Exploring Neuropsychiatry: Contemporary Challenges, Breakthroughs, and Philosophical Perspectives.

This editorial provides a concise and updated overview of neuropsychiatry, emphasizing its definitional challenges and profound implications for education, training, research, and the integration of phenomenology and philosophy of mind. Neuropsychiatry, situated at the crossroads of neurology and psychiatry, grapples with complex definitional issues that impede research progress. Establishing a unified conceptual framework is essential for focused research and delving into fundamental questions regarding topics like "consciousness." Nevertheless, the integration of philosophical perspectives into neuropsychiatry, while valuable, faces hurdles due to conceptual ambiguities and the fluid boundaries of the field. These obstacles disrupt research and hinder progress in effectively addressing neuropsychiatric conditions. This editorial advocates for a systematic approach to defining neuropsychiatry to mitigate these concerns. Additionally, as neuropsychiatry evolves, it necessitates an integrative approach. Recent advancements in neuroscience, propelled by technologies like artificial intelligence and advanced neuroimaging, reshape our comprehension of brain-behavior interactions, offering potential biomarkers and comprehensive treatment approaches.

2-[3-(1H-Benzimidazol-2-yl)prop-yl]-1H-benzimidazol-3-ium 3,4,5-tri-hydroxy-benzoate-1,3-bis-(1H-benzimidazol-2-yl)propane-ethyl acetate (2/1/2.94): co-crystallization between a salt, a neutral mol-ecule and a solvent.

The chemical formula of the title compound, 2C17H17N4 +·2C7H5O5 -·C17H16N4·2.94C4H8O2, was established by X-ray diffraction of a single-crystal obtained by reacting 1,3-bis-(benzimidazol-2-yl)propane (L) and gallic acid (HGal) in ethyl acetate. The mol-ecular structure can be described as a salt (HL)+(Gal)- co-crystallized with a mol-ecule L, with a stoichiometric relation of 2:1. Moreover, large voids in the crystal are filled with ethyl acetate, the amount of which was estimated by using a solvent mask during structure refinement, affording the chemical formula (HL +·Gal-)2·L·(C4H8O2)2.94. The arrangement of components in the crystal is driven by O-H⋯O, N-H⋯O and O-H⋯N hydrogen bonds rather than by π-π or C-H⋯π inter-actions. In the crystal, mol-ecules and ions shape the boundary of cylindrical tunnels parallel to [100] via R (rings) and D (discrete) supra-molecular motifs. These voids, which account for about 28% of the unit-cell volume, contain disordered solvent mol-ecules.

Loss-of-function of MEDIATOR 12 or 13 subunits causes the swelling of root hairs in response to sucrose and abscisic acid in Arabidopsis.

Root hairs are epidermal cell extensions that increase the root surface for water and nutrient acquisition. Thus, both the initiation and elongation of root hairs are critical for soil exploration and plant adaptation to ever changing growth conditions. Here, we describe the critical roles of two subunits of the Mediator complex, MED12 and MED13, in root hair growth in response to sucrose and abscisic acid, which are tightly linked to abiotic stress resistance. When compared to the WT, med12 and med13 mutants showed increased sensitivity to sucrose and ABA treatments on root meristem and elongation zones that were accompanied with alterations in root hair length and morphology, leading to the isodiametric growth of these structures. The swollen root hair phenotype appeared to be specific, since med8 or med16 mutants did not develop rounded hairs when supplied with 4.8% sucrose. Under standard growth medium, MED12 and MED13 were mainly expressed in root vascular tissues and cotyledons, and their expression was repressed by sucrose or ABA. Interestingly, med12 and med13 mutants manifested exacerbated levels of nitric oxide under normal growth conditions, and upon sucrose supplementation in trichoblast cells, which coincided with root hair deformation. Our results indicate that MED12 and MED13 play non-redundant functions for maintenance of root hair integrity in response to sucrose and ABA and involve nitric oxide as a cellular messenger in Arabidopsis thaliana.

Brain Nocardiosis Defined by 18 F-Fluorocholine PET/CT.

ABSTRACT: Nocardia infection (nocardiosis) is usually acquired by inhalation; so pulmonary nocardiosis is the most common clinical presentation. Extrapulmonary localization occurs through hematogenous dissemination or contiguous spread. Nocardia can involve the central nervous system in a very reduced number of patients, mainly in immunocompromised. We present a case of a 56-year-old woman with a history of aggressive systemic mastocytosis, treated with chemotherapy 1 year ago. Patient reported intense headache, disorientation, and blurry vision without other symptoms being diagnosed with a rare brain nocardiosis by Nocardia cerradoensis . Neither bacteremia nor pulmonary involvement was detected. Brain PET/CT illustrated 18 F-fluorocholine avidity on brain abscesses.

The role of plasma volume and fluid overload in the tolerance to ultrafiltration and hypotension in hemodialysis patients.

