Inter- and intra-observer agreement of high-resolution ultrasonography and power Doppler in assessment of joint inflammation and bone erosions in patients with rheumatoid arthritis.

To assess the inter- and intra-observer reproducibility of musculoskeletal ultrasonography among rheumatologist in detecting inflammatory and morphostructural changes in small joints of the hands in patients with rheumatoid arthritis (RA). Five members of the "Escuela de Ecografía del Colegio Mexicano de Reumatología" tested their inter- and intra-observer reliabilities in the assessment of basic sonographic findings of joint inflammation and bone erosion. Their results were compared to those obtained by a group of international experts from European League Against Rheumatism. A clinical rheumatologist evaluated eight RA patients. Five Siemens Acuson Antares ultrasound machines (7-13 MHz linear probes) were used. The OMERACT preliminary definitions of joint effusion, synovial hypertrophy, bone erosions and tenosynovitis were adopted. Inter-observer and intra-observer agreement was calculated by overall agreement and kappa statistics. Mean kappa value for joint effusion was good, 0.654 (85%); synovial hypertrophy, 0.550 (77.2%); power Doppler signal, 0.550 (82.5%); bone erosions, 0.549 (81%); and tenosynovitis, 0.500 (91.5%). Mean and overall intra-observer agreement for semiquantitative score was good for joint effusion, 0.630 (77.2%) and bone erosions, 0.605 (56.25%); and moderate to synovial hypertrophy, 0.476 (65%) and power Doppler signal, 0.471 (80%). Mean kappa value for joint effusion was 0.381 (95%), synovial hypertrophy, 0.447 (72%); power Doppler signal, 0.496 (81%); bone erosions, 0.294 (81%); and tenosynovitis, 0.030 (66%). Mean and overall inter-observer agreement for semiquantitative score was poor for joint effusion, 0.325 (57%) and bone erosions, 0.360 (43%); and moderate to synovial hypertrophy, 0.431 (55%) and power Doppler signal, 0.496 (81%). Intra-observer variability reached the highest levels of agreement. Factors related to the experience of the rheumatologist, the time spent in each examination and knowledge of the software ultrasound equipment could influence the lower level of inter-observer agreement in this study.

Investigating the regulation of the unc-33 promoter by environmental stressors.

Environmental factors such as prenatal stress are hypothesized to contribute to the development of schizophrenia. Lee and colleagues determined rats exposed to prenatal stress exhibited decreased levels of only one protein, DPYSL2, in their prefrontal cortex and hippocampus. DYPSL2, a protein seen to be inactivated in schizophrenic patients, is important for neuronal development. The C. elegans homolog of DPYSL2, UNC-33, is also found to be critical for axonal outgrowth and synapse formation. Herein, we study the effects of environmental stressors such as increasing temperatures and pathogens on the expression of GFP driven by the unc-33 promoter. Results indicate that neuronal GFP expression was lower in C. elegans exposed to these prenatal stressors, making this the first report denoting an environmental regulation of the unc -33 promoter. This study provides insight into unc-33 and the regulation of its expression in relation to temperature and infection.

Fatal reversible cerebral vasoconstriction syndrome: An unusual presentation of a rare disease / [Vasoconstricción cerebral fatal, presentación inusual de una enfermedad inusual].

The reversible cerebral vasoconstriction syndrome is a variable, segmental, and multifocal constriction of brain arteries, usually with a benign course. We describe the case of a 49-year-old woman who presented with headaches, visual symptoms, and seizures. Three days after admission, vasoconstriction areas were found in at least two vascular territories in two segments of the same arteries. The patient was admitted to the intensive care unit where her blood pressure was monitored and she received medical treatment. Surprisingly, the patient presented an unpredicted evolution in developing malignant cerebral edema on the seventh day after admission. She then suffered brain death and was taken to organ donation. A guided nervous system necropsy was later performed. The pathology discarded vasculitis and exhibited hemorrhage areas in the cerebral convexity. Herein, we discuss the most relevant aspects of cases with fulminant evolution reported in the literature. The reversible cerebral vasoconstriction syndrome is usually associated with fatal outcomes when patients exhibit focalization, their first neuroimaging typically shows disturbances, and a rapid clinical deterioration occurs. It is crucial to identify factors linked to poor prognosis and set intervention strategies and early prevention.

