Practical issues concerning the use of Magnetic Resonance Imaging in Multiple Sclerosis in Latin America: Discussion from 16 centres on behalf of the Foro Latam EM Study Group.

MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis have been recently published, and they have been fundamental for improving patient care. Implementation of these and previous MAGNIMS recommendations have not been established in many countries. Addressing the local limitations behind these difficulties is needed. A panel of 14 MS neurologists from 16 different reference centres from Chile, Argentina, Mexico, Colombia, Ecuador, Panamá, Perú and Brazil met to discuss the current situation regarding the use of MRI in MS including a) Access and availability, b) Standardized acquisition protocols and reports, and c) Multicentric research potential.

Use of Tablet Devices in the Management of Agitation Among Inpatients with Dementia: An Open-Label Study.

OBJECTIVE: To investigate the feasibility, safety, and utility of tablet devices as novel nonpharmacologic tools in managing older psychiatric inpatients with agitation and dementia. METHODS: Thirty-six patients at a geriatric psychiatry inpatient unit were provided with tablets when agitated and used various apps on the tablet related to communication, games, music, web browser, and photography during their stay. Study staff documented the frequency, duration, and app usage history and rated the extent to which agitation improved after tablet use. RESULTS: All participants, regardless of dementia severity, were able to use apps and were rated by staff to have clinical benefit. Dementia severity was negatively associated with app complexity. Age was negatively associated with frequency and duration of tablet use. CONCLUSION: Tablet use as a nonpharmacologic intervention for agitation in older adults, including those with severe dementia, appears to be feasible, safe, and of potential utility.

Individualized texting for adherence building (iTAB): improving antiretroviral dose timing among HIV-infected persons with co-occurring bipolar disorder.

HIV+ persons with co-occurring bipolar disorder (HIV+/BD+) have elevated rates of medication nonadherence. We conducted a 30-day randomized controlled trial of a two-way, text messaging system, iTAB (n = 25), compared to an active comparison (CTRL) (n = 25) to improve antiretroviral (ARV) and psychotropic (PSY) adherence and dose timing. Both groups received medication adherence psychoeducation and daily texts assessing mood. The iTAB group additionally received personalized medication reminder texts. Participants responded to over 90 % of the mood and adherence text messages. Mean adherence, as assessed via electronic monitoring caps, was high and comparable between groups for both ARV (iTAB 86.2 % vs. CTRL 84.8 %; p = 0.95, Cliff's d = 0.01) and PSY (iTAB 78.9 % vs. CTRL 77.3 %; p = 0.43, Cliff's d = -0.13) medications. However, iTAB participants took ARVs significantly closer to their intended dosing time than CTRL participants (iTAB: 27.8 vs. CTRL: 77.0 min from target time; p = 0.02, Cliff's d = 0.37). There was no group difference on PSY dose timing. Text messaging interventions may represent a low-burden approach to improving timeliness of medication-taking behaviors among difficult-to-treat populations. The benefits of improved dose timing for long-term medication adherence require additional investigation.

Effects of logging, hunting, and forest fragment size on physiological stress levels of two sympatric ateline primates in Colombia.

Habitat fragmentation and anthropogenic disturbances are of major concern to the conservation of endangered species because of their potentially negative impact on animal populations. Both processes can impose physiological stress (i.e. increased glucocorticoid output) on animals, and chronically elevated stress levels can have detrimental effects on the long-term viability of animal populations. Here, we investigated the effect of fragment size and human impact (logging and hunting pressure) on glucocorticoid levels of two sympatric Neotropical primates, the red howler monkey (Alouatta seniculus) and the critically endangered brown spider monkey (Ateles hybridus). These two species have been reported to contrast strongly in their ability to cope with anthropogenic disturbances. We collected faecal samples from eight spider monkey groups and 31 howler monkey groups, living in seven and 10 different forest fragments in Colombia, respectively. We measured faecal glucocorticoid metabolite (FGCM) levels in both species using previously validated methods. Surprisingly, fragment size did not influence FGCM levels in either species. Spider monkeys showed elevated FGCMs in fragments with the highest level of human impact, whereas we did not find this effect in howler monkeys. This suggests that the two species differ in their physiological responsiveness to anthropogenic changes, further emphasizing why brown spider monkeys are at higher extinction risk than red howler monkeys. If these anthropogenic disturbances persist in the long term, elevated FGCM levels can potentially lead to a state of chronic stress, which might limit the future viability of populations. We propose that FGCM measurements should be used as a tool to monitor populations living in disturbed areas and to assess the success of conservation strategies, such as corridors connecting forest fragments.