INTRODUCTION: Ultrafiltration (UF) in hemodialysis (HD) patients is accompanied by irregular falls in plasma volume (PV) and blood pressure (BP). METHODS: We obtained in 321 patients (large cohort), body weight (BW), BP, samples of blood to determine hemoglobin (Hb) and hematocrit (Ht), Pre and Post HD. We estimated the % variation of the PV and its effect on the BP. In a small cohort of 38/321 patients, arterial blood was drawn Pre and Post HD and at 2, 48, and 72 h to determined Hb and Ht and % variation of the PV. Bio-impedance spectroscopy (BIS) was performed, in the same times, to estimate: dry weight (DW), total body water (TBW), extracellular water (ECW), Fluid overload (FO) and phase angle (PhA). RESULTS: We divided our large cohort in two groups. The Hypotensive group with a fall equal or more than 20 mmHg (96/321,30%) and Normotensive group with a drop equal or less than 19 mmHg (225/321,70%). The UF was 2.73 ± 0.72 L in the Hypotensive group and 2.53 ± 0.85 L in the Normotensive group (p < 0.0001). The % PV was -11.7 ± 17.8 in the Hypotensive group and -8.53 ± 10.07 in the Normotensive group (p < 0.0001). The systolic blood pressure (SBP) correlated with the % change of the PV (r = -0.232; p < 0.0001). The FO was contrasted with the % of water removed by UF (r = -0.890; p < 0.0001). CONCLUSION: The SBP drop was secondary to the fall in the PV after UF. The FO was irregular and modulates in part the fall in the SBP.

Cerebellar Cognitive-Affective Syndrome Secondary to Epstein-Barr Virus Infection: A Case Report.

Throughout history, the cerebellum was initially perceived as potentially vestigial until the 19th century. However, subsequent research illuminated its pivotal role in coordination. Over the course of the 20th century, it became predominantly associated with motor functions. Nevertheless, in the latter half of the century, Schmahmann's pioneering research expanded the understanding of the cerebellum to encompass its involvement in cognition and emotions. In light of this evolving background, the primary objective of this paper is to present a clinical case featuring a 60-year-old male with a history of Epstein-Barr virus. This patient underwent a comprehensive neuropsychiatric assessment at a tertiary care hospital, involving thorough clinical, paraclinical, and neuroimaging examinations. The extensive medical findings strongly indicate the presence of a cognitive-affective cerebellar syndrome.

Overlap of obsessive and posttraumatic symptoms: A systematic review / Superposición de síntomas obsesivos y postraumáticos: Una revisión sistemática

Abstract Background Current medical literature suggests a symptomatic overlap between posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), which makes understanding their impact on the treatment process a challenging undertaking. Objective The key aim of this work was to deliver a comprehensive overview of empirical and observational studies concerning the overlap between both psychopathologies. Method Two independent authors searched PubMed, PsycINFO, and Web of Science databases between April and July 2020 utilizing relevant MeSH terms. Subsequently, a systematic scoping review was undertaken according to the PRISMA-ScR Statement to identify all relevant publications concerning the overlap of OCD and PTSD symptomatology. We included peer reviewed studies published in any language that contributed quantitative or qualitative data that addressed the relationship between OCD and PTSD symptoms as the main aim or outcome of the study. Non-peer-reviewed articles, studies that did not address this phenomenon of interest, and gray literature documents were excluded. This review was not registered into the International Prospective Register of Systematic Reviews, since, according to the National Institute of Health Research, scoping reviews are ineligible for registration into PROSPERO. Results Twenty-five relevant studies were included (11 cross-sectional studies, 5 longitudinal-prospective studies, 4 case series, 4 case studies and 1 retrospective study). We did not conduct any statistical analysis due to the diversity of the included studies, thus proceeding to realize a thematic synthesis of the obtained data. Discussion and conclusion A symptomatic overlap exists between both comorbidities in some clinical populations, and this relationship may hamper treatment outcomes.

Resumen Antecedentes La literatura médica sugiere la existencia de una superposición sintomática entre el trastorno por estrés postraumático (TEPT) y el trastorno obsesivo-compulsivo (TOC), situación que puede comprometer el tratamiento de esta población clínica. Objetivo El objetivo clave de este trabajo consiste en ofrecer una visión general de estudios empíricos y observacionales sobre la superposición entre ambas psicopatologías. Método Dos autores independientes buscaron en las bases de datos PubMed, PsycINFO y Web of Science entre abril y julio de 2020 utilizando DeCS relevantes. Se realizó una revisión sistemática exploratoria de acuerdo con la Declaración PRISMA-ScR para identificar todas las publicaciones relevantes sobre esta superposición sintomática. Se incluyeron estudios revisados por pares publicados en cualquier idioma que aportaron datos cuantitativos o cualitativos, que abordaron la relación entre los síntomas de TOC y TEPT. Se excluyeron los artículos no revisados por pares, aquellos que no abordaron este fenómeno de interés y la literatura gris. Esta revisión no se registró en el Registro Prospectivo Internacional de Revisiones Sistemáticas, ya que acorde al Instituto Nacional de Investigación en Salud, las revisiones sistemáticas exploratorias no son elegibles para su registro en PROSPERO. Resultados Se incluyeron 25 estudios relevantes (11 estudios transversales, 5 estudios longitudinales-prospectivos, 4 series de casos, 4 estudios de casos y 1 estudio retrospectivo). No se realizó ningún análisis estadístico debido a la diversidad de los estudios incluidos, por lo que se procedió a realizar una síntesis temática. Discusión y conclusión Existe una superposición sintomática entre ambas comorbilidades y esta relación puede obstaculizar el tratamiento.

