Optogenetic inhibition of rat anterior cingulate cortex impairs the ability to initiate and stay on task.

Our prior research has identified neural correlates of cognitive control in the anterior cingulate cortex (ACC), leading us to hypothesize that the ACC is necessary for increasing attention as rats flexibly learn new contingencies during a complex reward-guided decision-making task. Here, we tested this hypothesis by using optogenetics to transiently inhibit the ACC while rats of either sex performed the same two-choice task. ACC inhibition had a profound impact on behavior that extended beyond deficits in attention during learning when expected outcomes were uncertain. We found that ACC inactivation slowed and reduced the number of trials rats initiated, and impaired both their accuracy and their ability to complete sessions. Further, drift-diffusion model analysis suggested that free-choice performance and evidence accumulation (i.e., reduced drift rates) were degraded during initial learning-leading to weaker associations that were more easily overridden in later trial blocks (i.e., stronger bias). Together, these results suggest that in addition to attention-related functions, the ACC contributes to the ability to initiate trials and generally stay on task.Significant Statement Attentional deficits and the ability to stay on task are defining hallmarks of some of the most prevalent and disruptive neuropsychiatric disorders. Here, we use an optogenetic approach and computational modeling to study how within-subject modulation of the anterior cingulate cortex (ACC) impacts the ability of rats to initiate and complete a complex reward-guided decision-making task. We found that on days in which the ACC was inhibited, the ability of rats to initiate and stay on task was impaired, as well as their task accuracy and ability to complete sessions.

Status of breast cancer in Latin American: Results of the breast cancer revealed initiative.

The Breast Cancer Revealed initiative was designed and conducted to know the status of breast cancer at each point of breast cancer care, through i) prevention, ii) detection, iii) diagnosis, iv) treatment, and iv) the capacity of our health systems. The expert panel from 11 Latin American countries identified several strategies and proposed high impact priorities, including implementation of prevention policies, improve primary healthcare capacity for breast cancer screening, have adequate infrastructure to make effective and timely diagnoses, have a multidisciplinary team in the treatment process, access to a variety of treatments for all types of patients, have a coordinated and articulated system from primary care to specialized hospital. In a region with limited resources, prioritization in high-impact strategies for breast cancer control could lead to improved clinical outcomes and quality of life for our patients.

Neural signals implicated in the processing of appetitive and aversive events in social and non-social contexts.

In 2014, we participated in a special issue of Frontiers examining the neural processing of appetitive and aversive events. Specifically, we reviewed brain areas that contribute to the encoding of prediction errors and value versus salience, attention and motivation. Further, we described how we disambiguated these cognitive processes and their neural substrates by using paradigms that incorporate both appetitive and aversive stimuli. We described a circuit in which the orbitofrontal cortex (OFC) signals expected value and the basolateral amygdala (BLA) encodes the salience and valence of both appetitive and aversive events. This information is integrated by the nucleus accumbens (NAc) and dopaminergic (DA) signaling in order to generate prediction and prediction error signals, which guide decision-making and learning via the dorsal striatum (DS). Lastly, the anterior cingulate cortex (ACC) is monitoring actions and outcomes, and signals the need to engage attentional control in order to optimize behavioral output. Here, we expand upon this framework, and review our recent work in which within-task manipulations of both appetitive and aversive stimuli allow us to uncover the neural processes that contribute to the detection of outcomes delivered to a conspecific and behaviors in social contexts. Specifically, we discuss the involvement of single-unit firing in the ACC and DA signals in the NAc during the processing of appetitive and aversive events in both social and non-social contexts.

Overexpressing Histone Deacetylase 5 in Rat Dorsal Striatum Alters Reward-Guided Decision-Making and Associated Neural Encoding.