Elevated neurobehavioral symptoms are associated with everyday functioning problems in chronic methamphetamine users.

Chronic methamphetamine (MA) use is commonly associated with neural injury and neurocognitive deficits. The authors examined the nature and correlates of self-reported neurobehavioral symptoms (e.g., apathy, disinhibition, and executive dysfunction) in 73 individuals with histories of MA dependence (MA+) and 85 comparison participants with comparable demographics and risk histories. MA+ individuals endorsed significantly more severe neurobehavioral symptoms on the Frontal Systems Behavioral Scale, especially those of disinhibition and executive dysfunction. Elevations in neurobehavioral symptoms were independent of common comorbidities, including hepatitis C infection, attention-deficit/hyperactivity disorder (ADHD), mood disorders, and other substance-use factors. Notably, the severity of neurobehavioral symptoms was uniquely associated with self-reported decrements in instrumental activities of daily living in the MA-dependent sample. Findings indicate that chronic MA users may experience elevated neurobehavioral symptoms of disinhibition and executive dysfunction, potentially increasing their risk of functional declines.

Alouatta seniculus: density, home range and group structure in a bamboo forest fragment in the Colombian Andes.

We evaluated population density, group structure and home range of red howler monkeys in a bamboo forest fragment in the Cordillera Central mountain range of Colombia. We estimated a density of 377.7 individuals/km(2), which is a higher density than normally reported for this species. The average home range size was 3.6 ± 1.1 ha. We found large groups (15.1 ± 4.0 individuals) with subgrouping behavior (daily divisions in foraging subgroups), and a high number of adult and subadult individuals of both sexes per group (mean of 5 males and 7 females per group). The small home range and large group size observed may be related to the high density of howler monkeys in this fragment, which we suggest could be the result of limited dispersal opportunities for these monkeys. The results illustrate the great plasticity of the genus Alouatta, which enables the monkeys to live in a wide range of conditions.

HIV-infected persons with bipolar disorder are less aware of memory deficits than HIV-infected persons without bipolar disorder.

Episodic memory deficits are common in HIV infection and bipolar disorder, but patient insight into such deficits remains unclear. Thirty-four HIV-infected individuals without bipolar disorder (HIV+/BD-) and 47 HIV+ individuals with comorbid bipolar disorder (HIV+/BD+) were administered the Hopkins Verbal Learning Test-Revised and the Brief Visuospatial Memory Test-Revised to examine objective learning/memory functioning. Subjective memory complaints were assessed via the memory subscale of the Patient's Assessment of Own Functioning Inventory. HIV+/BD+ individuals performed poorer on tests of visual learning and visual/verbal recall than did HIV+/BD- participants (ps < .05). Memory complaints only predicted verbal learning (at a trend level, p = .10) and recall (p = .03) among the HIV+/BD- individuals. Memory complaints were not associated with memory performance within the HIV+/BD+ group (ps > .10). Memory complaints were associated with depressive symptoms in both groups (ps < 0.05). These complaints were also predictive of immunosuppression, higher unemployment, and greater dependence on activities of daily living among the HIV+/BD+ individuals (ps < .05). Awareness of memory abilities was particularly poor among HIV+/BD+ individuals (i.e., objective learning/memory did not correspond to reported complaints), which has important implications for the capacity of these individuals to engage in error-monitoring and compensatory strategies in daily life. Memory complaints are associated with depressed mood regardless of group membership. Among HIV+/BD+ individuals, these complaints may also signify worse HIV disease status and problems with everyday functioning. Clinicians and researchers should be cognizant of what these complaints indicate in order to lead treatment most effectively; use of objective neurocognitive assessments may still be warranted when working with these populations.