Determinación de cistatina C para evaluación del filtrado glomerular en fases predialíticas de la enfermedad renal crónica / Cystatin C's determination for evaluation of glomerular masking in pre-dialytic phases of the chronic renal disease

RESUMEN Introducción: La enfermedad renal crónica afecta alrededor de la décima parte de la población mundial y los métodos analíticos que más se utilizan para su diagnóstico tienen una baja sensibilidad y precisión. Objetivo: Determinar las concentraciones de cistatina C para la evaluación del filtrado glomerular en fases predialíticas de la enfermedad renal crónica. Métodos: Se realizó un estudio descriptivo, transversal. El universo de estudio estuvo conformado por 102 pacientes con enfermedad renal crónica en estadios del uno al cuatroque se atendieron en consulta externa del servicio de Nefrología.La muestra fueron 81 pacientes que no presentaron factores modificadores del filtrado glomerular, creatinina y cistatina C relacionados con la enfermedad renal crónica. Resultados: Predominaron los pacientes mayores de 61 años. La cistatina C se elevó en más pacientes que la creatinina. La cistatina C se elevó por igual en ambos sexos y la creatinina más en hombres. La media de los resultados se alejó más de la media del valor de referencia en la cistatina C y la creatinina no presentó valores normales en pacientes con insuficiencia renal crónica. Las ecuaciones que utilizan la cistatina C fueron mejor predictoras de daño renal. Conclusiones: La cistatina C fue mejor predictora de daño renal.

ABSTRACT Introduction: The renal chronic disease affects around a tenth part of the worldwide population and the most used analytical methods for its diagnosis have a low sensibility and precision. Objective: To determine cystatin C's concentrations for evaluation of glomerular masking in pre-dialytic phases of the renal chronic disease. Methods: A descriptive, cross-sectional study was carried out.The study universe was made up of 102 patients with chronic kidney disease in stages from one to four who were treated in an outpatient department of the Nephrology service. The samplewas 81 patients who did not present the modifier factors of glomerular masking, creatinine and cystatin C related with the renal chronic disease. Results: The patients older than 61 years predominated. The cystatin C augmented in more patients than the creatinine. The cystatin C augmented equally in both sexes and the creatinine more in men. The average of the results moved away over the average of the value of reference in the cystatin C and the creatinine did not present normal values in patients with renal chronic insufficiency. The equations that they use cystatin C were better forecaster of damage renal. Conclusions: The cystatin C was the best predictor of renal damage.

Asociación entre gastos de bolsillo de salud y pobreza utilizando datos de la Encuesta Permanente de Hogares en Paraguay en el 2014 / Association between out-of-pocket health expenses and poverty using data from the Permanent Household Survey in Paraguay in 2014

La cobertura y acceso universal de salud requiere de protección financiera, lo que puede evaluarse a través del gasto de bolsillo ante una enfermedad. El objetivo del trabajo fue analizar la asociación entre el gasto de bolsillo de salud y la pobreza en Paraguay. Se utilizó la Encuesta Permanente de Hogares del 2014 para determinar la razón entre gasto de bolsillo ante una enfermedad con los ingresos del hogar, con las transferencias estatales para pobres, con la canasta básica de consumo y de alimentos. Fueron incluidos 5.165 hogares de los cuales 21,49% eran pobres. Hubo gasto de bolsillo en el 45,19% de los hogares asociándose significativamente con la pobreza (OR: 1,8; IC95%: 1,57 a 2,06). El 1,99% de los hogares tuvo gasto de bolsillo mayor a 25% de sus ingresos y el 5,98% mayor a 10% de sus ingresos, ambos indicadores se asociaron significativamente con la pobreza (OR: 3,70; IC95%: 2,50 a 5,50 y OR: 3,04; IC95%: 2,40 a 2,06, respectivamente). Hubo empobrecimiento en el 1,44% de los hogares, y la brecha de la pobreza pasó de 34,58% a 37,67%. Entre los hogares pobres el gasto de bolsillo fue equivalente a 4,9 días de consumo, a 11,5 días de alimentación y a 42% del valor de transferencias estatales. Estos hallazgos reflejan una insuficiente protección financiera del sistema de salud en Paraguay

Universal health coverage and access requires financial protection, which can be assessed through out-of-pocket costs for illness. The objective of the study was to analyze the association between out-of-pocket health spending and poverty in Paraguay. The 2014 Permanent Household Survey was used to determine the ratio between out-of-pocket expenses for illness and household income, state transfers for the poor, and the basic consumption and food basket. Five thousand one hundred sixty five households were included, of which 21.49% were poor. There was out-of-pocket spending in 45.19% of the households, significantly associated with poverty (OR: 1.8; 95%CI: 1.57 to 2.06), 1.99% of households had out-of-pocket expenses greater than 25% of their income and 5.98% greater than 10% of their income, both indicators were significantly associated with poverty (OR: 3.70; 95%CI: 2.50 to 5.50 and OR: 3.04; 95%CI: 2.40 to 2.06, respectively). There was impoverishment in 1.44% of households, and the poverty gap went from 34.58% to 37.67%. Among poor households, out-of-pocket spending was equivalent to 4.9 days of consumption, 11.5 days of food, and 42% of the value of state transfers. These findings reflect insufficient financial protection for the health system in Paraguay

Beacon-Related Parameters of Bluetooth Low Energy: Development of a Semi-Automatic System to Study Their Impact on Indoor Positioning Systems.

