Patterns and Trends in the Use of Medications for COPD Control in a Cohort of 9476 Colombian Patients, 2017-2019.

Purpose: Chronic obstructive pulmonary disease (COPD) affects approximately 174 million people worldwide. The objective was to determine the trends of COPD medication use in a group of Colombian patients. Patients and Methods: This was a retrospective study on prescription patterns of bronchodilators and other medications used in COPD from a population database with follow-up at 12 and 24 months. Patients older than 18 years of age of any sex with a COPD diagnostic code between 2017 and 2019 were included. Sociodemographic variables, medications, treatment schedules for COPD, comorbidities, comedications, and the specialty of the prescriber were considered. Results: Data from 9476 people with COPD was evaluated. The mean age was 75.9 ± 10.7 years, 50.1% were male, and 86.8% were prescribed by a general practitioner. A total of 57.9% had comorbidities, most often hypertension (44.4%). At the baseline measurement, on average, they received 1.6 medications/patient, mainly short-acting antimuscarinics (3784; 39.9%), followed by short-acting ß-agonists (2997, 31.6%) and inhaled corticosteroids (ICS) (2239, 23.6%); more than half (5083, 53.6%) received a long-acting bronchodilator. Prescription of triple therapy (antimuscarinic, ß-agonist, and ICS) went from 645 (6.8%) at baseline to 1388 (20.6%) at the 12-month mark. Conclusion: This group of patients with COPD treated in Colombia frequently received short-acting bronchodilators and ICS, but a growing proportion are undergoing controlled therapy with long-acting bronchodilators, a situation that can improve the indicators of morbidity, exacerbations, and hospitalization.

Clinical characterization of a cohort of patients treated for systemic lupus erythematosus in Colombia: A retrospective study.

INTRODUCTION: Systemic lupus erythematosus is an autoimmune disease associated with serious complications and high costs. The aim was to describe the clinical characteristics and health care resource utilization of a Colombian systemic lupus erythematosus outpatient cohort. METHODS: This was a retrospective descriptive study. Clinical records and claims data for systemic lupus erythematosus patients from ten specialized care centers in Colombia were reviewed for up to 12 months. Baseline clinical variables, Systemic Lupus Erythematosus Disease Activity Index, drug use, and direct costs were measured. Descriptive statistics were analyzed using SPSS. RESULTS: A total of 413 patients were included; 361 (87.4%) were female, and the mean age was 42 ± 14 years. The mean disease evolution was 8.9 ± 6.0 years; 174 patients (42.1%) had a systemic manifestation at baseline, mostly lupus nephritis (105; 25.4%). A total of 334 patients (80.9%) had at least one comorbidity, mainly antiphospholipid syndrome (90; 21.8%) and hypertension (76; 18.4%). The baseline Systemic Lupus Erythematosus Disease Activity Index score was 0 in 215 patients (52.0%), 1-5 in 154 (37.3%), 6-10 in 41 (9.9%) and 11+ in 3 (0.7%). All patients received pharmacological therapy, and the most common treatment was corticosteroids (293; 70.9%), followed by antimalarials (chloroquine 52.5%, hydroxychloroquine 31.0%), immunosuppressants (azathioprine 45.3%, methotrexate 21.5%, mycophenolate mofetil 20.1%, cyclosporine 8.0%, cyclophosphamide 6.8%, leflunomide 4.8%) and biologicals (10.9%). The mean annual costs were USD1954 per patient/year, USD1555 for antirheumatic drugs (USD10,487 for those with biologicals), USD86 for medical visits, USD235 for drug infusions and USD199 for laboratory tests. CONCLUSIONS: Systemic lupus erythematosus generates an important economic and morbidity burden for the Colombian health system. Systemic lupus erythematosus outpatient attention costs in the observation year were mainly determined by drug therapy (especially biologics), medical visits and laboratory tests. New studies addressing the rate of exacerbations, long-term follow-up or costs related to hospital care are recommended.

Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies.

BACKGROUND: Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. OBJECTIVE: Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). METHODS: This study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions. RESULTS: A total of 2 co-design workshops were held with 18 users-young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions-young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. CONCLUSIONS: The application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C-a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.