Sustained attention deficits among HIV-positive individuals with comorbid bipolar disorder.

Difficulties with sustained attention have been found among both persons with HIV infection (HIV+) and bipolar disorder (BD). The authors examined sustained attention among 39 HIV+ individuals with BD (HIV+/BD+) and 33 HIV-infected individuals without BD (HIV+/BD-), using the Conners' Continuous Performance Test-II (CPT-II). A Global Assessment of Functioning (GAF) score was also assigned to each participant as an overall indicator of daily functioning abilities. HIV+/BD+ participants had significantly worse performance on CPT-II omission errors, hit reaction time SE (Hit RT SE), variability of SE, and perseverations than HIV+/BD- participants. When examining CPT-II performance over the six study blocks, both HIV+/BD+ and HIV+/BD- participants evidenced worse performance on scores of commission errors and reaction times as the test progressed. The authors also examined the effect of current mood state (i.e., manic, depressive, euthymic) on CPT-II performance, but no significant differences were observed across the various mood states. HIV+/BD+ participants had significantly worse GAF scores than HIV+/BD- participants, which indicates poorer overall functioning in the dually-affected group; among HIV+/BD+ persons, significant negative correlations were found between GAF scores and CPT-II omission and commission errors, detectability, and perseverations, indicating a possible relationship between decrements in sustained attention and worse daily-functioning outcomes.

HIV-infected individuals with co-occurring bipolar disorder evidence poor antiretroviral and psychiatric medication adherence.

The contribution of bipolar disorder (BD), a prevalent serious mental illness characterized by impulsivity and mood instability, to antiretroviral (ART) and psychiatric medication adherence among HIV-infected (HIV+) individuals is unknown. We examined medication adherence among 44 HIV+/BD+ persons as compared to 33 demographically- and medically-comparable HIV+/BD- persons. Classification of adherent (≥ 90%) or non-adherent (<90%) based on proportion of correctly taken doses over 30 days was determined using electronic medication monitoring devices. HIV+/BD+ persons were significantly less likely to be ART adherent (47.7%) as compared to HIV+/BD- (90.9%) persons. Within the HIV+/BD+ group, mean psychiatric medication adherence was significantly worse than ART medication adherence, although there was a significant correlation between ART and psychiatric adherence levels. Importantly, 30-day ART adherence was associated with plasma virologic response among HIV+/BD+ individuals. Given the high overlap of HIV and BD, and the observed medication adherence difficulties for these persons, specialized adherence improvement interventions are needed.

Immunoglobulin A, G and M levels in saliva in children between 3 - 12 years of age, healthy and with gingivitis.

UNLABELLED: The aim of this study was to measure the level of immunoglobulin A, G and M in saliva of 3- to 12-year-old children, both healthy and diagnosed with gingivitis. METHODS: A sample of 177 children was selected, of whom 24 were healthy and 153 were diagnosed with gingivitis according to Loe 's index. Samples of saliva were taken and the ELISA test was applied to obtain the immunoglobulin concentrations expressed in microg/ml. A relationship was established between the immunoglobulin levels, the disease (gingival index) and Loe 's bacterial plaque index. IgG levels were higher in healthy children. In the group with gingivitis, 95.8% of the children had incipient gingivitis with a low average index of bacterial plaque (1.33). A direct correlation was found between age and gingival index, while an inverse correlation was found between age and bacterial plaque index. The analysis of the behavior of immunoglobulin according to age showed that age was only significantly correlated to IgA levels. The analysis comparing immunoglobulin levels and clinical parameters for gingivitis showed a direct correlation between gingival index and lgM The gingival index was found that to increase with the age of the subject, even though bacterial plaque decreases. It was also found that age is a better predictor of lgA level than gingival index and bacterial plaque index are; and that gingival index is a better predictor of lgM level than age and bacterial plaque index are.

Use of space, activity patterns, and foraging behavior of red howler monkeys (Alouatta seniculus) in an Andean forest fragment in Colombia.