Accumulating evidence in the past decade implicates histone-modifying enzymes, such as class I histone deacetylases (HDACs), in learning and memory and, recently, habit formation. However, it is unclear whether HDACs play roles in complex cognitive function. To address this issue, we examined the role of dorsal striatal HDAC5, a class II HDAC, in reward-guided decision-making and associated neural encoding in rats. We first injected adeno-associated virus to overexpress a nuclear-localized HDAC5 in dorsal striatum (DS). We then recorded neural correlates from dorsolateral striatum (DLS) as rats performed two reward-guided choice tasks, in which we manipulated either the size of or delay to reward. During these tasks, rats first learned which of two options led to the better reward and then reversed those contingencies in a second block of trials. We found that rats with HDAC5 overexpression in DS responded faster and chose higher value reward more often during the first block of trials but were less able to reverse those contingencies in the second block of trials. At the neural level, HDAC5 overexpression in DS elevated and reduced the number of cells in DLS that increased firing to stimuli and reward, respectively, and shifted encoding toward cues that predicted more immediate reward. These results suggest that the HDAC5 overexpression in DS contributes to inflexible decision-making, demonstrating a role of histone-modifying enzymes in complex cognitive function.SIGNIFICANCE STATEMENT HDACs are important for learning and habit formation. Here, we expanded on these functions and found that overexpression of HDAC5 produced faster and more automatic behavior, and related changes in dorsolateral striatal neural firing in rats performing a value-based decision-making task. These results implicate HDAC5 as a potential therapeutic target for psychiatric conditions that impair decision-making and executive function.

Prior Cocaine Exposure Increases Firing to Immediate Reward While Attenuating Cue and Context Signals Related to Reward Value in the Insula.

The insula contributes to behavioral control and is disrupted by substance abuse, yet we know little about the neural signals underlying these functions or how they are disrupted after chronic drug self-administration. Here, male and female rats self-administered either cocaine (experimental group) or sucrose (control) for 12 consecutive days. After a 1 month withdrawal period, we recorded from insula while rats performed a previously learned reward-guided decision-making task. Cocaine-exposed rats were more sensitive to value manipulations and were faster to respond. These behavioral changes were accompanied by elevated counts of neurons in the insula that increased firing to reward. These neurons also fired more strongly at the start of long-delay trials, when a more immediate reward would be expected, and fired less strongly in anticipation of the actual delivery of delayed rewards. Although reward-related firing to immediate reward was enhanced after cocaine self-administration, reward-predicting cue and context signals were attenuated. In addition to revealing novel firing patterns unique to insula, our data suggest changes in such neural activity likely contribute to impaired decision making observed after drug use.SIGNIFICANCE STATEMENT The insula plays a clear role in drug addiction and drug-induced impairments of decision making, yet there is little understanding of its underlying neural signals. We found that chronic cocaine self-administration reduces cue and context encoding in insula while enhancing signals related to immediate reward. These changes in neural activity likely contribute to impaired decision making and impulsivity observed after drug use.

Prediction errors and valence: From single units to multidimensional encoding in the amygdala.

The amygdala-one of the primary structures of the limbic system-is comprised of interconnected nuclei situated within the temporal lobe. It has a well-established role in the modulation of negative affective states, as well as in fear processing. However, its vast projections with diverse brain regions-ranging from the cortex to the brainstem-are suggestive of its more complex involvement in affective or motivational aspects of cognitive processing. The amygdala can play an invaluable role in context-dependent associative learning, unsigned prediction error learning, influencing outcome selection, and multidimensional encoding. In this review, we delve into the amygdala's role in associative learning and outcome selection, emphasizing its intrinsic involvement in the appropriate context-dependent modulation of motivated behavior.

A Transmembrane Histidine Kinase Functions as a pH Sensor.

The two-component system DesK-DesR regulates the synthesis of unsaturated fatty acids in the soil bacteria Bacillus subtilis. This system is activated at low temperature and maintains membrane lipid fluidity upon temperature variations. Here, we found that DesK-the transmembrane histidine kinase-also responds to pH and studied the mechanism of pH sensing. We propose that a helix linking the transmembrane region with the cytoplasmic catalytic domain is involved in pH sensing. This helix contains several glutamate, lysine, and arginine residues At neutral pH, the linker forms an alpha helix that is stabilized by hydrogen bonds in the i, i + 4 register and thus favors the kinase state. At low pH, protonation of glutamate residues breaks salt bridges, which results in helix destabilization and interruption of signaling. This mechanism inhibits unsaturated fatty acid synthesis and rigidifies the membrane when Bacillus grows in acidic conditions.

