Efficacy of an Early Cognitive-Behavioral Intervention for Acute Stress Disorder in Mexican Earthquake Victims.

Acute stress disorder (ASD) refers to the symptoms associated with posttraumatic stress disorder (PTSD) within the first four weeks following the traumatic event. Recent theoretical models suggest that early detection of ASD provides an opportunity to implement early interventions to prevent the development of PTSD or ameliorate its symptomatology. The aim of the present study was the evaluation of the efficacy of an ASD treatment for earthquake victims, which would serve as an early intervention for PTSD. A single-case (n = 1) quasi-experimental design was used, with pre and post-assessments, as well as one, three and six-month follow-ups, with direct treatment replications. Fourteen participants completed the treatment and the follow-up measurements. The results obtained using a single-case analysis showed significant clinical improvement and clinically significant change when employing a clinical significance analysis and the reliable index of change. Statistical analyses of the dataset displayed statistically significant differences between the pre and post-assessments and the follow-up measures, as well as large effect sizes in all clinical measures. These results suggest that the treatment was an efficacious early intervention for PTSD during the months following the traumatic event, although some relevant study limitations are discussed in the text.

Adaptación de la Lista Checable de Trastorno por Estrés Postraumático para DSM-5 en Población Mexicana / Adaptation of the Posttraumatic Stress Disorder Checklist for DSM-5 in Mexican Population

Resumen La Lista Checable de Trastorno por Estrés Postraumático (PCL) ha sido una de las escalas más aplicadas en el ámbito clínico, misma que ha sido adaptada recientemente a los criterios del DSM-5 (PCL-5). Considerando la problemática que representa el TEPT en la población y los cambios recientes propuestos en el DSM-5, resulta importante contar con escalas validadas en México con base a los nuevos criterios diagnósticos descritos. El presente trabajo describe las propiedades psicométricas para la validación en población mexicana de la PCL-5, donde se contó con 204 estudiantes universitarios del sistema abierto de la UNAM, de 18 a 59 años, reclutados a través de una plataforma virtual. Los resultados mostraron una adecuada consistencia interna (.97), así como una validez convergente apropiada (rs = .58 a .88). A su vez, se realizaron distintos análisis factoriales exploratorios y confirmatorios donde se obtuvieron ajustes adecuados a los modelos planteados en el DSM-5 y estudios previos de la escala original. Se concluye que la escala es válida y confiable en población mexicana, lo que la convierte en el único instrumento adaptado al DSM-5 para la evaluación del TEPT en dicho contexto. Sin embargo, se recomiendan estudios adicionales con un mayor control sobre distintos tipos de trauma para mejor descripción del constructo.

Abstract The Posttraumatic Stress Disorder Checklist (PCL) has been one of the most applied scales in the clinical field, which has been recently adapted to the DSM-5 criteria (PCL-5). Considering the problems posed by PTSD in the population and the recent changes proposed in the DSM-5, it is important to have validated scales in Mexican population based on the new diagnostic criteria described. The present work describes the psychometric properties for the validation in Mexican population of the PCL-5, where 204 students from open and distance learning university between 18 and 59 years old participated, recruited through a virtual platform. The results showed an adequate internal consistency (.97), as well as an appropriate convergent validity (rs=.58 to .88). At the same time, different exploratory and confirmatory factor analyses were conducted, where appropriate adjustments to the models proposed in the DSM-5 and previous studies of the original scale were obtained. We conclude that the scale is valid and reliable in the Mexican population, which makes it the only instrument adapted to the DSM-5 for the evaluation of PTSD in this context. However, additional studies with greater control over different types of trauma are recommended for a better description of the construct.

Profiling of Alzheimer's disease patients in Puerto Rico: A comparison of two distinct socioeconomic areas.