Howler monkeys are among the most studied primates in the Neotropics, however, behavioral studies including estimation of food availability in Andean forests are scarce. During 12 months we studied habitat use, behavior, and feeding ecology of two groups of red howler monkeys (Alouatta seniculus) in an isolated fragment in the Colombian Andes. We used a combination of focal animal and instantaneous sampling. We estimated fruit production (FP) using phenology transects, and calculated young leaf abundance by observing marked trees. The home range area used by each group was 10.5 and 16.7 ha and daily distances traveled were 431 ± 228 and 458 ± 259 m, respectively. We found that both groups spent most of their time resting (62-64%). Resting time did not increase with leaf consumption as expected using a strategy of energy minimization. We did not find a relationship between daily distances traveled and leaf consumption. However, howlers consumed fruits according to their availability, and the production of young leaves did not predict feeding time on this resource. Overall, our results are similar to those found on other forest types. We found that despite limited FP in Andean forests, this did not lead to a higher intake of leaves, longer resting periods, or shorter traveling distances for red howlers.

Immunoglobulin A, G and M levels in saliva in children between 3-12 years of age, healthy and with gingivitis

El objetivo de este estudio cuantificar los niveles de inmunoglobulinas A, G y M en saliva de niños entre 3 – 12 añossanos y con gingivitis. Métodos: la muestra fue de 177 niños distribuidos en dos grupos: 24 sanos y 153 con diagnóstico de gingivitis según el índice de Loe a quienes se les tomaron muestras de saliva y por medio de la prueba de ELISA se obtuvieronlas concentraciones de las inmunoglobulinas expresadas enµg/ml. Resultados: Se encontró que en la saliva de los niños sanos los niveles de IgG son significativamente mayores que en los niños con gingivitis. El grupo gingivitis estuvo conformado por un 95.8 por ciento de niños con diagnóstico de gingivitis incipiente que presentó un promedio bajo de índice de placabacteriana. Al hacer análisis de correlación entre las variables estudiadas, se encontró una correlación directa entre la edad y el índice gingival, una correlación inversa entre la edad y el índice de placa bacteriana, correlación directa entre los niveles de IgA y la edad y correlación directa entre el índice gingival y la IgM. Conclusiones: Se encontró que en la medida en que el individuo crece aumenta el índice gingival, aunque se presenta menor cantidad de placa bacteriana. También seconcluyó que la edad es mejor predictor de los niveles de IgA que el índice gingival y el índice de placa bacteriana y que el índice gingival es mejor predictor de los niveles de IgM que la edad y el índice de placa bacteriana.

Implications of hepatitis C virus infection for behavioral symptoms and activities of daily living.

Hepatitis C virus (HCV) is neurovirulent and has been shown to be associated with neuropsychological (NP) deficits in a subset of infected individuals. Despite these previous findings, little work has been done to examine neurobehavioral symptoms associated with HCV infection. We examined 34 HCV seropositive (HCV+) individuals and 35 healthy comparison participants (HCV-) with the self-rating form of the Frontal Systems Behavior Scale (FrSBe). Results showed that at the group level, only the FrSBe apathy subscale mean was clinically elevated (T score >65) among HCV+ persons; executive dysfunction, disinhibition, and total subscale means were not clinically elevated. At the individual level, a significantly higher proportion of HCV+ individuals than of HCV- individuals reported clinically elevated FrSBe T scores . Moreover, HCV+ individuals were nearly 3 times as likely to report clinically elevated FrSBe T scores of apathy, executive dysfunction, and disinhibition as compared to HCV- participants. A multiple regression that included substance use disorders, neuropsychological impairment, and age indicated that HCV status was an independent predictor of self-reported FrSBe total T scores. Across all participants, small, yet significant, correlations were found between elevated self-reported FrsBe T scores and dependence in activities of daily living. These results show that a subset of HCV-infected individuals report clinically elevated behavioral symptoms. Clinical implications for the assessment and management of elevated behavioral symptoms in HCV are discussed.