Driving the catalytic activity of a transmembrane thermosensor kinase.

DesK is a Bacillus thermosensor kinase that is inactive at high temperatures but turns activated when the temperature drops below 25 °C. Surprisingly, the catalytic domain (DesKC) lacking the transmembrane region is more active at higher temperature, showing an inverted regulation regarding DesK. How does the transmembrane region control the catalytic domain, repressing activity at high temperatures, but allowing activation at lower temperatures? By designing a set of temperature minimized sensors that share the same catalytic cytoplasmic domain but differ in number and position of hydrogen-bond (H-bond) forming residues along the transmembrane helix, we are able to tune, invert or disconnect activity from the input signal. By favoring differential H-bond networks, the activation peak could be moved towards lower or higher temperatures. This principle may be involved in regulation of other sensors as environmental physicochemical changes or mutations that modify the transmembrane H-bond pattern can tilt the equilibrium favoring alternative conformations.

Prior cocaine self-administration impairs attention signals in anterior cingulate cortex.

Although maladaptive decision-making is a defining feature of drug abuse and addiction, we have yet to ascertain how cocaine self-administration disrupts neural signals in anterior cingulate cortex (ACC), a brain region thought to contribute to attentional control. To address this issue, rats were trained on a reward-guided decision-making task; reward value was manipulated by independently varying the size of or the delay to reward over several trial blocks. Subsequently, rats self-administered either a cocaine (experimental group) or sucrose (control) during 12 consecutive days, after which they underwent a 1-month withdrawal period. Upon completion of this period, rats performed the previously learned reward-guided decision-making task while we recorded from single neurons in ACC. We demonstrate that prior cocaine self-administration attenuates attention and attention-related ACC signals in an intake-dependent manner, and that changes in attention are decoupled from ACC firing. These effects likely contribute to the impaired decision-making-typified by chronic substance abuse and relapse-observed after drug use.

Diagnóstico de infección por Helicobacter pylori mediante test de aliento con urea C-14 en población ecuatoriana / Diagnosis of Helicobacter pylori infection by C-14 urea breath test in Ecuadorian population

siendo el test de aliento con urea carbono-14 (C-14) uno de los métodos de diagnóstico no invasivos; sin embar-go, no ha sido comprobada su utilidad en la población ecuatoriana.Objetivo: Evaluar la sensibilidad y especificidad del test de aliento con urea C-14 para predecir la infección por HP en la población ecuatoriana.Métodos: Estudio de Pruebas Diagnósticas realizado en pacientes que acudieron a la consulta externa del servicio de gastroenterología del Hospital Teófilo Dávila de la ciudad de Machala, en el periodo abril 2018 a marzo 2019. Los pacientes se sometieron a una endoscopia superior de luz blanca (ES) con toma de biopsias para investigar la infec-ción por HP; además, se realizó un test de aliento con urea C-14, para compararla con los resultados de las biopsias.Resultados: Se estudiaron 78 pacientes con una edad media de 33.76±11.2 años. El diagnóstico de gastritis se confirmó a través de la ES e histopatología en el 100% de los pacientes. El test de aliento con urea C-14 fue positi-va en 47/78 (60.3%) pacientes. Se demostró evidencia de infección por HP en biopsias gástricas de 50/78 (64.1%) pacientes. La sensibilidad, especificidad, VPP, VPN, observada y la concordancia entre evaluadores fue de 94%, 100%, 100%, 90%, 96% y 92% (P <0.001), respectivamente.Conclusiones: El test de aliento con urea C-14, es una herramienta útil para predecir infección por HP en la población ecuatoriana