OBJECTIVE: The Latino/Hispanic community in the United States is at higher risk of developing Alzheimer's disease than other ethnic groups. Specifically, Caribbean Hispanics showed a more severe Alzheimer's disease symptomatology than any other ethnic group. In a previous study, we demonstrated that the mortality rate associated with Alzheimer's disease in Puerto Rico is higher than that reported in the United States. Moreover, the mortality rate associated with Alzheimer's disease was higher among Puerto Rican living in Puerto Rico than those in the mainland United States. There is also a differential geographical distribution of mortality rate associated with Alzheimer's disease in Puerto Rico, which may be associated with differential socioeconomic status and/or access to healthcare. However, there is no information regarding the clinical profile of Alzheimer's disease patients in Puerto Rico. METHODS: Here, we present the results of a retrospective study directed to profile Alzheimer's disease patients clustered into two groups based on areas previously determined with low (Metro Region) and high (Northwest-Central Region) mortality rate associated with Alzheimer's disease in Puerto Rico. RESULTS: Significant difference in the age-at-diagnosis and years of education was found among patients within the two studied regions. Despite these differences, both regions showed comparable levels of initial and last Mini Mental State Examination scores and rate of cognitive decline. Significant difference was also observed in the occurance of co-morbidities associated with Alzheimer's disease. CONCLUSIONS: The differential profile of Alzheimer's disease patients correlated with differences in socioeconomic status between these two regions, suggesting that covariant associated with social status may contribute to increased risk of developing Alzheimer's disease. Further studies should be conducted to determine the role of socioeconomic factors and healthy living practices as risk factors for Alzheimer's disease.

Thrombophilia in human immunodeficiency virus-infected patients with osteonecrosis: Is there a real connection? The first case-control study.

Several reports have described an increased incidence of osteonecrosis in human immunodeficiency virus-infected patients (HIV+), but the cause has not been established. The association between thrombophilia and osteonecrosis in HIV+ was studied. A case-control study in HIV+, 19 cases and 38 controls, was designed. Magnetic resonance imaging was made in both groups to confirm or exclude hip osteonecrosis. The extensive tests of thrombophilia were measured, and the clinical data were recorded, nadir of CD4(+) cell count and well-known risk factors for osteonecrosis. Thrombophilia has been frequently found both in patients with and without osteonecrosis (thrombophilia, 68.4% vs 60.5%), but no specific thrombophilia tests were significantly associated with osteonecrosis. A low nadir of CD4(+) (<60 cells/microL) and corticoid use were significantly (P < .05) associated with osteonecrosis. In multivariate analysis, only nadir of CD4(+) <60 cells/microL remained a predictor of osteonecrosis (odds ratio = 7.33; 95% confidence interval, 1.80-29.82, P = .005). Thrombophilia might have a limited role in the development of osteonecrosis in HIV+. Nadir of CD4(+) <60 cells/microL and corticoid use were main factors.

Geographical differences in the occurrence of Alzheimer's disease mortality: United States versus Puerto Rico.

Since the implementation of the 10th International Classification of Disease in 1999, the trend in Alzheimer's disease mortality rate has not been reported. Here, the age-adjusted Alzheimer's disease mortality rate in Puerto Rico and United States from 1999 to 2004 was analyzed. The results showed an increasing trend in Alzheimer's disease mortality rate in both the United States and Puerto Rico. However in Puerto Rico, the Alzheimer's disease mortality rate (32.4/100,000) was higher than that observed in United States (20.9/100,000). Interestingly, the Alzheimer's disease mortality rate of Puerto Ricans living in Puerto Rico is much higher than Puerto Ricans living in the United States. The higher occurrence of Alzheimer's disease mortality in Puerto Rico versus the United States could be explained by factors such as coding practices, genetics, socioeconomics, and health care. These results highlight the need for comprehensive studies on factors that may influence diagnosis, death certificate coding practices, and development of Alzheimer's disease pathology in different geographical regions.

[Osteonecrosis in HIV-infected patients]. / Osteonecrosis en pacientes infectados por HIV.

Osteonecrosis, also known as avascular necrosis, is chiefly characterized by death of bone caused by vascular compromise. The true incidence of osteonecrosis in HIV-infected patients is not well known and the pathogenesis remains undefined. Hypothetical risk factors peculiar to HIV-infected individuals that might play a role in the pathogenesis of osteonecrosis include the introduction of protease inhibitors and resulting hyperlipidemia, the presence of anticardiolipin antibodies in serum leading to a hypercoagulable state, immune recovery and vasculitis. Hereby we present a series of 13 HIV-infected patients with osteonecrosis. The most common symptom upon presentation was arthralgia. The majority of the patients had received steroids, 9 had developed hyperlipidemia after the introduction of HAART, 8 were smokers and 4 patients were alcoholics. In 2 patients, seric anticardiolipin antibodies were detected. Twelve patients had AIDS and were on HAART (11 were on protease inhibitors). We believe that osteonecrosis should be included as differential diagnosis of every HIV-infected patient who complains of pain of weight bearing joints. Likewise, it seems prudent to rule out HIV infection in subjects with osteonecrosis.

