These findings suggest that psychosis transition can be predicted in a broader risk spectrum by sequentially integrating algorithms' and clinicians' risk estimates. For clinical translation, the proposed workflow should undergo large-scale international validation.

Perfil de uso de anticoagulantes en pacientes hospitalizados, interacciones farmacológicas y reacciones adversas identificadas / Anticoagulant use profile in hospitalized patients, drug interactions and identified adverse reactions

RESUMEN Son conocidos los efectos de los anticoagulantes como tratamiento o profilaxis de eventos trombóticos, esto permitió establecer una terapia individualizada según sus necesidades. Se realizó un estudio descriptivo, transversal, no aleatorizado, en 138 pacientes hospitalizados mayores de edad en una institución de cuarto nivel de atención con tratamiento anticoagulante terapéutico y profiláctico, se abordó el tipo de fármaco indicado, periodicidad, efectos adversos, controles de laboratorio, interacciones farmacológicas y causalidad de las reacciones adversas. Se encontró que el anticoagulante con mayor frecuencia de uso fue enoxaparina (68%), el control más utilizado fue el tiempo de protrombina (60,39%), interacciones farmacológicas se identificaron en 47,1%, las más frecuentes con ácido acetil salicílico (29,7% del total de interacciones), las reacciones adversas más frecuentes fueron de índole hematológico (58,3%); y la evaluación de causalidad de reacciones adversas fue 4,2% probable. El estudio mostró que el anticoagulante más utilizado fue enoxaparina. Las interacciones farmacológicas de los anticoagulantes fueron muy frecuentes, especialmente con warfarina. Las reacciones adversas de mayor ocurrencia fueron las de tipo hemorrágico ; y la evaluación de causalidad fue de categoría posible para la mayoría de estas reacciones adversas.

SUMMARY The effects of anticoagulants are known as treatment or prophylaxis of thrombotic events, allowing to establish an individualized therapy according to their needs. A descriptive cross-sectional, non-randomized study was carried out in 138 hospitalized patients of legal age in a fourth-level care institution with therapeutic and prophylactic anticoagulant treatment, addressing the type of drug indicated, periodicity, side effects, laboratory controls, pharmacological interactions and causality of adverse reactions. It was found that the anticoagulant with the highest frequency of use was enoxaparin (68%), the most used control was the prothrombin time (60.39%), pharmacological interactions were identified in 47.1%, being the most frequent with acetylsalicylic acid (29.7% of the total number of interactions), the most frequent adverse reactions were of a hematological nature (58.3%); and the causality assessment of adverse reactions was 4.2% probable. The study showed that the most used anticoagulant was enoxaparin. The pharmacological interactions of anticoagulants were very frequent, especially with warfarin. The most frequent adverse reactions were those of hemorrhagic type; and the causality assessment was of possible category for most of these adverse reactions.

Alteraciones urinarias en niños con primera infección urinaria e infección urinaria recurrente / Urinary disorders in children with first urinary infection and recurrent urinary tract infection

Introducción: las infecciones del tracto urinario son un problema frecuente en la población pediátrica. La infección del tracto urinario recurrente tiene mayor riesgo de cicatrices renales y daño glomerular. Objetivo: describir la frecuencia de hematuria, presencia de proteínas en orina, elevación en tensión arterial y hallazgos ecográficos en pacientes pediátricos desde 1 mes hasta 14 años de edad, con diagnóstico de infección del tracto urinario. Métodos: estudio descriptivo transversal, realizado entre octubre de 2014 y febrero de 2016, en pacientes que asistieron al servicio de urgencias pediátricas del Hospital de San José, con diagnóstico de infección del tracto urinario. Resultados: se diagnosticaron 125 pacientes con infección del tracto urinario, la mediana de edad fue de 2,75 años, más frecuente en mujeres (75,2 por ciento) y la mayoría recibió tratamiento intrahospitalario (58,4 por ciento). Se observó que en el grupo de infección del tracto urinario recurrente fue más frecuente el hallazgo de hematuria, que en la infección del tracto urinario primer episodio (21,9 vs. 11,8 por ciento), al igual que las malformaciones renales (32,0 vs. 14,5 %). En la tensión arterial no se observaron grandes diferencias entre los grupos, con una frecuencia de tensión arterial elevada en hospitalizados de 19,6 por ciento para primer episodio, y 18,2 por ciento en recurrentes. La presencia anormal de proteínas en orina fue de 35,4 por ciento en el grupo de infección del tracto urinario primer episodio. Conclusiones: son frecuentes la presencia de hematuria, malformaciones renales y elevación de la tensión arterial en pacientes con infección del tracto urinario. Se encuentra una frecuencia inusual de pacientes con elevación de la presión arterial y proteínas en orina, probablemente por falsos positivos. Se debe insistir en seguimiento ambulatorio del uroanálisis y la tensión arterial, para garantizar que esta se normalice o para detectar daños permanentes(AU)