El síndrome de vasoconstricción cerebral reversible se produce por la constricción variable, segmentaria y multifocal, de las arterias cerebrales y, generalmente, es de curso benigno. Se describe el caso de una mujer de 49 años que consultó por cefalea, síntomas visuales y convulsiones; tres días después, presentaba áreas de vasoconstricción en, por lo menos, dos territorios vasculares y dos segmentos de las mismas arterias. Fue internada en la unidad de cuidados intensivos para controlarle la presión arterial y recibir tratamiento médico. Tuvo una evolución tórpida y, en el séptimo día de hospitalización, desarrolló edema cerebral maligno, tras lo cual ocurrió la muerte cerebral. Se inició entonces el plan de donación de órganos y, posteriormente, se practicó una autopsia guiada del cerebro. El estudio de patología descartó vasculitis y reveló áreas de hemorragia en la convexidad cerebral. Se discuten los aspectos más relevantes de los casos con evolución fulminante informados en la literatura científica. El síndrome de vasoconstricción cerebral reversible se asocia con resultados fatales cuando los pacientes tienen una deficiencia neurológica focal, la neuroimagen inicial muestra alteraciones y hay un deterioro clínico rápido. Es importante conocer los factores asociados con un mal pronóstico, y establecer estrategias tempranas de intervención y prevención.

Prokaryotic responses to a warm temperature anomaly in northeast subarctic Pacific waters.

Recent studies on marine heat waves describe water temperature anomalies causing changes in food web structure, bloom dynamics, biodiversity loss, and increased plant and animal mortality. However, little information is available on how water temperature anomalies impact prokaryotes (bacteria and archaea) inhabiting ocean waters. This is a nontrivial omission given their integral roles in driving major biogeochemical fluxes that influence ocean productivity and the climate system. Here we present a time-resolved study on the impact of a large-scale warm water surface anomaly in the northeast subarctic Pacific Ocean, colloquially known as the Blob, on prokaryotic community compositions. Multivariate statistical analyses identified significant depth- and season-dependent trends that were accentuated during the Blob. Moreover, network and indicator analyses identified shifts in specific prokaryotic assemblages from typically particle-associated before the Blob to taxa considered free-living and chemoautotrophic during the Blob, with potential implications for primary production and organic carbon conversion and export.

Three decades of Canadian marine harmful algal events: Phytoplankton and phycotoxins of concern to human and ecosystem health.

Spatial and temporal trends of marine harmful algal events in Canada over the last three decades were examined using data from the Harmful Algal Event Database (HAEDAT). This database contains the most complete record of algal blooms, phycotoxins and shellfish harvesting area closures in Canada since 1987. This 30-year review of 593 Canadian HAEDAT records from 1988 to 2017, together with other Canadian data and publications, shows that recurring harmful algal events have been widespread throughout both the Atlantic and Pacific coastal regions. The 367 paralytic shellfish toxin (PST) reports revealed annual and frequent recurrence throughout both the Atlantic and Pacific regions, including multi-year PST events in the Bay of Fundy, the Estuary and Gulf of St. Lawrence and the Strait of Georgia. The 70 amnesic shellfish toxin (AST) records revealed no recognizable trend, as these events were usually area specific and did not recur annually. The increasing frequency of diarrhetic shellfish toxin (DST) events over the period of this review, in total 59 records, can be at least partially explained by increased sampling effort. Marine species mortalities caused by harmful algae (including diatoms, dictyochophytes, dinoflagellates, and raphidophytes), were a common occurrence in the Pacific region (87 reports), but have been reported much less frequently in the Atlantic region (10 reports). Notable Canadian records contained in HAEDAT include the first detection worldwide of amnesic shellfish poisoning (ASP), attributed to the production of domoic acid (an AST) by a diatom (Pseudo-nitzschia multiseries) in Prince Edward Island in 1987. The first proven case of diarrhetic shellfish poisoning (DSP) in Canada and North America was recorded in 1990, and the first closures of shellfish harvesting due to DST (associated with the presence of Dinophysis norvegica) occurred in Nova Scotia in 1992, followed by closures in Newfoundland and Labrador in 1993. In 2008, mass mortalities of fishes, birds and mammals in the St. Lawrence Estuary were caused by Alexandrium catenella and high levels of PST. During 2015, the Pacific coast experienced a large algal bloom that extended from California to Alaska. It resulted in the closure of several shellfish harvesting areas in British Columbia due to AST, produced by Pseudo-nitzschia australis. Data from the Canadian Arctic coast is not included in HAEDAT. However, because of the emerging importance of climate change and increased vessel traffic in the Arctic, information on the occurrence of harmful algal species (pelagic and sympagic = sea ice-associated) in that region was compiled from relevant literature and data. The results suggest that these taxa may be more widespread than previously thought in the Canadian Arctic. Information in HAEDAT was not always robust or complete enough to provide conclusions about temporal trends. Compilation of spatial and temporal information from HAEDAT and other records is nevertheless important for evaluating the potential role of harmful algae as a stressor on Canadian marine ecosystems, and will support the next step: developing a knowledge gap analysis that will establish research priorities for determining their consequences on human and ecosystem health.