Indoor positioning systems (IPS) are used to locate people or objects in environments where the global positioning system (GPS) fails. The commitment to make bluetooth low energy (BLE) technology the leader in IPS and their applications is clear: Since 2009, the Bluetooth Special Interest Group (SIG) has released several improved versions. BLE offers many advantages for IPS, e.g., their emitters or beacons are easily deployable, have low power consumption, give a high positioning accuracy and can provide advanced services to users. Fingerprinting is a popular indoor positioning algorithm that is based on the received signal strength (RSS); however, its main drawbacks are that data collection is a time-consuming and labor-intensive process and its main challenge is that positioning accuracy is affected by various factors. The purpose of this work was to develop a semi-automatic data collection support system in a BLE fingerprinting-based IPS to: (1) Streamline and shorten the data collection process, (2) carry out impact studies by protocol and channel on the static positioning accuracy related to configuration parameters of the beacons, such as transmission power (Tx) and the advertising interval (A), and their number and geometric distribution. With two types of systems-on-chip (SoCs) integrated in Bluetooth 5 beacons and in two different environments, our results showed that on average in the three BLE advertising channels, the configuration of the highest Tx (+4 dBm) in the beacons produced the best accuracy results. However, the lowest Tx (-20 dBm) did not worsen them excessively (only 11.8%). In addition, in both scenarios, when lowering the density of beacons by around 42.7%-50%, the error increase was only around 8%-9.2%.

Gastos empobrecedores de salud: un desafío para la cobertura universal de salud en el Paraguay / Impoverishing health expenditure: a challenge for universal health coverage in Paraguay

El gasto de bolsillo es la principal fuente de financiamiento del sistema de salud en Paraguay. Es necesario revertir esta situación para que la Cobertura Universal de Salud sea efectiva en 2030, un logro que forma parte de los Objetivos de Desarrollo Sostenible. El objetivo de este estudio fue determinar la incidencia del Gasto Empobrecedor en Salud en los hogares paraguayos. Tomó en cuenta aquellos hogares cuyos gastos de bolsillo causaron una caída por debajo de la línea de pobreza, así como los hogares que profundizaron su pobreza a causa de estos gastos de salud. Como material y método, el estudio analizó la Encuesta Permanente de Hogares 2014; tomó la definición de los gastos de bolsillo de la Organización Mundial de la Salud y la definición oficial de pobreza monetaria del país de la Dirección General de Estadísticas, Encuestas y Censos de la STP. El resultado es que 23,387 hogares fueron empujados por debajo de la línea de pobreza debido a gastos de bolsillo en caso de enfermedad. Esto representó el 1,8% de los hogares no pobres y el 1,4% del total de hogares. Además, el 61.9% de los hogares que ya se encontraban en situación de pobreza la empeoraron debido a los gastos de bolsillo en salud. La conclusión es que los hogares paraguayos están expuestos a gastos de salud excesivos y que se requieren políticas específicas para protegerlos. Las estrategias para combatir la pobreza pueden ser más efectivas cuando se consideran los gastos de salud en caso de una enfermedad o accidente.

Out-of-pocket spending is the main financing of the health system in Paraguay. Reversing this situation is necessary for the Universal Health Coverage to be effective in 2030, an achievement that is part of the Sustainable Development Goals. The objective of this study was to determine the incidence of Impoverishment health expenditure in Paraguayan households. I take into account those households whose out-of-pocket expenses caused a fall below the poverty line, as well as households that deepened their poverty as a cause of these health expenditures. As a material and method, the study analyzed the Permanent Household Survey 2014; took the definition of the outof- pocket expenses of the World Health Organization and the official definition of monetary poverty of the country of the General Directorate of Statistics, Surveys and Census of the STP. The result is that 23,387 households were pushed below the poverty line due to out-of-pocket expenses in case of illness. This represented 1.8% of non-poor households and 1.4% of total households. In addition, 61.9% of households already in poverty worsened their poverty due to out-of-pocket health expenditures. The conclusion is that Paraguayan households are exposed to excessive health expenditures and that specific policies are required to protect the population in the area. Strategies to combat poverty can be more effective when considering health expenditures in case of the event of an illness or accident.

Survival and Clinical Outcomes of Tunneled Central Jugular and Femoral Catheters in Prevalent Hemodialysis Patients.

BACKGROUND: The literature on the outcomes of tunneled femoral catheters compared to that of jugular catheters is scarce and derived mainly from small cohorts. MATERIAL AND METHODS: Seven hundred and sixty six catheters were placed in 673 hemodialysis patients, 622 in the jugular/subclavian veins and 144 in the femoral veins. Patients were followed prospectively for 36 months. RESULTS: The survival of the tunneled catheters was 771 days 95% CI (737-805) for jugular and 660 days 95% CI (582-739) for femoral veins. Blood flow (0.292 ± 0.003 L/min) and infection rate (0.25 × 1,000 days/catheter) were similar for upper and lower extremities vascular accesses. Factors including sex, age, diabetes and previous catheters did not affect the outcome. CONCLUSIONS: Femoral catheters provide outstanding vascular access with excellent, function and low risk of infection.