Background: Early detection of Helicobacter pylori infection has become more relevant, with urea carbon-14 (C-14) breath test as one of the non-invasive diagnostic methods; however, it has not been proven in Ecuadorian population.Objective: To evaluate the sensitivity and specificity of the C-14 urea breath test to predict HP infection in the Ecuadorian population.Methods: : Study of diagnostic tests performed on patients who attended the outpatient gastroenterology service of the Hospital Teófilo Dávila in the city of Machala, in the period April 2018 to March 2019. The patients underwent an upper endoscopy of white light (WLE) with biopsies taken to investigate HP infection. In addition, a breath test with C-14 urea was performed to compare it with the biopsies results.Results: 78 patients with a mean age of 33.76±11.2 years were studied. The diagnosis of gastritis was confirmed through endoscopy and histopathology in 100% of the patients. The breath test with urea C-14 was positive in 47/78 (60.3%) patients. Evidence of HP infection was demonstrated in gastric biopsies from 50/78 (64.1%) pa-tients. Sensitivity, specificity, PPV, NPV, and inter-rater reliability were 94%, 100%, 100%, 90%, 96%, and 92% (P <0.001), respectively.Conclusions: The C-14 urea breath test is a useful tool for predicting HP infection in the Ecuadorian population

Reverse Engineering of a Thermosensing Regulator Switch.

To address the mechanism of thermosensing and its implications for molecular engineering, we previously deconstructed the functional components of the bacterial thermosensor DesK, a histidine kinase with a five-span transmembrane domain that detects temperature changes. The system was first simplified by building a sensor that consists of a single chimerical transmembrane segment that retained full sensing capacity. Genetic and biophysical analysis of this minimal sensor enabled the identification of three modular components named determinants of thermodetection (DOTs). Here we combine and tune the DOTs to determine their contribution to activity. A transmembrane zipper represents the master DOT that drives a reversible and activating dimerization through the formation of hydrogen bonds. Our findings provide the mechanism and insights to construct a synthetic transmembrane helix based on a poly-valine scaffold that harbors the DOTs and regulates the activity. The construct constitutes a modular switch that may be exploited in biotechnology and genetic circuitry.

The impact of drugs of abuse on executive function: characterizing long-term changes in neural correlates following chronic drug exposure and withdrawal in rats.

Addiction has long been characterized by diminished executive function, control, and impulsivity management. In particular, these deficits often manifest themselves as impairments in reversal learning, delay discounting, and response inhibition. Understanding the neurobiological substrates of these behavioral deficits is of paramount importance to our understanding of addiction. Within the cycle of addiction, periods during and after withdrawal represent a particularly difficult point of intervention in that the negative physical symptoms associated with drug removal and drug craving increase the likelihood that the patient will relapse and return to drug use in order to abate these symptoms. Moreover, it is often during this time that drug induced deficits in executive function hinder the ability of the patient to refrain from drug use. Thus, it is necessary to understand the physiological and behavioral changes associated with withdrawal and drug craving-largely manifesting as deficits in executive control-to develop more effective treatment strategies. In this review, we address the long-term impact that drugs of abuse have on the behavioral and neural correlates that give rise to executive control as measured by reversal learning, delay discounting, and stop-signal tasks, focusing particularly on our work using rats as a model system.

Previous cocaine self-administration disrupts reward expectancy encoding in ventral striatum.

The nucleus accumbens core (NAc) is important for integrating and providing information to downstream areas about the timing and value of anticipated reward. Although NAc is one of the first brain regions to be affected by drugs of abuse, we still do not know how neural correlates related to reward expectancy are affected by previous cocaine self-administration. To address this issue, we recorded from single neurons in the NAc of rats that had previously self-administered cocaine or sucrose (control). Neural recordings were then taken while rats performed an odor-guided decision-making task in which we independently manipulated value of expected reward by changing the delay to or size of reward across a series of trial blocks. We found that previous cocaine self-administration made rats more impulsive, biasing choice behavior toward more immediate reward. Further, compared to controls, cocaine-exposed rats showed significantly fewer neurons in the NAc that were responsive during odor cues and reward delivery, and in the reward-responsive neurons that remained, diminished directional and value encoding was observed. Lastly, we found that after cocaine exposure, reward-related firing during longer delays was reduced compared to controls. These results demonstrate that prior cocaine self-administration alters reward-expectancy encoding in NAc, which could contribute to poor decision making observed after chronic cocaine use.