Introduction: urinary tract infections are a frequent problem in the pediatric population. Recurrent urinary tract infection has a higher risk of kidney scars and glomerular damage. Objective: to describe frequency of hematuria, presence of proteins in urine, increase of blood pressure, and ultrasound findings in pediatric patients from 1 month to 14 years old with a diagnosis of urinary tract infection. Methods: cross-sectional descriptive study conducted from October 2014 to February 2016, in patients who attended the pediatric emergency´s service of the Hospital of San José with a diagnosis of urinary tract infection. Results: 125 patients with urinary tract infection were diagnosed, the median age was 2.75 years, it was more frequent in women (75.2 percent) and the majority of them received intrahospital treatment (58.4 percent). It was observed that in the recurrent urinary tract infection group the finding of hematuria was more frequent, than in the group of urinary tract infection as a first episode (21.9 vs. 11.8 percent), as well as the renal malformations (32,0 vs. 14.5percent). In blood pressure, there were no large differences among the groups, with a rate of high blood pressure frequency in hospitalized patients of 19.6 percent for first episode, and 18.2 percent in recurrent patients. The abnormal presence of proteins in urine was of 35.4 percent in the group of urinary tract infection first episode(AU) Conclusions: the presence of hematuria, renal malformations and increase of blood pressure in patients with urinary tract infection are frequent. There is an unusual frequency of patients with high blood pressure and proteins in the urine, probably due to false positives. It must be addressed the ambulatory monitoring of urinalysis and blood pressure to ensure that it normalizes or to detect permanent damage

Alteraciones urinarias en niños con primera infección urinaria e infección urinaria recurrente / Urinary disorders in children with first urinary infection and recurrent urinary tract infection

Introducción: las infecciones del tracto urinario son un problema frecuente en la población pediátrica. La infección del tracto urinario recurrente tiene mayor riesgo de cicatrices renales y daño glomerular. Objetivo: describir la frecuencia de hematuria, presencia de proteínas en orina, elevación en tensión arterial y hallazgos ecográficos en pacientes pediátricos desde 1 mes hasta 14 años de edad, con diagnóstico de infección del tracto urinario. Métodos: estudio descriptivo transversal, realizado entre octubre de 2014 y febrero de 2016, en pacientes que asistieron al servicio de urgencias pediátricas del Hospital de San José, con diagnóstico de infección del tracto urinario. Resultados: se diagnosticaron 125 pacientes con infección del tracto urinario, la mediana de edad fue de 2,75 años, más frecuente en mujeres (75,2 por ciento) y la mayoría recibió tratamiento intrahospitalario (58,4 por ciento). Se observó que en el grupo de infección del tracto urinario recurrente fue más frecuente el hallazgo de hematuria, que en la infección del tracto urinario primer episodio (21,9 vs. 11,8 por ciento), al igual que las malformaciones renales (32,0 vs. 14,5 %). En la tensión arterial no se observaron grandes diferencias entre los grupos, con una frecuencia de tensión arterial elevada en hospitalizados de 19,6 por ciento para primer episodio, y 18,2 por ciento en recurrentes. La presencia anormal de proteínas en orina fue de 35,4 por ciento en el grupo de infección del tracto urinario primer episodio. Conclusiones: son frecuentes la presencia de hematuria, malformaciones renales y elevación de la tensión arterial en pacientes con infección del tracto urinario. Se encuentra una frecuencia inusual de pacientes con elevación de la presión arterial y proteínas en orina, probablemente por falsos positivos. Se debe insistir en seguimiento ambulatorio del uroanálisis y la tensión arterial, para garantizar que esta se normalice o para detectar daños permanentes(AU)