Gasto catastrófico y cobertura universal de salud: Análisis en el Sistema Nacional de Salud del Paraguay / Catastrophic health expenditure and universal health coverage: Analysis in the National Health System of Paraguay

Introducción: La cobertura universal de salud es una meta de salud de los Objetivos del Desarrollo Sostenible de las NNUU para el 2030. Un componente de la cobertura en salud es la protección financiera para recibir atención médica ante una enfermedad. Y, un indicador de la protección financiera es la incidencia de Gastos Catastróficos por motivos de salud. Objetivo: El objetivo de este trabajo es describir la evolución del Gasto Catastrófico de salud de los hogares paraguayos entre el 2000 y el 2015. Materiales y Métodos: El material utilizado fue la Encuesta Permanente de Hogares de la DGEEC. El Gasto Catastrófico fue definido como aquellos gastos de bolsillo ≥ al 30% de la capacidad de pago de los hogares. Resultados: Los resultados indican que, durante ese periodo, la proporción de hogares afectados por gastos catastróficos varió entre 2,8% y 4,33%, siendo la mediana 4,10%. Los más afectados fueron los hogares rurales y los pobres. La proporción de hogares afectados presentó una tendencia al descenso, sobre todo para hogares urbanos y no pobres. Conclusión: La conclusión es que los hogares paraguayos están expuestos a gastos catastróficos por motivos de salud. La ocurrencia es mayor según las referidas características socioeconómicas. El desempeño actual del sistema nacional de salud no será suficiente para alcanzar la cobertura universal con protección financiera para todos. Por tanto, es necesario implementar nuevas políticas para la población más expuesta.

Introduction: Universal health coverage is a health goal of the UN Sustainable Development Goals by 2030. One component of health coverage is the financial protection to receive medical care for a disease. And, an indicator of financial protection is the incidence of Catastrophic Expenditures for health reasons. The objective of this paper is to describe the evolution of the Catastrophic Health Expenditure of Paraguayan households between 2000 and 2015. Materials and Methods: The material used was the Permanent Household Survey of the DGEEC. Catastrophic Expenditure was defined as those out-of-pocket expenses ≥ 30% of the household's payment capacity. Results: The results indicate that during this period, the proportion of households affected by catastrophic expenses ranged between 2.8% and 4.33%, with the median being 4.10%. Rural households and the poor were the most affected. The proportion of affected households showed a downward trend, especially for urban and non-poor households. Conclusion: In conclusion, Paraguayan households are exposed to catastrophic expenses for health reasons. The occurrence is greater according to the referred socioeconomic characteristics. The current performance of the national health system will not be enough to achieve universal coverage with financial protection for all. Therefore, it is necessary to implement new policies for the most exposed population.

Gastos catastróficos de salud en los hogares del Paraguay / Catastrophic health expenses in households of Paraguay

Cada año numerosas familias enfrentan gastos excesivos ante una enfermedad a pesar de que el sistema de salud tiene como uno de sus objetivos la protección financiera de la población de forma equitativa. El objetivo que nos propusimos fue describir la incidencia del gasto catastrófico de salud en los hogares paraguayos. Como material y método analizamos el módulo de salud de la Encuesta Permanente de Hogares de la Dirección General de Estadísticas Encuestas y Censos de Paraguay del 2014. Incluimos como gasto de bolsillo los pagos directos por consultas, medicamentos, estudios de diagnóstico y hospitalizaciones de las personas enfermas o accidentadas. La capacidad de pago la definimos como la suma de todos los ingresos menos los gastos de subsistencia, utilizando una estructura conocida de gastos. Calculamos el gasto catastrófico de salud utilizando distintos umbrales de relación entre el gasto de bolsillo con la capacidad de pago de los hogares (GBS/CPH). Llegamos a los siguientes resultados: En los hogares con al menos un enfermo y que tuvieron gasto de bolsillo para recibir atención la relación GBS/CPH fue en promedio de 9,1%. Entre todos los hogares, las incidencias estimadas de gasto catastrófico fueron 2%, 2,8%, 4,4% y 8,7% utilizando umbrales GBS/GCS ( 40%, 30%, 20% y 10% respectivamente. Como conclusión, la EPH es un instrumento útil, pero con limitaciones, para estimar los gastos catastróficos en el sistema de salud paraguayo. Los resultados indican que es necesario diseñar e implementar mecanismos específicos para evitar este tipo de gastos(AU)