Vasoconstricción cerebral fatal, presentación inusual de una enfermedad inusual / Fatal reversible cerebral vasoconstriction syndrome: An unusual presentation of a rare disease

Resumen | El síndrome de vasoconstricción cerebral reversible se produce por la constricción variable, segmentaria y multifocal, de las arterias cerebrales y, generalmente, es de curso benigno. Se describe el caso de una mujer de 49 años que consultó por cefalea, síntomas visuales y convulsiones; tres días después, presentaba áreas de vasoconstricción en, por lo menos, dos territorios vasculares y dos segmentos de las mismas arterias. Fue internada en la unidad de cuidados intensivos para controlarle la presión arterial y recibir tratamiento médico. Tuvo una evolución tórpida y, en el séptimo día de hospitalización, desarrolló edema cerebral maligno, tras lo cual ocurrió la muerte cerebral. Se inició entonces el plan de donación de órganos y, posteriormente, se practicó una autopsia guiada del cerebro. El estudio de patología descartó vasculitis y reveló áreas de hemorragia en la convexidad cerebral. Se discuten los aspectos más relevantes de los casos con evolución fulminante informados en la literatura científica. El síndrome de vasoconstricción cerebral reversible se asocia con resultados fatales cuando los pacientes tienen una deficiencia neurológica focal, la neuroimagen inicial muestra alteraciones y hay un deterioro clínico rápido. Es importante conocer los factores asociados con un mal pronóstico, y establecer estrategias tempranas de intervención y prevención.

Abstract | The reversible cerebral vasoconstriction syndrome is a variable, segmental, and multifocal constriction of brain arteries, usually with a benign course. We describe the case of a 49-year-old woman who presented with headaches, visual symptoms, and seizures. Three days after admission, vasoconstriction areas were found in at least two vascular territories in two segments of the same arteries. The patient was admitted to the intensive care unit where her blood pressure was monitored and she received medical treatment. Surprisingly, the patient presented an unpredicted evolution in developing malignant cerebral edema on the seventh day after admission. She then suffered brain death and was taken to organ donation. A guided nervous system necropsy was later performed. The pathology discarded vasculitis and exhibited hemorrhage areas in the cerebral convexity. Herein, we discuss the most relevant aspects of cases with fulminant evolution reported in the literature. The reversible cerebral vasoconstriction syndrome is usually associated with fatal outcomes when patients exhibit focalization, their first neuroimaging typically shows disturbances, and a rapid clinical deterioration occurs. It is crucial to identify factors linked to poor prognosis and set intervention strategies and early prevention.

ACV y covid-19: una revisión de los estudios observacionales publicados en época de pandemia / Stroke and COVID-19: A review of observational studies published during the pandemic