Guía de práctica clínica para la prevención, el diagnóstico, el tratamiento y la rehabilitación de la falla cardiaca en población mayor de 18 años, clasificación B, C y D. Componente de rehabilitación cardiaca / Practice Guidelines for the prevention, diagnosis, treatment, and rehabilitation of heart failure in a population greater than 18 years-old: B, C and D Classification. Cardiac rehabilitation component

Resumen Introducción: Los programas de rehabilitación cardiaca integran la realización de ejercicio supervisado con prevención secundaria y soporte sicosocial que permite mejorar la adherencia a medidas con impacto claro sobre la morbilidad y mortalidad en pacientes con falla cardiaca. Metodología: Para el desarrollo de la guía de práctica clínica basada en la evidencia se siguieron los pasos definidos en la Guía Metodológica para la Elaboración de Guías de Práctica Clínica con Evaluación Económica en el Sistema General de Seguridad Social en Salud Colombiano del Ministerio de Salud y Protección Social de Colombia. Resultados: Se establecen las recomendaciones para el desarrollo adecuado de un programa de rehabilitación cardiaca integral en pacientes con falla cardiaca, abordando aspectos de evaluación de capacidad funcional, efectividad y seguridad del ejercicio, dosificación, modalidad y rehabilitación en pacientes con dispositivos. Conclusión: La práctica de ejercicio en pacientes con falla cardíaca estable ha demostrado disminuir las hospitalizaciones, mejorar la calidad de vida y la capacidad funcional y ser seguro en aquellos a quienes se les ha implantado un dispositivo.

Abstract Introduction: Cardiac rehabilitation programs combine the performing of supervised exercise with secondary prevention and psycho-social support that helps to improve adherence to measures, with a clear impact on the morbidity and mortality in patients with heart failure. Methodology: For the development of the evidence-based clinical practice guidelines, the steps followed were those defined in the Methodological Guidelines for the Preparation of Clinical Practice Guidelines with an Economic Assessment in the General Social Security System in Colombian Health by the Ministry of Health and Social Protection of Colombia. Results: Recommendations were established for the adequate development of an integrated cardiac rehabilitation program for patients with heart failure. The aspects approached included the assessment of functional capacity, effectivity and safety of the exercise, dosification, methodology, and rehabilitation in patients with devices. Conclusion: The practice of exercise in patients with stable heart has shown to reduce the number of hospital admissions, improve the quality of life and functional capacity. It has also shown to be safe in those that have a device implanted.

Subtipos neurocognitivos de esquizofrenia / Neurocognitive Subtypes of Schizophrenia

Objetivo. Identificar empíricamente subtipos neurocognitivos de esquizofrenia y establecer la asociación de estos con características clínicas. Métodos. Se aplicaron pruebas de atención sostenida, función ejecutiva, reconocimiento facial de emociones, memoria verbal y de trabajo a 253 sujetos con esquizofrenia. A partir de los resultados de estas pruebas se identificaron los subtipos mediante análisis de clases latentes. Posteriormente, se evaluó la asociación de cada subtipo con características clínicas. Resultados. Se identificaron cuatro subtipos: 1) déficit cognitivo global, 2) déficit de memoria y función ejecutiva, 3) déficit de memoria y reconocimiento de emociones y 4) sin déficit cognitivo. Al comparar con el subtipo sin déficit cognitivo, se observó que tanto el de déficit de memoria y función ejecutiva como el de déficit cognitivo global tenían mayor frecuencia individuos de sexo masculino, desempleados, con deterioro grave y adherentes al tratamiento. Sin embargo, en el subtipo con déficit cognitivo global la diferencia fue más alta y presentaron una frecuencia más baja de antecedentes de episodios depresivos (OR 0,39; IC95%: 0,16 a 0,97). El subtipo de déficit de memoria y reconocimiento emocional tenía más sujetos con deterioro grave (OR 5,52; IC95%: 1,89 a 16,14) y desempleo (OR 2,43; IC95%: 1,06 a 5,55), pero menos con antecedentes de episodios depresivos (OR 0,21; IC95%: 0,07 a 0,66). Conclusión. Los resultados muestran cuatro subtipos neurocognitivos de esquizofrenia con un posible espectro de severidad, asociándose en un extremo con mayor disfunción, y en el otro con mayor psicopatología afectiva y menor adherencia al tratamiento

Objective. To empirically identify schizophrenia neurocognitive subtypes and establish their association with clinical characteristics. Methods. Sustained attention, executive function, facial emotion recognition, verbal learning, and working memory tests were applied to 253 subjects with schizophrenia. We identified neurocognitive subtypes by a latent class analysis of the tests results. After, we made a search for the association of these subtypes with clinic characteristics. Results. We identified four neurocognitive subtypes: 1) 'Global cognitive deficit', 2) 'Memory and executive function deficit', 3) 'Memory and facial emotion recognition deficit,' and 4) 'Without cognitive deficit.' In comparison with the subtype 'without cognitive deficit,' we found that the 'memory and executive function deficit subtype' and the 'global cognitive deficit subtype' had a higher frequency of male, unemployed, severe impairment, and adherence to treatment participants. However, in the 'global cognitive deficit subtype' the differences were higher and there was also a lower frequency of past major depressive episodes (OR 0.39; 95%CI: 0.16 to 0.97). The 'memory and facial recognition deficit subtype' had a higher probability of severe impairment (OR 5.52; 95%CI: 1.89 to 16.14) and unemployed (OR 2.43; 95%CI: 1.06 to 5.55) participants, but also a lower probability of past depressive episodes (OR 0.21; 95%CI: 0.07 to 0.66). Conclusion. Our results suggest the existence of four neurocognitive subtypes in schizophrenia with a spectrum of dysfunction and severity. We found higher dysfunction in those with worse cognitive dysfunction, and higher affective psychopathology and less treatment adherence in those with less cognitive dysfunction

Neurocognitive subtypes of schizophrenia.