Introduction: urinary tract infections are a frequent problem in the pediatric population. Recurrent urinary tract infection has a higher risk of kidney scars and glomerular damage. Objective: to describe frequency of hematuria, presence of proteins in urine, increase of blood pressure, and ultrasound findings in pediatric patients from 1 month to 14 years old with a diagnosis of urinary tract infection. Methods: cross-sectional descriptive study conducted from October 2014 to February 2016, in patients who attended the pediatric emergency´s service of the Hospital of San José with a diagnosis of urinary tract infection. Results: 125 patients with urinary tract infection were diagnosed, the median age was 2.75 years, it was more frequent in women (75.2 percent) and the majority of them received intrahospital treatment (58.4 percent). It was observed that in the recurrent urinary tract infection group the finding of hematuria was more frequent, than in the group of urinary tract infection as a first episode (21.9 vs. 11.8 percent), as well as the renal malformations (32,0 vs. 14.5percent). In blood pressure, there were no large differences among the groups, with a rate of high blood pressure frequency in hospitalized patients of 19.6 percent for first episode, and 18.2 percent in recurrent patients. The abnormal presence of proteins in urine was of 35.4 percent in the group of urinary tract infection first episode(AU) Conclusions: the presence of hematuria, renal malformations and increase of blood pressure in patients with urinary tract infection are frequent. There is an unusual frequency of patients with high blood pressure and proteins in the urine, probably due to false positives. It must be addressed the ambulatory monitoring of urinalysis and blood pressure to ensure that it normalizes or to detect permanent damage

Detecção de Salmonella em tomates (Lycopersicon esculentum MILL) pelos métodos FDA-BAM e Mini Vidas ­ Biomérieux / Detection of Salmonella in tomatoes (Lycopersicon esculentum MILL) by FDA-BAM methods and Mini Vidas - Biomerieux

Diversos surtos de Salmonella ocasionados pelo consumo de tomate contaminados com este micro -organismo têm sido relatados ultimamente, o que torna primordial a investigação sobre a presença desse patógeno nesse alimento. Métodos que permitam a avaliação rápida da presença de Salmonella em alimentos são de suma importância. O objetivo desse estudo foi comparar o método tradicional da Food and Drug Administration - Bacteriologycal Analytical Manual (FDA-BAM) com um método rápido da mini Vitek Immuno Diagnostic System Assay (Mini­Vidas-SLM)-bioMérieux, para detecção de Salmonella Brazil inoculada artificialmente na superfície de tomates. Foram analisadas 215 amostras de tomates inoculadas artificialmente com Salmonella Brazil com níveis de inóculos variando de 0,4 a 940 UFC/tomate. Os resultados obtidos mostraram que os métodos estudados apresentaram uma ótima concordância entre si, para todas as faixas de inóculo analisadas.

Incidentaloma suprarrenal, patología emergente en la era de los avances imaginológicos / Adrenal Incidentaloma, Emerging Pathology in the Age of the Imaging Advances

El incidentaloma adrenal es una masa encontrada de forma incidental durante un estudio de imagen, con múltiples implicaciones clínicas según su etiología; por esto es importante discutir su abordaje diagnóstico y el manejo médico correspondiente. Se presenta el caso de un paciente masculino de 64 años de edad, hospitalizado por cuadro clínico de síncope, hipertensión no controlada e hiperglucemia, a quien además se le había detectado previamente una masa suprarrenal en estudio ambulatorio de imagen. Durante su estancia se realizaron estudios imaginológicos y laboratorios para determinar la etiología de esta masa, su relación con el cuadro clínico actual y su tratamiento. Se concluye que el incidentaloma adrenal es una entidad frecuente cuyo reto diagnóstico consiste en establecer si se trata de una entidad maligna o benigna y si es funcionante o no, con el fin de determinar si requiere manejo quirúrgico o solo observación.