RESUMEN INTRODUCCIÓN: En marzo 2020 la Organización Mundial de la Salud decretó la pandemia por covid-19. Se han informado casos de ACV relacionados con esta infección viral. OBJETIVOS: Conocer la experiencia de diferentes partes del mundo respecto al ACV y covid-19 con el fin de mejorar el reconocimiento y saber qué hacer cuando se empiecen a presentar estos pacientes en nuestro medio. MÉTODOS: Se hizo una revisión de los estudios observacionales disponibles utilizando PubMed, Scopus, así como otras fuentes de literatura gris para las publicaciones sobre ACV y covid-19. Se identificaron datos demográficos, tiempo de aparición del ACV desde el diagnóstico de covid-19. Principales hallazgos radiológicos, laboratorios y pronóstico. RESULTADOS: Se obtuvieron ocho estudios, con 43 sujetos que tuvieron ACV isquémico e infección por SARS-CoV-2. La edad promedio fue de 67,4 años, siendo en su mayoría hombres (58,1%).Un hallazgo importante fue el número de casos de ACV con oclusión de vaso grande en 22 de 31 casos reportados (71%). La mediana de NIHSS fue de 14,5 puntos. Se presentó una mortalidad del 27,5% de los sujetos con ACV El estadio más frecuente por covid-19 fue el de condición severa 58,3%. La aparición del ACV luego de la infección por SARS-CoV-2 fue de 10,6 días en promedio. En los laboratorios se identificó una elevación del fibrinógeno (92%), dímero-D (76%) y LDH (82%) respectivamente. El tratamiento recibido de forma más frecuente para el ACV fue la antiagregación, en 51%, mientras que las terapias de reperfusión se hicieron en el 30% de los casos. La mayoría de los pacientes (93%) presentaron síntomas de covid-19, solo 3 pacientes (7%) no presentaron síntomas típicos de esta enfermedad, sin embargo tuvieron alteración del estado de conciencia asociado al ACV CONCLUSIÓN: Los estados de inflamación e hipercoagulabilidad que se presentan durante la infección por SARS-CoV-2 probablemente están en relación con el desarrollo de ACV, lo cual en este caso podrá explicar el gran número de oclusiones de vaso grande. Los marcadores de inflamación generalmente están presentes. Establecer códigos protegidos de ACV es una medida a efectuar en nuestro medio.

SUMMARY INTRODUCTION: In March 2020, COVID-19 was declared a pandemic by the World Health Organization and cases of stroke related to the virus soon were reported. OBJECTIVES: To become aware of the experiences different parts of the world have encountered with stroke and COVID 19 in order to enhance our knowledge, improve recognition and response to patients in our clinical setting. METHODS: A review of the available observational studies was done using PubMed, Scopus and other sources of gray literature for the publications on stroke and COVID-19. Demographic data, time of stroke onset since the diagnosis of COVID-19, main radiological findings, lab tests and prognosis were identified. RESULTS: Eight studies were selected with 43 subjects who had ischemic stroke and SARS-CoV-2 infection. The average age was 67.4 years, being mostly men (58%). An important finding was the number of stroke cases with large vessel occlusion, with 22 of 31 cases reported (71%). The NIHSS median was 14.5 points, and 27.5% of subjects with stroke and COVID-19 died. The most frequent disease severity for COVID-19 was "severe", accounting for 58% of the cases. The onset of stroke after SARS-CoV-2 infection was 10.6 days on average. In the laboratories an elevation of fibrinogen (92%), D-Dimer (76%) and LDH (82%) were respectively identified. The most frequent treatment received for stroke were antiplatelet medications (51%), while reperfusion therapy was done in 30% of cases. Most patients presented to the hospital with typical symptoms of COVID-19 (93%), (7%) 3 patients did not have respiratory symptoms, however they presented with a decreased level of consciousness associated with stroke findings. CONCLUSION: Inflammation and hypercoagulability, both present during the infection by SARS-CoV-2, are probably related to the development of a stroke, which in this case could explain the large number of large vessel occlusions. Protected stroke code is a protocol that should be implemented in our region.

Sternoclavicular joint involvement in rheumatoid arthritis: clinical and ultrasound findings of a neglected joint.