Every year, many families face excessive expenses in the presence of an illness, despite the fact that the health system has the equitable financial protection of the population as one of its objectives. The objective of this study was to describe the incidence of catastrophic health expenses in Paraguayan households. We analyzed the health module of the Permanent Household Survey (PHS) of the General Directorate of Statistics, Surveys and Census of Paraguay of 2014. We included consultations, medicines, diagnostic studies and hospitalizations of sick or injured people as direct out-of-pocket expenses. The ability to pay is defined as the sum of all incomes minus subsistence expenses, using a known structure of expenses. We calculated the catastrophic health expenses using different thresholds for the relationship between out-of-pocket cost and household payment capacity (OPC/HPC). In households with at least one patient who had out-of-pocket cost to receive care, the OPC/HPC ratio was 9.1% in average. Among all households, the estimated incidences of catastrophic expenses were 2%, 2.8%, 4.4% and 8.7% using 40%, 30%, 20% and 10% OPC/HPC thresholds respectively. The PHS is a useful instrument, but with limitations, to estimate catastrophic expenses in the Paraguayan health system. These results indicate that it is necessary to design and implement specific mechanisms to avoid this type of expenses(AU)

Composición del gasto de bolsillo en el sistema de salud del Paraguay / Composition of out-of-pocket health spending in the health system of Paraguay

La protección financiera de la población, con equidad, es un objetivo del sistema de salud. Sin embargo, numerosas personas enfermas incurren en gasto de bolsillo (GBS) para obtener atención, situación que es inequitativa. El objetivo de este artículo fue analizar la composición del GBS, su magnitud y distribución en la población general y pobre. Como metodología se analizó el módulo de salud de la Encuesta Permanente de Hogares del 2014. La población que incurrió en GBS fue el 75,1% de la población enferma, 75,8% para los no pobres, 73,3% para los pobres no extremos y 73,0% para los pobres extremos. El GBS promedio fue de 54,5 USD; 63,3 USD para los no pobres; 26,2 USD para los pobres no extremos y 30,4 USD para los pobres extremos. El 53% del GBS fue por pagos por medicamentos, 22,6% debido a estudios de diagnóstico, 18,7% por hospitalizaciones y 5,7% por consultas. La proporción de GBS por compra de medicamentos fue mayor entre los pobres: 72,3% para los pobres extremos y 68,6% para los pobres no extremos. Si bien el GBS se acumuló 87% entre los no pobres la relación de los precios promedios sobre el ingreso promedio fue más elevado entre los pobres: 95,8% para los pobres extremos, 40,7% para los pobres no extremos y 21,4% para los no pobres, pero los gastos por hospitalizaciones pueden superar el ingreso total. Los resultados señalan inequidad en el financiamiento del sistema de salud paraguayo.

Financial protection with equity for the population is an objective of the health system. However, many sick people incur pocket expenses to obtain care, a situation that is inequitable. The objective of this article is to analyze the composition of pocket expenses, its magnitude and distribution in the general and poor population. As a methodology, the health module of the Permanent Household Survey for 2014 was analyzed. The population that incurred in pocket expenses was 75.1% of the sick population, 75.8% of the non-poor, 73.3% of the non-extreme poor, and 73.0% of the extreme poor. The average pocket expenses was 54.5 USD, 63.3 USD for non-poor, 26.2 USD for non-extreme poor and 30.4 USD for extreme poor. Fifty three percent of the pocket expenses were for payments of medicines, 22.6% due to diagnostic studies, 18.7% for hospitalizations and 5.7% for consultations. The proportion of pocket expenses per drug purchase was higher among the poor: 72.3% for the extreme poor and 68.6% for the non-extreme poor. While pocket expenses accounted for 87.0% of the non-poor incomes, the ratio of average prices to average income was higher among the poor: 95.8% for extreme poor, 40.7% for non-extreme poor, and 21, 4% for non-poor, but hospitalization expenses may exceed total income. These data indicate inequity in the financing of the Paraguayan health system.

The MEDIATOR genes MED12 and MED13 control Arabidopsis root system configuration influencing sugar and auxin responses.

KEY MESSAGE: Arabidopsis med12 and med13 mutants exhibit shoot and root phenotypes related to an altered auxin homeostasis. Sucrose supplementation reactivates both cell division and elongation in primary roots as well as auxin-responsive and stem cell niche gene expression in these mutants. An analysis of primary root growth of WT, med12, aux1-7 and med12 aux1 single and double mutants in response to sucrose and/or N-1-naphthylphthalamic acid (NPA) placed MED12 upstream of auxin transport for the sugar modulation of root growth. The MEDIATOR (MED) complex plays diverse functions in plant development, hormone signaling and biotic and abiotic stress tolerance through coordination of transcription. Here, we performed genetic, developmental, molecular and pharmacological analyses to characterize the role of MED12 and MED13 on the configuration of root architecture and its relationship with auxin and sugar responses. Arabidopsis med12 and med13 single mutants exhibit shoot and root phenotypes consistent with altered auxin homeostasis including altered primary root growth, lateral root development, and root hair elongation. MED12 and MED13 were required for activation of cell division and elongation in primary roots, as well as auxin-responsive and stem cell niche gene expression. Remarkably, most of these mutant phenotypes were rescued by supplying sucrose to the growth medium. The growth response of primary roots of WT, med12, aux1-7 and med12 aux1 single and double mutants to sucrose and application of auxin transport inhibitor N-1-naphthylphthalamic acid (NPA) revealed the correlation of med12 phenotype with the activity of the auxin intake permease and suggests that MED12 acts upstream of AUX1 in the root growth response to sugar. These data provide compelling evidence that MEDIATOR links sugar sensing to auxin transport and distribution during root morphogenesis.