OBJECTIVE: To empirically identify schizophrenia neurocognitive subtypes and establish their association with clinical characteristics. METHODS: Sustained attention, executive function, facial emotion recognition, verbal learning, and working memory tests were applied to 253 subjects with schizophrenia. We identified neurocognitive subtypes by a latent class analysis of the tests results. After, we made a search for the association of these subtypes with clinic characteristics. RESULTS: We identified four neurocognitive subtypes: 1) “Global cognitive deficit”, 2) “Memory and executive function deficit”, 3) “Memory and facial emotion recognition deficit,” and 4) “Without cognitive deficit.” In comparison with the subtype “without cognitive deficit,” we found that the “memory and executive function deficit subtype” and the “global cognitive deficit subtype” had a higher frequency of male, unemployed, severe impairment, and adherence to treatment participants. However, in the “global cognitive deficit subtype” the differences were higher and there was also a lower frequency of past major depressive episodes (OR 0.39; 95%CI: 0.16 to 0.97). The “memory and facial recognition deficit subtype” had a higher probability of severe impairment (OR 5.52; 95%CI: 1.89 to 16.14) and unemployed (OR 2.43; 95%CI: 1.06 to 5.55) participants, but also a lower probability of past depressive episodes (OR 0.21; 95%CI: 0.07 to 0.66). CONCLUSION: Our results suggest the existence of four neurocognitive subtypes in schizophrenia with a spectrum of dysfunction and severity. We found higher dysfunction in those with worse cognitive dysfunction, and higher affective psychopathology and less treatment adherence in those with less cognitive dysfunction.

Sensibilidad en el Reconocimiento de Emociones Faciales Como Endofenotipo de Esquizofrenia / Sensitivity in the Recognition of Facial Emotions as an Endophenotype for Schizophrenia / Sensibilidade no Reconhecimento de Emoções Faciais Como Endofenótipo de Esquizofrenia

Los endofenotipos son rasgos presentes antes de la aparición de un trastorno y podrían ser útiles para identificar genes de susceptibilidad. Se determinó si personas con esquizofrenia y sus familiares de primer grado no afectados tenían un desempeño menor que los controles en la Tarea de Multitransformación de Expresión Emocional, que mide reconocimiento de emociones faciales. Las personas con esquizofrenia y sus familiares mostraron menor sensibilidad o requirieron más intensidad para identificar emociones que los controles. La exactitud para identificar emociones fue similar entre familiares y controles, pero menor en aquellos con esquizofrenia. Esto sugiere que la sensibilidad para el reconocimiento de emociones faciales es un endofenotipo de la esquizofrenia.

Endophentoypes are the traits present before the appearance of a disorder and could be useful to identify susceptibility genes. The purpose of this study was to determine whether persons suffering from schizophrenia and their immediate relatives performed less well than controls in the Emotional Expression Multi-transformation Task, which measures recognition of facial expressions. Persons with schizophrenia and their relatives showed less sensitivity than controls or required greater intensity to identify emotions than controls did. Accuracy in the identification of emotions was similar in relatives and controls, but lower in individuals with schizophrenia. This suggests that sensitivity in the recognition of facial emotions is an endophenotype for schizophrenia.

Os endofenótipos são traços presentes antes do surgimento de um transtorno e poderiam ser úteis para identificar genes de suscetibilidade. Determinou-se se pessoas com esquizofrenia e seus familiares de primeiro grau não afetados tinham um desempenho menor que os controles na Tarefa de Multitransformação de Expressão Emocional, que mede reconhecimento de emoções faciais. As pessoas com esquizofrenia e seus familiares mostraram menor sensibilidade ou requereram mais intensidade para identificar emoções que os controles. A exatidão para identificar emoções foi similar entre familiares e controles, mas menor naqueles com esquizofrenia. Isso sugere que a sensibilidade para o reconhecimento de emoções faciais é um endofenótipo da esquizofrenia.