Osteonecrosis en pacientes infectados por HIV / Osteonecrosis in HIV-infected patients

Según la literatura, la osteonecrosis tiene una mayor incidencia en los pacientes infectados con HIV que en la población general. Ello sería resultado de la confluencia de factores de riesgo clásicos y de otros propios de esta población o más prevalentes en ella, como el tratamiento con inhibidores de proteasa, la dislepemia producto de su consumo, la presencia de anticuerpos anticardiolipina séricos, la hipercoagulabilidad, la restauración inmune y las vasculitis. Presentamos una serie de 13 pacientes infectados con HIV con osteonecrosis. El motivo de consulta fue dolor en grandes articulaciones. Cuatro eran alcoholistas, 8 tabaquistas y 9 tenían dislipemia. Once habían recibido esteroides en algún momento de la vida aunque sólo uno estaba reciciéndolos al momento de inicio del dolor. En 2 se detectaron anticuerpos anticardiolipina séricos. Doce tenían sida y recebían tratamiento antirretroviral de alta eficacia (11 con inhibidores de proteasa). Ellos lograron una adecuada recuperacíon inmunológica. Consideramos necesario incluir la osteonecrosis como diagnóstico diferencial de artralgia persistente en pacientes infectados con HIV e investigar infección por HIV en todo paciente con osteonecrosis sin claros factores predisponentes. (AU)

Osteonecrosis en pacientes infectados por HIV / Osteonecrosis in HIV-infected patients

Según la literatura, la osteonecrosis tiene una mayor incidencia en los pacientes infectados con HIV que en la población general. Ello sería resultado de la confluencia de factores de riesgo clásicos y de otros propios de esta población o más prevalentes en ella, como el tratamiento con inhibidores de proteasa, la dislepemia producto de su consumo, la presencia de anticuerpos anticardiolipina séricos, la hipercoagulabilidad, la restauración inmune y las vasculitis. Presentamos una serie de 13 pacientes infectados con HIV con osteonecrosis. El motivo de consulta fue dolor en grandes articulaciones. Cuatro eran alcoholistas, 8 tabaquistas y 9 tenían dislipemia. Once habían recibido esteroides en algún momento de la vida aunque sólo uno estaba reciciéndolos al momento de inicio del dolor. En 2 se detectaron anticuerpos anticardiolipina séricos. Doce tenían sida y recebían tratamiento antirretroviral de alta eficacia (11 con inhibidores de proteasa). Ellos lograron una adecuada recuperacíon inmunológica. Consideramos necesario incluir la osteonecrosis como diagnóstico diferencial de artralgia persistente en pacientes infectados con HIV e investigar infección por HIV en todo paciente con osteonecrosis sin claros factores predisponentes.

Osteonecrosis en pacientes infectados por HIV. / [Osteonecrosis in HIV-infected patients]

Osteonecrosis, also known as avascular necrosis, is chiefly characterized by death of bone caused by vascular compromise. The true incidence of osteonecrosis in HIV-infected patients is not well known and the pathogenesis remains undefined. Hypothetical risk factors peculiar to HIV-infected individuals that might play a role in the pathogenesis of osteonecrosis include the introduction of protease inhibitors and resulting hyperlipidemia, the presence of anticardiolipin antibodies in serum leading to a hypercoagulable state, immune recovery and vasculitis. Hereby we present a series of 13 HIV-infected patients with osteonecrosis. The most common symptom upon presentation was arthralgia. The majority of the patients had received steroids, 9 had developed hyperlipidemia after the introduction of HAART, 8 were smokers and 4 patients were alcoholics. In 2 patients, seric anticardiolipin antibodies were detected. Twelve patients had AIDS and were on HAART (11 were on protease inhibitors). We believe that osteonecrosis should be included as differential diagnosis of every HIV-infected patient who complains of pain of weight bearing joints. Likewise, it seems prudent to rule out HIV infection in subjects with osteonecrosis.

Industria y las tuberías para conduccion del agua

Menciona antecedentes de la conduccion del agua para consumo humano y otros usos. Señala las ventajas actuales que ofrece las tuberías de presión Eternit (asbesto-cemento) para abastecimiento de agua potable en el Perú