Influence of renal function on anticoagulation control in patients with non-valvular atrial fibrillation taking vitamin K antagonists.

BACKGROUND AND PURPOSE: Chronic kidney disease (CKD) has been related to poor anticoagulation control and an increased risk of bleeding. This study aims to evaluate the association between impaired renal function (eGFR <60 mL/min/1.73 m2 ) and anticoagulation control in patients with non-valvular atrial fibrillation (AF) on vitamin K antagonists (VKA) therapy. We also assessed whether the predictive value of the SAMe-TT2 R2 score prevailed for subgroups both with and without CKD. METHODS: This is an ancillary analysis of 1381 patients from the PAULA study, which was a cross-sectional, retrospective and nationwide multicenter study. RESULTS: A total of 370 patients had eGFR <60 mL/min/1.73 m2 . Anticoagulation control levels progressively worsened across each stage of CKD. Multiple linear regression analysis showed CKD as an independent predictor of time in therapeutic range (TTR). In the subgroup of patients with preserved renal function, female sex, diet affecting INR, polypharmacy and amiodarone were associated with poorer TTR. The SAMe-TT2 R2 score had a significant but modest predictive value for TTR<65% (AUC, area under the curve 0.558, P = .002). In the subgroup of patients with CKD, the SAMe-TT2 R2 (>2 points) showed no significant predictive capacity for TTR (AUC 0.528, P = .354). The average TTR was similar for both sexes (P = .255), but with a higher percentage of males subjects with TTR ≥65% (P = .013). CONCLUSION: Chronic kidney disease is associated with poor anticoagulation control in patients with non-valvular AF taking VKA. The SAMe-TT2 R2 score was not predictive of poor TTR in the subgroup with CKD, although a modest predictive value for poor TTR was found in those without CKD.

Espacios de decisión en la descentralización de salud del Paraguay / Decision spaces on health decentralization in Paraguay

Aunque está establecida en las leyes, la descentralización se desarrolla con lentitud en Paraguay. Este artículo la evaluó en la salud pública, desde el marco conceptual de los Espacios de Decisión donde El Principal tomador de decisiones es el Ministerio de Salud, mientras que sus Agentes son los establecimientos y Consejos de Salud. Se entrevistaron a 511 personas del sistema público de salud. Las funciones evaluadas fueron: administración de recursos financieros y humanos, gestión de servicios mediante reglas de dirección y organización, administración de reglas de acceso para mejorar la accesibilidad, y participación social en torno a los servicios de salud. Se incluyeron en el estudio a las capitales departamentales de la Región Oriental y al Departamento de Presidente Hayes de la Región Occidental. La descentralización de la salud pública paraguaya se encontró que estaba entre mínima e incipiente. La mayor descentralización estuvo en la función de organización, sugiriendo una opción local a favor del proceso, seguida por la de dirección, el acceso, los recursos humanos y la participación. La menor descentralización en Finanzas puede relacionarse con la carencia crónica de recursos fiscales del Estado.

Although decentralization it is established by the law, it develops slowly in Paraguay. This article evaluates public health decentralization from the conceptual framework of Decision Spaces where the major decision maker is the Ministry of Health while its Agents are Health establishments and Councils. Five hundred eleven people from the public health system were interviewed. The decentralized functions studied were: management of financial and human resources, service management by rules of organization and direction, access rules management to improve accessibility and social participation in relation to health services. In this study, the departmental capitals of the Eastern Region and the capital of the department of President Hayes in the Western Region were included. The decentralization ofthe Paraguayan public health was between Minimum to Incipient. The greater decentralization was in the organization function, suggesting a local option in favor of the process, followed by direction, access, human resources and participation. The lower decentralization in Finances can be related to the chronic lack of fiscal resources of the state.

Diplomado de ciencias del laboratorio para tecnólogos de la salud en laboratorio clínico / Diploma course on Laboratory Sciences for health technicians of Clinical Laboratory

Introducción: la educación de posgrado constituye una de las direcciones principales de trabajo de la educación superior y tiene como objetivo promover la educación de los graduados universitarios. Una de sus vertientes es la superación profesional, que tiene como una de sus figuras organizativas el diplomado.Objetivos: valorar el programa de estudio del diplomado de Ciencias del Laboratorio para tecnólogos de la salud en Laboratorio Clínico.Métodos: se realizó una investigación cualitativa de tipo educacional en el campo del posgrado del período comprendido entre noviembre de 2013 y julio de 2015 en la Facultad de Tecnología de la Salud perteneciente a la Universidad de Ciencias Médicas "Carlos J. Finlay", en Camagüey. Se emplearon métodos teóricos como el analítico-sintético, y el inductivo-deductivo. Dentro de los métodos empíricos el análisis de documentos, la caracterización del estado actual de la superación profesional de este egresado, la valoración de la factibilidad del diseño y encuesta a los diplomantes y profesores del claustro.Resultados: los resultados más significativos fueron que en los planes de estudios 2003-2004 y 2004-2005, no se diseñaron programas de las asignaturas de ciencias básicas biomédicas. La caracterización del estado actual de la superación profesional de este egresado permitió proyectar la superación profesional. Los laboratoristas clínico sienten satisfacción con la actividad que realizan y los atributos del diplomado fueron evaluados entre las categorías de muy adecuado y adecuado por los profesores de experiencias consultados.Conclusiones: los diferentes instrumentos aplicados para la valoración del diplomado demuestran que es adecuado su diseño, y se identifica que los módulos de Ciencias Básicas Biomédicas y el de Gestión de la Calidad y Bioquímica Clínica se le debe realizar transformaciones con el objetivo de perfeccionar su diseño curricular para otras ediciones(AU)