Enfermedad de Creutzfeldt Jakob - Hospital de San José, Bogotá DC, Colombia / Creutzfeldt-jakob disease. Hospital de San José, Bogotá DC, Colombia

Se calcula que la incidencia de la enfermedad de Creutzfeldt Jakob (ECJ) es de cerca de un caso por cada millón de habitantes y aunque es poco frecuente genera en quienes la padecen consecuencias catastróficas, con signos que se inician por lo regular como un cuadro demencial progresivo e irreversible que ocasiona la muerte de manera inevitable. No hay tratamiento específico y el diagnóstico a pesar de los grandes avances científicos sigue siendo desconcertante, ya que el rendimiento de las pruebas disponibles no es el mejor. Quizá es el estudio anatomopatológico el que establece el diagnóstico, pero se requiere instrumental desechable que condiciona importantes costos a los servicios de salud, además del alto riesgo de infección al personal médico que se involucra en el procedimiento...

Incidence of Creutzfeldt-Jakob disease (CJD) is estimated in about one person in every one million people. Although CJD is rare it results in catastrophic consequences for affected patients. Initially individuals may primarily experience a progressive and irreversible dementia that invariably leads to death. There is no particular treatment and diagnosis remains to be baffling despite the great scientific breakthroughs achieved, for, the diagnostic test results available for this condition do not indicate a good performance. Diagnosis may be confirmed by a biopsy/pathology lab examinationrequiring the use of single-use instruments leading to increased costs for health services and increased risk of infection for healthcare providers who participate in the procedure...

[Quality of clinical practice guidelines published in nutrition in hospitalized oncological adult patients]. / Calidad de las guías de práctica clínica publicadas en nutrición de pacientes hospitalizados adultos oncológicos.

BACKGROUND: There is a high variability in clinical practice regarding nutritional care which could affect nutritional status of oncological patients. This variability can be diminished following evidence based recommendations from clinical practice guidelines (CPG) with good methodological quality in its development. OBJECTIVE: To review and evaluate the quality of published guidelines in nutrition in hospitalized oncological adult patients. METHODS: A search of CPGs was conducted in MEDLINE, EMBASE, GIN, TripDatabase and pages of recognized guidelines developers. CPGs published between 2003 and 2012 were included. Four independent reviewers assessed the quality of CPGs using the AGREE II instrument. Characteristics of assessed guidelines were extracted and analyzed. RESULTS: 22 CPGs met selection criteria. 90% of guidelines are written in English. There was great variability in quality scores for each domain. Highest rated domain was "clarity of presentation" (median 65.95, range 19.40 to 93.10) while the lowest was "Applicability" (median 21.20, range 0 to 77.10). Sixteen guidelines scored low on "rigour of development" and six had an acceptable or good quality. Only five documents can be considered as "good quality guidelines" because they showed high performance in all domains. CONCLUSION: It was found a wide range of methodological quality scores of evaluated CPGs. Highest rated guidelines are made by agencies that develop guidelines but these are little known in our country. Most of the assessed guidelines have methodological weaknesses, which can affect the quality of the recommendations they make and its validity.

Calidad de las guías de práctica clínica publicadas en nutrición de pacientes hospitalizados adultos oncológicos / Quality of clinical practice guidelines published in nutrition in hospitalized oncological adult patients

Introducción: Existe alta variabilidad en la práctica clínica en nutrición que podría afectar el estado nutricional del paciente oncológico. Esta variabilidad disminuye con el uso de recomendaciones válidas basadas en la evidencia proveniente de guías de práctica clínica (GPC) con adecuada calidad metodológica en su elaboración. Objetivo: Revisar y evaluar la calidad de las guías publicadas en nutrición de pacientes adultos oncológicos hospitalizados. Métodos: Una búsqueda de GPC fue realizada en MEDLINE, EMBASE GIN, TripDatabase y páginas de elaboradores reconocidos de guías. Se incluyeron guías basadas en la evidencia publicadas entre 2003 y 2012. Cuatro revisores independientes evaluaron la calidad de las GPC usando el instrumento AGREE II. Las características de las guías evaluadas fueron extraídas y analizadas. Resultados: Fueron seleccionadas 22 GPC. Un 90% de las guías están escritas en inglés. Hubo gran variabilidad en los puntajes de calidad de cada dominio. El dominio mejor puntuado fue "Claridad de la presentación" (mediana 65,95, rango 19,40-93,10) mientras que el más bajo fue "Aplicabilidad" (mediana 21,20, rango 0,077,10). Dieciséis guías puntuaron bajo en "Rigor metodológico" y seis presentaron una calidad aceptable o buena. Cinco GPC presentaron un alto desempeño en todos los dominios y fueron consideradas de alta calidad. Conclusión: Hubo un amplio rango de puntajes de calidad metodológica de las GPC. Las guías mejor puntuadas son elaboradas por entidades desarrolladores de guías, pero poco conocidas en nuestro medio. Muchas GPC presentan debilidades metodológicas que pueden afectar la calidad de las recomendaciones que emiten y por lo tanto su validez (AU)