Predictive Validity of Sepsis-3 Definitions and Sepsis Outcomes in Critically Ill Patients: A Cohort Study in 49 ICUs in Argentina.

OBJECTIVES: The new Sepsis-3 definitions have been scarcely assessed in low- and middle-income countries; besides, regional information of sepsis outcomes is sparse. Our objective was to evaluate Sepsis-3 definition performance in Argentina. DESIGN: Cohort study of 3-month duration beginning on July 1, 2016. SETTINGS: Forty-nine ICUs. PATIENTS: Consecutive patients admitted to the ICU with suspected infection that triggered blood cultures and antibiotic administration. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Patients were classified as having infection, sepsis (infection + change in Sequential Organ Failure Assessment ≥ 2 points), and septic shock (vasopressors + lactate > 2 mmol/L). Patients on vasopressors and lactate less than or equal to 2 mmol/L (cardiovascular dysfunction) were analyzed separately, as those on vasopressors without serum lactate measurement. Systemic inflammatory response syndrome was also recorded. Main outcome was hospital mortality. Of 809 patients, 6% had infection, 29% sepsis, 20% cardiovascular dysfunction, 40% septic shock, and 3% received vasopressors with lactate unmeasured. Hospital mortality was 13%, 20%, 39%, 51%, and 41%, respectively (p = 0.000). Independent predictors of outcome were lactate, Sequential Organ Failure Assessment score, comorbidities, prior duration of symptoms (hr), mechanical ventilation requirement, and infection by highly resistant microorganisms. Area under the receiver operating characteristic curves for mortality for systemic inflammatory response syndrome and Sequential Organ Failure Assessment were 0.53 (0.48-0.55) and 0.74 (0.69-0.77), respectively (p = 0.000). CONCLUSIONS: Increasing severity of Sepsis-3 categories adequately tracks mortality; cardiovascular dysfunction subgroup, not included in Sepsis-3, has distinct characteristics. Sequential Organ Failure Assessment score shows adequate prognosis accuracy-contrary to systemic inflammatory response syndrome. This study supports the predictive validity of Sepsis-3 definitions.

Activation of the bacterial thermosensor DesK involves a serine zipper dimerization motif that is modulated by bilayer thickness.

DesK is a bacterial thermosensor protein involved in maintaining membrane fluidity in response to changes in environmental temperature. Most likely, the protein is activated by changes in membrane thickness, but the molecular mechanism of sensing and signaling is still poorly understood. Here we aimed to elucidate the mode of action of DesK by studying the so-called "minimal sensor DesK" (MS-DesK), in which sensing and signaling are captured in a single transmembrane segment. This simplified version of the sensor allows investigation of membrane thickness-dependent protein-lipid interactions simply by using synthetic peptides, corresponding to the membrane-spanning parts of functional and nonfunctional mutants of MS-DesK incorporated in lipid bilayers with varying thicknesses. The lipid-dependent behavior of the peptides was investigated by circular dichroism, tryptophan fluorescence, and molecular modeling. These experiments were complemented with in vivo functional studies on MS-DesK mutants. Based on the results, we constructed a model that suggests a new mechanism for sensing in which the protein is present as a dimer and responds to an increase in bilayer thickness by membrane incorporation of a C-terminal hydrophilic motif. This results in exposure of three serines on the same side of the transmembrane helices of MS-DesK, triggering a switching of the dimerization interface to allow the formation of a serine zipper. The final result is activation of the kinase state of MS-DesK.