Introduction: postgraduate education is one of the main working directions of higher education, and aims to promote the education of university graduates. One of its aspects is the professional self-improvement, which has the diploma course as one of its organizational tasks.Objectives: to evaluate the studies program of the Diploma Course on Laboratory Sciences for health technicians of Clinical Laboratory.Methods: A qualitative research of educational type was conducted at the postgraduate level in the period from November 2013 to July 2015, at the School of Health Technology belonging to Carlos J. Finlay University of Medical Sciences of Camagüey. Theoretical methods were used, such as analysis-synthesis and induction-deduction. Among the empirical methods, we used document analysis, the characterization of the current state of the graduates' professional development, the assessment of the design's feasibility, and surveys to diploma course students and faculty members.Results: the most significant results were that, in the studies program of the academic years 2003-2004 and 2004-2005, syllabuses for the subjects of basic biomedical sciences were not designed. The characterization of the current state of the graduates' professional development permitted to project the profesional improvements. The clinical laboratory workers feel themselves satisfied with the activity they performed, while the experienced professors surveyed evaluated the diploma course's features within the categories of very appropriate and appropriate.Conclusions: The different instruments used for the assessment of the diploma course show that it design is appropriate. We identified that the modules of Basic Biomedical Sciences and Management of Quality and Clinical Biochemistry should be changed in order to improve their programs' design for further editions(AU)

Diplomado de ciencias del laboratorio para tecnólogos de la salud en laboratorio clínico / Diploma course on Laboratory Sciences for health technicians of Clinical Laboratory

INTRODUCCIÓN: la educación de posgrado constituye una de las direcciones principales de trabajo de la educación superior y tiene como objetivo promover la educación de los graduados universitarios. Una de sus vertientes es la superación profesional, que tiene como una de sus figuras organizativas el diplomado. OBJETIVOS: valorar el programa de estudio del diplomado de Ciencias del Laboratorio para tecnólogos de la salud en Laboratorio Clínico. MÉTODOS: se realizó una investigación cualitativa de tipo educacional en el campo del posgrado del período comprendido entre noviembre de 2013 y julio de 2015 en la Facultad de Tecnología de la Salud perteneciente a la Universidad de Ciencias Médicas "Carlos J. Finlay", en Camagüey. Se emplearon métodos teóricos como el analítico-sintético, y el inductivo-deductivo. Dentro de los métodos empíricos el análisis de documentos, la caracterización del estado actual de la superación profesional de este egresado, la valoración de la factibilidad del diseño y encuesta a los diplomantes y profesores del claustro. RESULTADOS: los resultados más significativos fueron que en los planes de estudios 2003-2004 y 2004-2005, no se diseñaron programas de las asignaturas de ciencias básicas biomédicas. La caracterización del estado actual de la superación profesional de este egresado permitió proyectar la superación profesional. Los laboratoristas clínico sienten satisfacción con la actividad que realizan y los atributos del diplomado fueron evaluados entre las categorías de muy adecuado y adecuado por los profesores de experiencias consultados. CONCLUSIONES: los diferentes instrumentos aplicados para la valoración del diplomado demuestran que es adecuado su diseño, y se identifica que los módulos de Ciencias Básicas Biomédicas y el de Gestión de la Calidad y Bioquímica Clínica se le debe realizar transformaciones con el objetivo de perfeccionar su diseño curricular para otras ediciones.

INTRODUCTION: postgraduate education is one of the main working directions of higher education, and aims to promote the education of university graduates. One of its aspects is the professional self-improvement, which has the diploma course as one of its organizational tasks. OBJECTIVES: to evaluate the studies program of the Diploma Course on Laboratory Sciences for health technicians of Clinical Laboratory. METHODS: A qualitative research of educational type was conducted at the postgraduate level in the period from November 2013 to July 2015, at the School of Health Technology belonging to Carlos J. Finlay University of Medical Sciences of Camagüey. Theoretical methods were used, such as analysis-synthesis and induction-deduction. Among the empirical methods, we used document analysis, the characterization of the current state of the graduates' professional development, the assessment of the design's feasibility, and surveys to diploma course students and faculty members. RESULTS: the most significant results were that, in the studies program of the academic years 2003-2004 and 2004-2005, syllabuses for the subjects of basic biomedical sciences were not designed. The characterization of the current state of the graduates' professional development permitted to project the profesional improvements. The clinical laboratory workers feel themselves satisfied with the activity they performed, while the experienced professors surveyed evaluated the diploma course's features within the categories of very appropriate and appropriate. CONCLUSIONS: The different instruments used for the assessment of the diploma course show that it design is appropriate. We identified that the modules of Basic Biomedical Sciences and Management of Quality and Clinical Biochemistry should be changed in order to improve their programs' design for further editions.