Introduction: Adrenal incidentaloma is a mass found incidentally during an imaging study with multiple clinical implications according etiology. For this reason, it is important to discuss the diagnostic approach and appropriate medical management. Case: 64 year old male patient, hospitalized for clinical symptoms of syncope, uncontrolled hypertension and hyperglycemia; in addition, a suprarenal mass was previously detected in an outpatient image study. During his stay, imaging and laboratory studies were conducted to determine the etiology of this mass, relative to the current clinical condition and treatment. Conclusion: The adrenal incidentaloma is a frequent diagnosis. Its challenge is to determine whether it is malignant or a benign entity and whether it is functioning or not, in order to determine if it requires surgical treatment or if it only requires observation.

Comportamento alimentar e transtorno alimentar: uma discussão de variáveis determinantes da anorexia e da bulimia / Eating behavior and eating disorders: a discussion of determinants variables of anorexia and bulimia

O presente trabalho apresenta uma revisão crítica dos critérios diagnósticos e modelos de determinação da anorexia e bulimia, a partir de publicações veiculadas no International Journal of Eating Disorders. Questiona, particularmente, a noção de determinação interna destes transtornos, enfatizando a questão da fobia de peso (fat phobia) como um exemplo deste modo de interpretação. A recuperação do modelo biocomportamental de anorexia induzida por atividade física (activicty anorexia), e do conjunto de experimentos que o embasam, pretende incitar a consideração de explicações alternativas aos transtornos alimentares, sem a necessidade de apelo para variáveis cognitivas ou emocionais como determinantes destes transtornos.(AU)

This paper presents a critical review of diagnostic criteria and determination models of anorexia and bulimia, used in the International Journal of Eating Disorders. It is particularly questioning the notion of internal determination of these disorders, emphasizing this mode of interpretation with an analysis of the weight phobia (fat phobia). The recovery of this biobehavioral model of anorexia induced by physical activity, and the set of experiments that underlie it, aims to bring the consideration of alternative explanations for eating disorders without the need to appeal to emotional or cognitive variables as determinants of these disorders.(AU)

Comportamento alimentar e transtorno alimentar: uma discussão de variáveis determinantes da anorexia e da bulimia / Eating behavior and eating disorders: a discussion of determinants variables of anorexia and bulimia

O presente trabalho apresenta uma revisão crítica dos critérios diagnósticos e modelos de determinação da anorexia e bulimia, a partir de publicações veiculadas no International Journal of Eating Disorders. Questiona, particularmente, a noção de determinação interna destes transtornos, enfatizando a questão da fobia de peso (fat phobia) como um exemplo deste modo de interpretação. A recuperação do modelo biocomportamental de anorexia induzida por atividade física (activicty anorexia), e do conjunto de experimentos que o embasam, pretende incitar a consideração de explicações alternativas aos transtornos alimentares, sem a necessidade de apelo para variáveis cognitivas ou emocionais como determinantes destes transtornos...

This paper presents a critical review of diagnostic criteria and determination models of anorexia and bulimia, used in the International Journal of Eating Disorders. It is particularly questioning the notion of internal determination of these disorders, emphasizing this mode of interpretation with an analysis of the weight phobia (fat phobia). The recovery of this biobehavioral model of anorexia induced by physical activity, and the set of experiments that underlie it, aims to bring the consideration of alternative explanations for eating disorders without the need to appeal to emotional or cognitive variables as determinants of these disorders...

PRUEBAS DE TOXICIDAD AGUDA CL (I) 50 EN PECES ESTUARINOS (Gambusia affinis) UTILIZANDO EFLUENTES INDUSTRIALES A LA BAHÍA DE CARTAGENA, COLOMBIA / ACUTE TOXICITY TESTS CL (I) 50 IN ESTUARINE FISH (Gambusia affinis) USING INDUSTRIAL EFFLUENTS TO THE BAY OF CARTAGENA, COLOMBIA