Impacto de la internación en terapia intensiva en la calidad de vida después de 1, 3, 6 y 12 meses / The impact of hospitalization in intensive care units on quality of life after 1, 3, 6 and 12 months

INTRODUCCION: A medida que más pacientes sobreviven a una internación en Unidades de Terapia Intensiva (UTI), se hace necesario conocer las secuelas a largo plazo. La calidad de vida relacionada a la salud tras la enfermedad crítica se mantiene por debajo de la media de la población general aún cinco años después del alta.OBJETIVO: Evaluar la calidad de vida de los pacientes a egreso de UTI mediante el cuestionario EuroQol 5D y predictores de mala evolución. Evaluar secuelas psíquicas y físicas una vez transcurridos 1, 3, 6 y 12 meses después del alta de UTI.METODOS: Se realizó un estudio descriptivo en un Hospital Interzonal de la Provincia de Buenos Aires (estudio prospectivo de serie de casos). Fueron incluidos aquellos pacientes sometidos a asistencia respiratoria mecánica invasiva por un período ≥ 48 horas que egresaron de UTI entre el 01/04/2010 y el 01/04/2011.RESULTADOS: Los criterios de inclusión fueron cumplidos por 51 pacientes. Se entrevistó a 36/46 pacientes (tras un mes), 25/34 pacientes (a los 3 meses), 12/15 pacientes (a los 6 meses) y 5/7 pacientes (a los 12 meses). Los datos demográficos reflejaron edad 33 [25-50] años, 71% de los pacientes de sexo masculino, 57% sin comorbilidades y con un puntaje APACHE II de 14,6 ± 6. El principal motivo de ingreso fue el trauma (50%). La dimensión más afectada fue la realización de actividades cotidianas, seguida de dolor/malestar y movilidad. La incidencia de ansiedad/depresión y estrés postraumático fue la reportada en otros estudios. La anemia, la traqueostomía y la alimentación enteral al alta fueron predictores de mala evolución según el índice EuroQol.CONCLUSIONES: La calidad de vida al alta de UTI se encontró muy deteriorada en la mayoría de las dimensiones. Las secuelas psíquicas se presentaron dentro del rango esperado. El índice EuroQol fue bajo en el primer mes, pero evolucionó favorablemente junto a la percepción de la propia calidad de vida medida por Escala Visual Análoga EuroQol.

INTRODUCTION: As more and more patients survive their hospitalization in Intensive Care Units (ICU), it is of utmost importance to find out and understand the long-term outcomes. Health-related quality of life after a critical illness is still below the average, even five years after discharge.OBJECTIVE: To assess patients quality of life after ICU discharge using the EuroQol-5D score and predictors of unfavorable prognosis. To assess psychological after-effects like anxiety, depression and post-traumatic stress disorder (PTSD), along with physical morbodity at 1, 3, 6 and 12 months after ICU discharge.METHODS: A descriptive study was conducted in a public hospital located in the province of Buenos Aires (prospective case study). It included all patients treated with invasive mechanical ventilation for at least 48 hours that survived ICU from April 1, 2010 through April 1, 2011.RESULTS: 51 patients qualified for inclusion in this study. Interviews were made to 36/46 patients after 1 month; 25/34 patients after 3 months; 12/15 patients after 6 months and 5/7 patients after 12 months. The demographic data showed age 33 [25-50], 71% male, 57% with no comorbidities and 14,6 ± 6,4 points in APACHE II score. The main reason for ICU admission was trauma (50%). The most affected dimension, as measured by EQ-5D, was usual activities, followed by pain/discomfort and self-care or morbility. The incidence of PTSD and anxiety/depression was similar was to what was reported in other studies. Anemia, tracheostomy and enteral feeding at discharge were predictors of unfavorable prognosis as indicated by the EuroQol index.CONCLUSIONS: The quality of life after ICU discharge was severely deteriorated in most dimensions. Psychological after-effects were within the expected values. The EuroQol index was low in the first month, but then it improved along with the quality of life as measured by the EuroQol Visual Analogue Scale.