ESTATUS DE LA POBLACIÓN DE MONOS AULLADORES ROJOS EN EL CAÑÓN DEL BARBAS, FRAGMENTO MONTANO, CORDILLERA CENTRAL, Colombia / Status of the red howler monkeys population in the Barbas canion, montane fragment, central mountains, Colombia

Los bosques de montaña en Colombia han sufrido fuerte degradación por causas antrópicas y en la actualidad la mayoría son remanentes aislados e inmersos en hábitat antropogénicos. Los aulladores rojos han persistido en estas condiciones pero poco se conoce sobre su biología y respuesta a la alteración de su ambiente. Durante cinco meses en el 2005, evaluamos densidad y estatus poblacional de esta especie en la cuenca del río Barbas (Departamentos de Quindío y Risaralda), fragmento aislado de bosque montano bajo de 790 ha . Estimamos la densidad empleando censos por transectos lineales repetidos. Adicionalmente seguimos tropas de aulladores y evaluamos variables de vegetación teniendo en cuenta los requerimientos ecológicos de la especie. Estimamos una densidad de 11.7±6 grupos y 132.1±68 individuos/km2, superior a la usualmente reportada en bosques continuos. Esta alta densidad probablemente se deba al aislamiento del fragmento, que limita las posibilidades de dispersión de los aulladores. El tamaño promedio por tropa fue 11.3±2.5 individuos, con más de cinco machos y siete hembras adultas, y de uno a cuatro inmaduros. En general el bosque ofrece buena disponibilidad de recursos estructurales y alimenticios para los aulladores. Esta población no se encuentra amenazada en la actualidad por actividades antrópicas. El fragmento ha sido recientemente protegido bajo la figura de Parque Regional Natural y se adelantan corredores de conexión con otros remanentes cercanos. Sin embargo, esta población de aulladores se encuentra aislada de otras poblaciones y por tanto es urgente desarrollar medidas de manejo del paisaje para atenuar los efectos del aislamiento.

The montane forests in Colombia have suffered strong degradation due to human activities; currently, most of them are remnants isolated and immersed in anthropogenic habitats. The red howler monkeys have persisted in these conditions but little is known on their biology and response to the alteration of their environment. During five months in 2005, we evaluated the population density and status of this species in the basin of the Barbas River (Quindío and Risaralda departments), a low montane isolated forest fragment of 790 ha . We estimated density by censuses for linear repeated transects. Additionally we followed troops of howlers and evaluated vegetation variables according to howler ecological requirements. We estimated a density of 11.7±6 groups and 132.1±68 individuals per km2, higher than what is usually reported for this species in continuous forests. This high density might be caused due to the isolation of the fragment that reduces the possibilities of dispersion of the howlers. The average troop size was 11±2.5 individuals, with more than five males and seven females, and one to four immature individuals. In general, the forest offers to the howlers, good availability of food and structural resources. Currently, this population is not threatened by anthropogenic activities. Recently, this fragment has been protected as a Regional Park , and it exists a project to develop corridors of connection with others remnants. Nevertheless, this howler population is isolated of other populations, and therefore urgent measures of landscape management are needed to attenuate the effects of the isolation.

Impairments in fine-motor coordination and speed of information processing predict declines in everyday functioning in hepatitis C infection.

Research increasingly supports the neurovirulence of chronic infection with the hepatitis C virus (HCV). For example, HCV infection has been associated with neuropsychological impairment in several ability areas, including psychomotor skills. This study aimed to examine whether HCV-associated neuropsychological impairment is predictive of declines in the independent performance of physical (PADLs) and instrumental (IADLs) activities of daily living. A total of 106 volunteers with HCV infection completed a comprehensive neuropsychological, medical, and psychiatric research evaluation. As compared to 30 HCV-seronegative comparison participants, the HCV-infected group reported significantly greater declines in both PADLs and IADLs. Within the HCV cohort, individuals with impaired speed of information processing reported significantly greater IADL declines, whereas impaired fine-motor coordination was associated with declines in both IADLs and PADLs. In a series of regression analyses, impaired speed of information processing and depressive symptoms (as measured by the Beck Depression Inventory) were the only independent predictors of IADL declines, whereas general affective distress (as measured by the Profile of Mood States), sex, and fine-motor coordination impairment were predictive of declines in PADLs. Although the clinical assessment of HCV typically emphasizes both affective (e.g., depression) and physical factors, findings from the present study suggest that cognitive impairment is an important contributor to everyday functioning in persons living with HCV infection and therefore warrants consideration in clinical and research evaluations.