Se efectuaron pruebas de toxicidad con dos efluentes de ALCO Ltda. (el efluente Cospique que descarga desechos industriales y el efluente Casimiro donde se vierten aguas de enfriamiento), para analizar su efecto en los peces estuarinos G. affinis en un tiempo de 24, 48, 72 y 96 horas de exposición, con sistemas estáticos y sin recambio. En los análisis estadísticos se realizan regresiones por mínimos cuadrados ordinarios para determinar el tiempo letal medio y las curvas de toxicidad, se hallan los valores de la CL (I) 50 con sus límites de confianza bajo el método PROBIT. Con el efluente Cospique los porcentajes (%) y tiempo de exposición que se encontraron CL (I) 50 fueron de 15,91; 15,18; 15,18 y 15,12; para 24, 48, 72 y 96 horas de exposición respectivamente. Por tanto, el efluente Cospique es de mayor letalidad, demostrando el efecto inmediato de los mismos. Para el caso de los efluentes de ALCO Ltda. se encontró que a mayor concentración hay mayor mortalidad y menor tiempo letal medio. Los efluentes industriales estudiados son considerados inestables por la formación de complejos químicos resultado de sus compuestos.

Toxicity tests were carried out with two effluents of ALCO Ltda. (effluent Cospique wich discharges industrial waste and effluent Casimiro into which the cooling water is discharged) in order to analyze their effect on the G. affinis fish during an exposure period of 24, 48, 72, and 96 hours with static systems and without replacement. Regressions by ordinary minimum quadratic were carried out in the statistical analyses to determine the median lethal time and the toxicity curves. The values for LC (I) 50 and their confidence limits were found using the PROBIT method. With the Cospique effluent the percentages (%) and the exposure time found LC (I) 50 were of 15,91; 15,18; 15,18 and 15,12 for 24, 48, 72 and 96 hours respectively. As a consequence, the Cospique effluent is of a higher lethality, demonstrating their immediate effects. In the case of ALCO Ltda. it was found that to higher concentrations was highest the mortality and lesser the median lethal time. The industrial effluents studied are considered unstable because of the formation of chemical complexes resulting from their compounds.

PRUEBAS DE TOXICIDAD AGUDA CL (I) 50 EN CAMARONES MARINOS (Litopenaeus schmitti Y L. vannamei) UTILIZANDO EFLUENTES INDUSTRIALES A LA BAHÍA DE CARTAGENA, COLOMBIA / ACUTE TOXICITY TESTS CL (I) 50 IN MARINE SHRIMP (Litopenaeus schmitti AND L. vannamei) USING INDUSTRIAL EFFLUENTS IN THE BAY OF CARTAGENA, COLOMBIA

Se efectuaron pruebas de toxicidad con dos efluentes de ALCO Ltda. (Cospique que descarga desechos industriales y Casimiro donde se vierten aguas de enfriamiento), para analizar su efecto en los camarones Litoenaeus schmitti y L. vannamei en un tiempo de 24, 48, 72 y 96 horas de exposición, con sistemas estáticos y sin recambio. En los análisis estadísticos se realizan regresiones por mínimos cuadrados ordinarios para determinar el tiempo letal medio y las curvas de toxicidad, se hallan los valores de la CL (I) 50 con sus límites de confianza bajo el método PROBIT. Con el efluente Cospique los porcentajes (%) y el tiempo de exposición que se encontraron CL (I) 50 fueron de 6,43 en 24 horas, 6,29 en 48 horas, 6,11 en 72 horas y 5,66 en 96 horas sobre L. vannamei; para 24 horas de 7,02; 48 horas de 6,9; 72 horas de 6,92 y 96 horas de 6,71 en L. schmitti. Por tanto, el efluente Cospique es de mayor letalidad, demostrando el efecto inmediato. Para el caso de los efluentes de ALCO Ltda. se encontró que a mayor concentración hay mayor mortalidad y menor tiempo letal medio. Los efluentes industriales estudiados son considerados inestables por la formación de complejos químicos resultado de sus compuestos alcalinos.