Impacto de la internación en terapia intensiva en la calidad de vida después de 1, 3, 6 y 12 meses / The impact of hospitalization in intensive care units on quality of life after 1, 3, 6 and 12 months

INTRODUCCION: A medida que más pacientes sobreviven a una internación en Unidades de Terapia Intensiva (UTI), se hace necesario conocer las secuelas a largo plazo. La calidad de vida relacionada a la salud tras la enfermedad crítica se mantiene por debajo de la media de la población general aún cinco años después del alta.OBJETIVO: Evaluar la calidad de vida de los pacientes a egreso de UTI mediante el cuestionario EuroQol 5D y predictores de mala evolución. Evaluar secuelas psíquicas y físicas una vez transcurridos 1, 3, 6 y 12 meses después del alta de UTI.METODOS: Se realizó un estudio descriptivo en un Hospital Interzonal de la Provincia de Buenos Aires (estudio prospectivo de serie de casos). Fueron incluidos aquellos pacientes sometidos a asistencia respiratoria mecánica invasiva por un período ≥ 48 horas que egresaron de UTI entre el 01/04/2010 y el 01/04/2011.RESULTADOS: Los criterios de inclusión fueron cumplidos por 51 pacientes. Se entrevistó a 36/46 pacientes (tras un mes), 25/34 pacientes (a los 3 meses), 12/15 pacientes (a los 6 meses) y 5/7 pacientes (a los 12 meses). Los datos demográficos reflejaron edad 33 [25-50] años, 71% de los pacientes de sexo masculino, 57% sin comorbilidades y con un puntaje APACHE II de 14,6 ± 6. El principal motivo de ingreso fue el trauma (50%). La dimensión más afectada fue la realización de actividades cotidianas, seguida de dolor/malestar y movilidad. La incidencia de ansiedad/depresión y estrés postraumático fue la reportada en otros estudios. La anemia, la traqueostomía y la alimentación enteral al alta fueron predictores de mala evolución según el índice EuroQol.CONCLUSIONES: La calidad de vida al alta de UTI se encontró muy deteriorada en la mayoría de las dimensiones. Las secuelas psíquicas se presentaron dentro del rango esperado. El índice EuroQol fue bajo en el primer mes, pero evolucionó favorablemente junto a la percepción de la propia calidad de vida medida por Escala Visual Análoga EuroQol.

INTRODUCTION: As more and more patients survive their hospitalization in Intensive Care Units (ICU), it is of utmost importance to find out and understand the long-term outcomes. Health-related quality of life after a critical illness is still below the average, even five years after discharge.OBJECTIVE: To assess patients quality of life after ICU discharge using the EuroQol-5D score and predictors of unfavorable prognosis. To assess psychological after-effects like anxiety, depression and post-traumatic stress disorder (PTSD), along with physical morbodity at 1, 3, 6 and 12 months after ICU discharge.METHODS: A descriptive study was conducted in a public hospital located in the province of Buenos Aires (prospective case study). It included all patients treated with invasive mechanical ventilation for at least 48 hours that survived ICU from April 1, 2010 through April 1, 2011.RESULTS: 51 patients qualified for inclusion in this study. Interviews were made to 36/46 patients after 1 month; 25/34 patients after 3 months; 12/15 patients after 6 months and 5/7 patients after 12 months. The demographic data showed age 33 [25-50], 71% male, 57% with no comorbidities and 14,6 ± 6,4 points in APACHE II score. The main reason for ICU admission was trauma (50%). The most affected dimension, as measured by EQ-5D, was usual activities, followed by pain/discomfort and self-care or morbility. The incidence of PTSD and anxiety/depression was similar was to what was reported in other studies. Anemia, tracheostomy and enteral feeding at discharge were predictors of unfavorable prognosis as indicated by the EuroQol index.CONCLUSIONS: The quality of life after ICU discharge was severely deteriorated in most dimensions. Psychological after-effects were within the expected values. The EuroQol index was low in the first month, but then it improved along with the quality of life as measured by the EuroQol Visual Analogue Scale.