Background: There is a high variability in clinical practice regarding nutritional care which could affect nutritional status of oncological patients. This variability can be diminished following evidence based recommendations from clinical practice guidelines (CPG) with good methodological quality in its development. Objective: To review and evaluate the quality of published guidelines in nutrition in hospitalized oncological adult patients. Methods: A search of CPGs was conducted in MEDLINE, EMBASE, GIN, TripDatabase and pages of recognized guidelines developers. CPGs published between 2003 and 2012 were included. Four independent reviewers assessed the quality of CPGs using the AGREE II instrument. Characteristics of assessed guidelines were extracted and analyzed. Results: 22 CPGs met selection criteria. 90% of guidelines are written in English. There was great variability in quality scores for each domain. Highest rated domain was "clarity of presentation" (median 65.95, range 19.40 to 93.10) while the lowest was "Applicability" (median 21.20, range 0 to 77.10). Sixteen guidelines scored low on "rigour of development" and six had an acceptable or good quality. Only five documents can be considered as "good quality guidelines" because they showed high performance in all domains. Conclusion: It was found a wide range of methodological quality scores of evaluated CPGs. Highest rated guidelines are made by agencies that develop guidelines but these are little known in our country. Most of the assessed guidelines have methodological weaknesses, which can affect the quality of the recommendations they make and its validity (AU)

Efficacy of robotic-assisted prostatectomy in localized prostate cancer: a systematic review of clinical trials.

Background. Radical prostatectomy is an effective treatment for clinically localized prostate cancer. The three approaches in current use have been extensively compared in observational studies, which have methodological limitations. Objective. To compare the efficacy and safety of three radical prostatectomy approaches in patients with localized prostate cancer: open, laparoscopic, and robotic-assisted laparoscopic surgery. Materials and Methods. A systematic review of the literature was carried out. Databases MEDLINE, EMBASE, LILACS, and CENTRAL were searched for randomized clinical trials that directly compared two or more radical prostatectomy approaches. Selection criteria, methodological rigor, and risk of bias were evaluated by two independent researchers using Cochrane Collaboration's tools. Results. Three trials were included. In one study, laparoscopic surgery was associated with fewer blood loss and transfusion rates than the open procedure, in spite of longer operating time. The other two trials compared laparoscopic and robotic-assisted surgery in which no differences in perioperative outcomes were detected. Nevertheless, robotic-assisted prostatectomy showed more favorable erectile function and urinary continence recovery. Conclusion. At the present time, no clear advantage can be attributed to any of the existing prostatectomy approaches in terms of oncologic outcomes. However, some differences in patient-related outcomes favor the newer methods. Larger trials are required.

Verbal working memory in individuals with schizophrenia and their first degree relatives: relationship with negative and disorganized symptoms.

OBJECTIVE: To determine whether there are differences in verbal working memory amongst subjects with schizophrenia, their first degree relatives and controls, and to evaluate the influence of symptoms on these differences, as an initial step to assess whether this cognitive function is an endophenotype. METHODS: We examined 197 cases with schizophrenia, 197 first degree relatives and 200 controls through psychiatric interviews and the Letters and Numbers Sequencing test (LNS). Performance was compared among the three groups adjusting for age, sex and education level. Adjustment for "negative symptoms" and "disorganization" was performed afterwards. RESULTS: Subjects with schizophrenia showed lower performance in the LNS than their first degree relatives and the healthy controls; the effect sizes were 0.75 and 1.18 respectively. There was a small difference between relatives and controls (effect size =0.38). These differences were significant after adjustment for negative and disorganized symptoms, but the effect sizes became smaller: 0.26 for relatives vs. subjects with schizophrenia, 0.56 for controls vs. subjects with schizophrenia and 0.33 for relatives vs. controls. Among individuals with schizophrenia, performance in the LNS was not associated with disorder duration, disease onset age, antipsychotics, history of depressive episodes or substance use disorders. CONCLUSION: Results suggest verbal working memory may be considered as an endophenotype in schizophrenia.