Toxicity tests were carried out with two effluents of ALCO Ltda. (effluent Cospique which discharges industrial wastes, and effluent Casimiro into which the cooling water is discharged) in order to analyze their effect on Litopenaeus schmitti and L. vannamei shrimp during an exposure period of 24, 48, 72, and 96 hours within static systems and without replacement. Regressions by ordinary minimum quadratic were carried out in the statistical analyses to determine the median lethal time and the toxicity curves. The values for LC (I) 50 and their confidence limits were found using the PROBIT method. With the Casimiro effluent the percentages (%) and the exposure time found LC (I) 50 were 6.43 in 24 hours, 6.29 in 48 hours, 6.11 in 72 hours, and 5.66 in 96 hours for L. vannamei. For L. schmitti the results were 7.02 in 24 hours, 6.9 in 48 hours, 6.92 in 72 hours, and 6.71 in 96 hours of exposure respectively. The above results indicate that effluents Cospique is of a higher lethality, demonstrating its immediate effects. In the case of ALCO Ltda. Effluents it was found that to higher concentrations was highest the mortality and lesser the lethal median time. The industrial effluents studied are considered unstable because of the formation of chemical complexes resulting from their compounds.

Production of bioemulsifiers by Amycolatopsis tucumanensis DSM 45259 and their potential application in remediation technologies for soils contaminated with hexavalent chromium.

In recent years, increasing interest has been shown in the use of bioemulsifiers as washing agents that can enhance desorption of soil-bound metals. However, high production costs derived from the use of expensive substrates for formulation of the fermentation media represent the main challenge for full, large-scale implementation of bioemulsifiers. This work reports on a first study of bioemulsifier production by the actinobacterium Amycolatopsis tucumanensis DSM 45259 using different carbon and nitrogen sources. Preliminary results on the potential use of these compounds as washing agents for soils contaminated with Cu(II) and Cr(VI) are also presented. The best specific production was detected using glycerol and urea as carbon and nitrogen substrates, respectively. However, with all of the substrates used during the batch assay, the bioemulsifiers showed high levels of stability at extreme conditions of pH, temperature, and salt concentration. Under the current assay conditions, the bioemulsifiers were not effective in removing Cu(II) from soil. However, they were able to mediate Cr(VI) recovery, with the removal percentage doubled compared to that seen when using deionized water. These findings appear promising for the development of remediation technologies for hexavalent chromium compounds based upon direct use of these microbial emulsifiers.

Incidência de Listeria monocytogenes em queijo minas frescal comercializado no município do Rio de Janeiro, RJ / Incidence of Listeria monocytogenes in cheese frescal commercialized in the city of Rio de Janeiro, RJ

A incidência de Listeria monocytogenes foi verificada em amostras de queijo Minas Frescal obtidas na cidade do Rio de Janeiro (RJ). Amostras de quatro marcas industriais diferentes foram coletadas em dois estabelecimentos comerciais. Dois métodos de detecção deste patógeno foram utilizados: o método “Bacterial Analytical Manual/Food and Drug Administration” – BAM/FDA e o método Canadense “Health Products and Food Branch” – HPFB. L. monocytogenes foi detectada em 58,8% do total de amostras analisadas. O Método BAM/FDA, 2003 detectou a bactéria em 35,3% das amostras de queijo, enquanto que o método HPFB detectou a presença desse micro-organismo em 41,2% das amostras. L. monocytogenes foi detectada por ambos os métodos em 17,6% das amostras analisadas. Em todas as amostras de uma mesma marca industrial (marca A) a presença de Listeria monocytogenes foi observada por ambos os métodos. A ocorrência desta bactéria nas amostras de queijos analisadas sugere a ausência ou aplicação incorreta de Boas Práticas de Manipulação durante o seu processamento, além da manipulação inadequada do produto durante ou após o processamento.

Alterações sensoriais na síndrome de Down / Sensorial alterations in Down's syndrome

A Síndrome de Down é uma das anormalidades cromossômicas mais comuns na população mundial, apresentando um conjunto de alterações que inclui os aspectos sensoriais. Reconhecendo a importância da utilização de instrumentos padronizados para avaliação, este estudo se propôs a investigar as possíveis alterações sensoriais em crianças com síndrome de Down, utilizando a Avaliação do Perfil Sensorial. Participaram do estudo 10 crianças inseridas em instituições de reabilitação, de dois municípios do estado de São Paulo. Os resultados apontaram para alterações no processamento sensorial, afetando aspectos dos sistemas vestibular, proprioceptivo, tátil, visual e auditivo. Verificou-se, ainda, estresse e cansaço diante de estímulo novo, bem como dificuldade no comportamento estratégico e na atenção. Os resultados são discutidos à luz da literatura e sugerem a necessidade de continuidade e ampliação de pesquisas na área, buscando maior conhecimento sobre o processamento sensorial de crianças com síndrome de Down e suas repercussões no desenvolvimento.