Equivalency of Spanish language versions of the trail making test part B including or excluding "CH".

Spanish speakers commonly use two versions of the alphabet, one that includes the sound "Ch" between C and D and another that goes directly to D, as in English. Versions of the Trail Making Test Part B (TMT-B) have been created accordingly to accommodate this preference. The pattern and total number of circles to be connected are identical between versions. However, the equivalency of these alternate forms has not been reported. We compared the performance of 35 healthy Spanish speakers who completed the "Ch" form (CH group) to that of 96 individuals who received the standard form (D group), based on whether they mentioned "Ch" in their oral recitation of the alphabet. The groups had comparable demographic characteristics and overall neuropsychological performance. There were no significant differences in TMT-B scores between the CH and D groups, and relationships with demographic variables were comparable. The findings suggest that both versions are equivalent and can be administered to Spanish speakers based on their preference without sacrificing comparability.

Preliminary evidence for impaired rapid verb generation in schizophrenia.

It has been hypothesized that nouns and verbs are processed within relatively separable semantic memory networks. Although abnormal semantic processing is a common feature of schizophrenia-spectrum disorders, no prior studies have specifically examined the comparability of noun and verb generation deficits in schizophrenia. In the current study, verb (action), noun (animal), and letter (f) fluency performance was evaluated in 22 inpatients with schizophrenia and 27 healthy comparison subjects. On average, individuals with schizophrenia performed approximately one standard deviation below the healthy comparison subjects on action, animal, and letter fluency. Action fluency-but not letter or animal fluency-was moderately correlated with tests of working memory, response inhibition, semantic memory, and cognitive flexibility. Findings suggest that verb- and noun-based fluency deficits are of comparable severity in schizophrenia, but that the impairment in verb generation may be driven by different underlying cognitive mechanisms. Further, hypothesis-driven research on the nature and extent of verb network disruption in schizophrenia appears warranted.

Nevo flámeo adquirido / Acquired nevus flammeus

Mientras que el nevo flámeo adquirido es un trastorno relativamente común, la forma adquirida es infrecuente y algunos de los casos descritos se han relacionado con traumatismos en la zona afectada. Presentamos un caso de nevo flámeo adquirido de naturaleza idiopática en el que no se detectaron factores precipitantes (AU)

Foliculitis por Demodex folliculorum: forma pigmentada / Secondary amyloidosis complicating arthropatic psoriasis

Se describe una variedad distintiva e infrecuente de foliculitis por Demodex folliculorum. Las lesiones clínicas consistían en máculas hiperpigmentadas asintomáticas, no descamativas, distribuidas bajo el mentón. El estudio histopatológico mostró dilatación folicular, inflamación perifolicular linfohistiocitaria e infestación folicular por Demodex folliculorum. Se observó una curación completa de las lesiones tras tratamiento con metronidazol tópico (AU)

[Authorship in the Chilean journal Revista de Otorrinolaringología y Cirurgía de Babeza y Cuello: analysis of three decades]. / Autoría en la Revista de Otorrinolaringología y Cirugía de Cabeza y Cuello: análisis de tres décadas.

BACKGROUND: The number of authors of scientific papers has increased significantly in the last decade. The increasing complexity of medical research but also vicious practices are possible causes of this trend. AIM: To analyze the number of authors and type of papers published in the Chilean Journal of Otorhinolaryngology and Head and Neck Surgery in the last three decades. MATERIAL AND METHODS: A review of all manuscripts published between 1970 and 1999. The number of authors and the type of paper was registered. RESULTS: Five hundred nineteen papers were reviewed. The mean number of authors per paper increased from 1.9 to 3 (p < 0.001). Research reports decreased from 79% to 61% and the number of review articles and case reports increased. No multicentric work was published in the period. CONCLUSIONS: A significant increase in the number of authors per manuscript was observed in this review.