Memoria de trabajo verbal en individuos con esquizofrenia y sus familiares de primer grado: Relación con los sintomas negativos y desorganizados / Verbal working memory in individuals with schizophrenia and their first degree relatives: relationship with negative and disorganized symptoms

Objetivo: Determinar si hay diferencias en la memoria de trabajo verbal entre sujetos con esquizofrenia, familiares de primer grado y controles, y evaluar la influencia que pueden tener en estas diferencias los síntomas del trastorno, como un paso para establecer si esta función cognitiva es un endofenotipo. Métodos: A 197 sujetos con esquizofrenia, 197 familiares de primer grado y 200 controles comunitarios, se les hizo evaluación psiquiátrica y se les aplicó la prueba sucesión de letras y números (SLN). Se comparó el desempeño de los tres grupos ajustando por edad, sexo y escolaridad, y luego se ajustó también por síntomas negativos y desorganizados. Resultados: Los sujetos con esquizofrenia mostraron un menor desempeño en la SLN con respecto a sus familiares de primer grado no-afectados y los controles, con tamaños de efecto de 0,75 y 1,18 respectivamente. Hubo una diferencia pequeña pero significativa entre familiares y controles (tamaño de efecto =0,38). Estas diferencias siguieron siendo significativas después de ajustar por síntomas negativos y desorganizados, pero los tamaños de efecto disminuyeron a: 0,26 para familiares vs sujetos con esquizofrenia, 0,56para controles vs sujetos con esquizofrenia y 0,33 para familiares vs controles. Entre los sujetos con esquizofrenia, el desempeño en la SLN no se asoció significativamente con duración del trastorno, edad de inicio, uso de antipsicóticos, ni historia de episodios depresivos o trastornos por uso de sustancias. Conclusión: Los resultados sugieren que la memoria de trabajo verbal puede ser considerada un endofenotipo de la esquizofrenia (AU)

Objective: To determine whether there are differences in verbal working memory amongst subjects with schizophrenia, their first degree relatives and controls, and to evaluate the influence of symptoms on these differences, as an initial step to assess whether this cognitive function is an endophenotype. Methods: We examined 197 cases with schizophrenia, 197 first degree relatives and 200 controls through psychiatric interviews and the Letters and Numbers Sequencing test (LNS). Performance was compared among the three groups adjusting for age, sex and education level. Adjustment for “negative symptoms” and “disorganization” was performed afterwards. Results: Subjects with schizophrenia showed lower performance in the LNS than their first degree relatives and the healthy controls; the effect sizes were 0.75 and 1.18 respectively. There was a small difference between relatives and controls (effect size =0.38). These differences were significant after adjustment for negative and disorganized symptoms, but the effect sizes became smaller: 0.26 for relatives vs. subjects with schizophrenia, 0.56 for controls vs. subjects with schizophrenia and 0.33 for relatives vs. controls. Among individuals with schizophrenia, performance in the LNS was not associated with disorder duration, disease onset age, antipsychotics, history of depressive episodes or substance use disorders. Conclusion: Results suggest verbal working memory may be considered as an endophenotype in schizophrenia (AU)

Use of black vulture (Coragyps atratus) in complementary and alternative therapies for cancer in Colombia: a qualitative study.

BACKGROUND: Although Coragyps atratus has been used as a traditional therapy for patients with cancer, the scientific literature does not contain enough information on how this therapy is used or the mechanisms that explain this therapeutic practice. OBJECTIVES: To understand the methods of use and the reasons given by patients and caregivers for the use of Coragyps atratus in cancer treatment. METHODS: This study used a qualitative design based on twenty in-depth interviews of patients with cancer or caregivers of patients with the disease. The analysis of the text was based on an inductive thematic approach. RESULTS: Resistance to disease and immune enhancement are properties attributed to Coragyps atratus when used for cancer treatment. The most recommended method of use is fresh blood ingestion, and the associated mechanism of action is transfer of immune factors to the individual who consumes it. CONCLUSIONS: Use of Coragyps atratus as a treatment for cancer is a popular alternative therapy in Colombia. More studies are needed to understand the clinical effects of this intervention in cancer patients.

Transcriptomic analysis reveals differential gene expression in response to aluminium in common bean (Phaseolus vulgaris) genotypes.

BACKGROUND AND AIMS: Aluminium (Al) resistance in common bean is known to be due to exudation of citrate from the root after a lag phase, indicating the induction of gene transcription and protein synthesis. The aims of this study were to identify Al-induced differentially expressed genes and to analyse the expression of candidate genes conferring Al resistance in bean. METHODS: The suppression subtractive hybridization (SSH) method was used to identify differentially expressed genes in an Al-resistant bean genotype ('Quimbaya') during the induction period. Using quantitative real-time PCR the expression patterns of selected genes were compared between an Al-resistant and an Al-sensitive genotype ('VAX 1') treated with Al for up to 24 h. KEY RESULTS: Short-term Al treatment resulted in up-regulation of stress-induced genes and down-regulation of genes involved in metabolism. However, the expressions of genes encoding enzymes involved in citrate metabolism were not significantly affected by Al. Al treatment dramatically increased the expression of common bean expressed sequence tags belonging to the citrate transporter gene family MATE (multidrug and toxin extrusion family protein) in both the Al-resistant and -sensitive genotype in close agreement with Al-induced citrate exudation. CONCLUSIONS: The expression of a citrate transporter MATE gene is crucial for citrate exudation in common bean. However, although the expression of the citrate transporter is a prerequisite for citrate exudation, genotypic Al resistance in common bean particularly depends on the capacity to sustain the synthesis of citrate for maintaining the cytosolic citrate pool that enables exudation.