Down syndrome is one of the most common chromosomic abnormalities in the world, presenting a set of alterations that includes sensorial aspects. Recognizing the importance of the use of standardized instruments for evaluation, possible alterations in children with Down syndrome were studied applying the Evaluation of the Sensorial Profile. Ten children living in two different cities of São Paulo state and attending rehabilitation institutions participated in the study. Results pointed out some changes in the sensorial processing, affecting aspects of the vestibular, proprioceptive, tatil, visual and hearing systems. Stress and fatigue were identified when children were exposed to a new stimulus, as well as difficulties in strategic behavior and in attention were observed. Results are discussed based on the literature, suggesting the need of continued research in the area for providing greater knowledge about the sensorial processing of children with Down syndrome and its repercussions on development.

Secagem de café em terreiro e em estufa / Drying of coffee in a greenhouse and terrace

O Brasil ocupa historicamente a posição de maior produtor e exportador de café verde do mundo (1,37 milhões de toneladas métricas de café em 2003, segundo a FAO, 2005).Existe atualmente uma forte demanda por cafés especiais, de bebida superior, pelos países importadores, entre eles destacam-se o Canadá, os Estados Unidos e a França, o que tem levado a busca de técnicas para produção de cafés de melhor qualidade. Sabe-se que qualidade final do grão beneficiado é resultante de vários fatores, incluindo cultivo, colheita, pós-colheita, pré-secagem, secagem, beneficiamento, armazenamento e industrialização (moagem e torração). Normalmente a etapa de pré-secagem é realizada em terreiro aberto, o que expõe o produto às condições ambientais, e completada em secadores rotativos. Nos últimos anos surgiu como alternativa o uso de estufas de lona plástica com a finalidade de proteger o produto, durante a etapa de pré-secagem, de eventuais precipitações que ocorram durante essa fase. A velocidade do ar e temperatura durante a pré-secagem são fatores fundamentais no processo que influenciam a qualidade do produto e a sua microbiota. Com base nessas considerações, o objetivo desse estudo foi comparar a pré-secagem do café em terreiro e em estufas, fechada e parcialmente aberta, avaliando as taxas de secagem em cada ambiente, a qualidade do produto seco e a microbiologia do produto...

Boas práticas de fabricação e aplicação da análise de perigos e pontos críticos de controle no processamento de água de coco / Practices of making and application from the analysis of dangers and control critics points in the coconut water processing

As características de baixa acidez da água de coco (pH > 4,5 e atividade de água próximo de 1,0), aliada ao seu crescente consumo, a tornam um produto passível de problemas de saúde pública. Deste modo, a aplicação do Sistema de Análise de Perigos e Pontos Críticos de Controle (APPCC) é fundamental para garantir a segurança alimentar desse produto. Esse estudo teve por objetivo aplicar o sistema APPCC para água de coco natural, congelada, e para aquelas obtidas pelos processos de descontaminação por luz ultravioleta (UV), esterilização Ultra High Temperature (UHT) e pasteurização. A implementação do programa de Boas Práticas de Fabricação é essencial para todas as formas de apresentação do produto, sobretudo para a água de coco natural, cuja garantia da qualidade concentra-se no manuseio higiênico da matéria-prima e processo. Foram estabelecidos pontos críticos de controle (PCC) para as etapas de filtração em membranas no sistema de descontaminação por UV, nas etapas de pasteurização, esterilização (produto e embalagem) e armazenamento refrigerado daqueles produtos que dependem de cadeia de frio. Face às características intrínsecas do produto, à presença de perigos na matéria-prima e ao crescente consumo de água de coco no país, é necessário um maior rigor na produção, comercialização, distribuição deste produto; além de maiores estudos sobre a segurança alimentar em toda a cadeia produtiva.