[Modification of risk factors in the developing of diabetes mellitus type 2 in obese children]. / Modificación de factores de riesgo para desarrollar diabetes mellitus tipo 2 en escolares obesos.

OBJECTIVE: To determine if an educational and dietetic program diminish the risk factors of diabetes mellitus type 2 in obese children. DESIGN: quasi-experimental trial. MATERIAL AND METHODS: We performed a study in 28 obese children. They received instruction in diabetes mellitus, participated in a nutritional education group, and received an individual dietetic treatment during six months. There was used a 24-hour recall about dietary intake, body mass index and blood pressure measure monthly. Glucose, leptin, and insulin levels were measured at baseline and after the six months of treatment. Kruskal-Wallis and Wilcoxon tests were used. RESULTS: We studied 13 female and 15 male obese children with an age average of 9.7 years. Body mass index (29.0 versus 25.6), blood pressure (121/80 versus 118/78 mm Hg), fasting glucose (95 versus 92 mg/dL), total cholesterol (166 versus 155 mg/dL), triglycerides (144 versus 142 mg/dL), insulin resistance index (5.9 versus 4.9), leptin (56.1 versus 57.3 ng/mL), and energy intake (3409 versus 2243 kcal) decreased, at the begin and at the end of the study. Nutriment and sufficiency balance were lower too (p<0.05). CONCLUSIONS: The program diminished the risk factors for diabetes mellitus and cardiovascular disease.

Infecciones asociadas a catéteres venosos centrales en pacientes críticos / Central venous catheter-related infections in critically ill patients

Objetivo: Determinar la incidencia de las distintas infecciones asociadas a catéteres (IAC): colonización del catéter (CC), bacteriemia asociada a catéter (BAC) e infecciones del sitio de salida (ISS), de acuerdo a las definiciones del CDC. Diseño: Estudio observacional, prospectivo, realizado en una UTI polivalente de 8 camas de un hospital escuela, durante el período de un año. Materiales y métodos: Fueron incluidos todos los pacientes ingresados a UTI desde el 01/01/00 al 01/01/01 que requirieran catéteres venosos centrales (CVC) durante más de 24 hs. Se consideró CC como el crecimiento de ò15 UFC en un recuento semicuantitativo o de ò10 UFC en un recuento cuantitativo de la punta distal del catéter con hemocultivos negativos; BAC al aislamiento del mismo germen (idéntica tipificación y sensibilidad) en la punta del catéter por cultivo semicuantitativo o cuantitativo y en hemocultivos periféricos; e ISS ante la presencia de eritema, induración o purulencia hasta 2 cm del sitio de salida del catéter. Los accesos utilizados fueron yugular, femoral y subclavio...

Infecciones asociadas a catéteres venosos centrales en pacientes críticos / Central venous catheter-related infections in critically ill patients

Objetivo: Determinar la incidencia de las distintas infecciones asociadas a catéteres (IAC): colonización del catéter (CC), bacteriemia asociada a catéter (BAC) e infecciones del sitio de salida (ISS), de acuerdo a las definiciones del CDC. Diseño: Estudio observacional, prospectivo, realizado en una UTI polivalente de 8 camas de un hospital escuela, durante el período de un año. Materiales y métodos: Fueron incluidos todos los pacientes ingresados a UTI desde el 01/01/00 al 01/01/01 que requirieran catéteres venosos centrales (CVC) durante más de 24 hs. Se consideró CC como el crecimiento de ò15 UFC en un recuento semicuantitativo o de ò10 UFC en un recuento cuantitativo de la punta distal del catéter con hemocultivos negativos; BAC al aislamiento del mismo germen (idéntica tipificación y sensibilidad) en la punta del catéter por cultivo semicuantitativo o cuantitativo y en hemocultivos periféricos; e ISS ante la presencia de eritema, induración o purulencia hasta 2 cm del sitio de salida del catéter. Los accesos utilizados fueron yugular, femoral y subclavio...(AU)