Aluminum resistance in common bean (Phaseolus vulgaris) involves induction and maintenance of citrate exudation from root apices.

Two common bean (Phaseolus vulgaris L.) genotypes differing in aluminum (Al) resistance, Quimbaya (Al-resistant) and VAX-1 (Al-sensitive) were grown in hydroponics for up to 25 h with or without Al, and several parameters related to the exudation of organic acids anions from the root apex were investigated. Al treatment enhanced the exudation of citrate from the root tips of both genotypes. However, its dynamic offers the most consistent relationship between Al-induced inhibition of root elongation and Al accumulation in and exclusion from the root apices. Initially, in both genotypes the short-term (4 h) Al-injury period was characterized by the absence of citrate efflux independent of the citrate content of the root apices, and reduction of cytosolic turnover of citrate conferred by a reduced Nicotinamide adenine dinucleotide phosphate-isocitrate dehydrogenase (EC 1.1.1.42) activity. Transient recovery from initial Al stress (4-12 h) was found to be dependent mainly on the capacity to utilize internal citrate pools (Al-resistant genotype Quimbaya) or enhanced citrate synthesis [increased activities of NAD-malate dehydrogenase (EC 1.1.1.37) and ATP-phosphofructokinase (EC 2.7.1.11) in Al-sensitive VAX-1]. Sustained recovery from Al stress through citrate exudation in genotype Quimbaya after 24 h Al treatment relied on restoring the internal citrate pool and the constitutive high activity of citrate synthase (CS) (EC 4.1.3.7) fuelled by high phosphoenolpyruvate carboxylase (EC 4.1.1.31) activity. In the Al-sensitive genotype VAX-1 the citrate exudation and thus Al exclusion and root elongation could not be maintained coinciding with an exhaustion of the internal citrate pool and decreased CS activity.

Intracellular distribution and binding state of aluminum in root apices of two common bean (Phaseolus vulgaris) genotypes in relation to Al toxicity.

The role of the intracellular distribution and binding state of aluminum (Al) in Al toxicity, using Al exchange and Al fractionation methodologies, were studied in two common bean (Phaseolus vulgaris L.) genotypes differing in Al resistance. These two genotypes are characterized by a similar initial period (4 h) of Al sensitivity followed by a contrasting recovery period (8-24 h). A higher initial Al accumulation in Quimbaya (Al resistant) in the 5-mm root apex compared with VAX-1 (Al sensitive) could be related to its higher content of unmethylated pectin and thus higher negative charge of the cell walls (CWs). The binding state and cellular distribution of Al in the root apices revealed that the root elongation rate was significantly negatively correlated with the free apoplastic and the stable-bound, not citrate-exchangeable CW Al representing the most important Al fraction in the root apex (80%), but not with the symplastic and the labile-bound, citrate-exchangeable CW Al. It is postulated that the induced and sustained recovery from the initial Al stress in the Al-resistant genotype Quimbaya requires reducing the stable-bound Al in the apoplast thus allowing cell elongation and division to resume.

[Rainfall and acute febrile syndrome in a dengue-endemic area]. / Pluviosidad como Predictor de Consulta por Síndrome Febril Agudo en un Area Endémica de Dengue.

OBJECTIVE: Describing patterns of acute febrile syndrome (AFS) consultation related to dengue and evaluating association with rainfall. METHODS: 318 undifferentiated AFS patients were detected in two clinics during a 7-month period (March to September) and then included in systematic clinical follow-up. 31 % of them (81/281) were IgM positive for dengue. Rainfall (litres/square meter-day) during the previous weeks was evaluated as a variable for predicting consultation patterns. RESULTS: June, July and September were the months in which the greatest number of AFS cases occurred. Cases of dengue were only significantly more frequent during July. When evaluating the previous weeks' rainfall patterns, consultation for AFS was seen to be associated with the average rainfall registered 5 weeks beforehand and such association was independent of the institution and/or month (incidence rate ratio IRR=1,04; 1-1.08 95 %CI, p=0.045). On the other hand, 5 consecutive weeks' average rainfall was an independent predictor of consultation for dengue 4 weeks later on (RTI=1 ,6 ; 1,15-2,22 95 %CI, p=0.006). A linear relationship was thus proposed (regarding these sentinel clinics) between consultation for dengue and rainfall: lt/mt-day (5 weeks' average rainfall) X 0 ,72 (0,60-0,84 95 %CI, p<0.001) = cases for each 100 000 habitants per week (4 weeks later). CONCLUSIONS: Studying rainfall could predict the pattern of consultation for dengue in endemic regions.

Pluviosidad como predictor de consulta por síndrome febril agudo en un área endémica de dengue / Rainfall and acute febrile syndrome in a dengue-endemic area

Objetivo Describir los patrones de consulta por SFA asociado al dengue y evaluar su asociación con la pluviosidad. Métodos En dos clínicas, durante un periodo de 7 meses (de marzo a septiembre) se identificaron 318 casos de SFA indiferenciado que se incluyeron en un seguimiento clínico sistemático. El 31 por ciento (81/281) fueron IgM positivos para dengue. Se evaluó la pluviosidad (litros/metro cuadrado por día) previa como variable explicatoria del patrón de consultas. Resultados Los meses con más casos de SFA fueron junio, julio y septiembre. Los casos de dengue sólo fueron significativamente más frecuentes en julio. Al evaluar los patrones de pluviosidad de las semanas anteriores, la consulta por SFA estuvo asociada con la pluviosidad promedio registrada 5 semanas antes y esta asociación fue independiente de la institución y del mes (Razón de tasas de incidencia ajustada: RTI=1,04; IC95 por ciento 1-1,08; p=0,045). Por otra parte, un promedio de la pluviosidad de 5 semanas consecutivas fue un predictor independiente de consulta por dengue, 4 semanas después (RTI=1,6; IC95 por ciento 1,15-2,22; p=0.006). Se evidenció una relación lineal entre la pluviosidad y las consultas por dengue: pluviosidad (promedio de 5 semanas) x 0,72 (IC95 por ciento 0,60-0,84; p<0,001)=casos por cada 100 000 habitantes en una semana (4 semanas después). Conclusiones La pluviosidad podría predecir el patrón de consulta por dengue en una región endémica.

Objective Describing patterns of acute febrile syndrome (AFS) consultation related to dengue and evaluating association with rainfall. Methods 318 undifferentiated AFS patients were detected in two clinics during a 7-month period (March to September) and then included in systematic clinical follow-up. 31 percent of them (81/281) were IgM positive for dengue. Rainfall (litres/square meter-day) during the previous weeks was evaluated as a variable for predicting consultation patterns. Results June, July and September were the months in which the greatest number of AFS cases occurred. Cases of dengue were only significantly more frequent during July. When evaluating the previous weeks' rainfall patterns, consultation for AFS was seen to be associated with the average rainfall registered 5 weeks beforehand and such association was independent of the institution and/or month (incidence rate ratio IRR=1,04; 1-1.08 95 percentCI, p=0.045). On the other hand, 5 consecutive weeks' average rainfall was an independent predictor of consultation for dengue 4 weeks later on (RTI=1 ,6 ; 1,15-2,22 95 percentCI, p=0.006). A linear relationship was thus proposed (regarding these sentinel clinics) between consultation for dengue and rainfall: lt/mt-day (5 weeks' average rainfall) X 0 ,72 (0,60-0,84 95 percentCI, p<0.001) = cases for each 100 000 habitants per week (4 weeks later). Conclusions: Studying rainfall could predict the pattern of consultation for dengue in endemic regions.

Spatial aluminium sensitivity of root apices of two common bean (Phaseolus vulgaris L.) genotypes with contrasting aluminium resistance.

The initial response of plants to aluminium (Al) is an inhibition of root elongation. In the present study, short and medium-term effects of Al treatment (20 muM) on root growth and Al accumulation of two common bean (Phaseolus vulgaris L.) genotypes, VAX-1 (Al-sensitive) and Quimbaya (Al-resistant), were studied. Root elongation of both genotypes was severely inhibited during the first 3-4 h of Al treatment. Thereafter, both genotypes showed gradual recovery. However, this recovery continued in genotype Quimbaya until the root elongation rate reached the level of the control (without Al) while the genotype VAX-1 was increasingly damaged by Al after 12 h of Al treatment. Short-term Al treatment (90 microM Al) to different zones of the root apex using agarose blocks corroborated the importance of the transition zone (TZ, 1-2 mm) as a main target of Al. However, Al applied to the elongation zone (EZ) also contributed to the overall inhibition of root elongation. Enhanced inhibition of root elongation during the initial 4 h of Al treatment was related to high Al accumulation in root apices in both genotypes (Quimbaya>VAX-1). Recovery from Al stress was reflected by decreasing Al contents especially in the TZ, but also in the EZ. After 24 h of Al treatment the high Al resistance of Quimbaya was reflected by much lower Al contents in the entire root apex. The results confirmed that genotypic differences in Al resistance in common bean are built up during medium-term exposure of the roots to Al. For this acquisition of Al resistance, the activation and maintenance of an Al exclusion mechanism, especially in the TZ but also in the EZ, appears to be decisive.