OBJECTIVE: To describe the prevalence of sternoclavicular (SC) joint involvement and the relationship between clinical and ultrasound (US) findings in patients with rheumatoid arthritis (RA). METHODS: One hundred three consecutive patients with RA and 103 age- and sex-matched healthy individuals were enrolled. Clinical evaluation and blinded US examinations of the SC joint were performed bilaterally in both groups. The presence of gray-scale synovitis, osteophytes, erosions, and intraarticular power Doppler (PD) was recorded. Interobserver agreement was calculated. RESULTS: A total of 412 SC joints were evaluated: 206 from patients with RA and 206 from healthy controls. In the RA group, 39 joints (19%) were found to be clinically involved (pain/swelling), in contrast to only 4 (1.9%) in the control group (P = 0.0001). In the RA group, US abnormalities were recorded in 89 SC joints (43%) compared with 36 (17%) in the healthy control group (P = 0.0001), comprising osteophytes in 59 (29%) versus 25 (12%; P = 0.0001), synovitis in 31 (15%) versus 5 (2%; P = 0.0001), erosions in 23 (11%) versus none (P = 0.0001), and intraarticular PD in 5 (2%) versus none (P = 0.03). Furthermore, a correlation between the presence of US synovitis (P < 0.001) and intraarticular PD (P < 0.0001) with a higher Disease Activity Score in 28 joints (DAS28) was found. CONCLUSION: In patients with RA, US detected a higher number of involved SC joints than with clinical assessment. Our results indicate that both gray-scale and PD US findings were more prevalent in patients with RA than in healthy controls. US synovitis and synovial hyperperfusion correlated with the DAS28, suggesting that SC joints actively participate in the systemic inflammatory process of RA.

Radiographic imaging in osteomyelitis: the role of plain radiography, computed tomography, ultrasonography, magnetic resonance imaging, and scintigraphy.

The diagnostic imaging of osteomyelitis can require the combination of diverse imaging techniques for an accurate diagnosis. Conventional radiography should always be the first imaging modality to start with, as it provides an overview of the anatomy and the pathologic conditions of the bone and soft tissues of the region of interest. Sonography is most useful in the diagnosis of fluid collections, periosteal involvement, and surrounding soft tissue abnormalities and may provide guidance for diagnostic or therapeutic aspiration, drainage, or tissue biopsy. Computed tomography scan can be a useful method to detect early osseous erosion and to document the presence of sequestrum, foreign body, or gas formation but generally is less sensitive than other modalities for the detection of bone infection. Magnetic resonance imaging is the most sensitive and most specific imaging modality for the detection of osteomyelitis and provides superb anatomic detail and more accurate information of the extent of the infectious process and soft tissues involved. Nuclear medicine imaging is particularly useful in identifying multifocal osseous involvement.

Corporalidad en el contexto de la psicoterapia / Understanding Corporality from the Context of Psychotherapy

El siguiente artículo presenta una reflexión teórica acerca del concepto de corporalidad y su relación con la psicoterapia, la cual está basada en resultados parciales de la investigación bibliográfica analítica proyecto insertado en la línea de investSigación Psicología Clínica y de la Salud, del Departamento de Psicología de la Universidad del Norte, Colombia. Se analiza la concepción y el uso del cuerpo en la Psicología, especialmente en psicoterapia, entendiéndolo como puerta de acceso experiencial y consciente a los afectos. Se concluye que las sensaciones corporales siempre implican una conexión directa con un afecto, lo cual hace que, si se atiende a la experiencia inmediata corporalmente sentida, se tenga mayor probabilidad de acceder al conocimiento consciente de las propias intenciones, afectos, decisiones y valoraciones.

This article presents a theoretical reflection about the concept of corporality and its relationship to psychotherapy, which is based on partial results of the analytical bibliographical research Corporality in the Context of Psychotherapy. This research was developed as a project of the research line Clinical and Health Psychology of the Psychology Department of Universidad del Norte, Colombia. The conception and function of the human body in psychology are analyzed, especially in psychotherapy. The human body is understood as the initial point from which we could have experiential and conscious access to affects. It is concluded that corporeal sensations always implied a direct connection to a specific affect. This idea means that if human beings attend to the immediate experience that is felt corporally, they will have more possibilities to access to conscious and experiential knowledge about their intentions, affects, decisions, and the valuing process.

Esquemas maladaptativos tempranos en pacientes diagnosticados con cáncer atendidos en tres centros oncológicos de la ciudad de Santa Marta (Colombia): Early maladaptive schemas in patients diagnosed with cancer, assisted in three oncological centres from the city of Santa Marta (Colombia)

El estudio se enmarca en el área de la psicología de la salud, desde un enfoque cognitivo, realizado con el objetivo de describir y establecer la prevalencia de Esquemas Maladaptativos Tempranos (EMTs) en pacientes diagnosticados con cáncer, que reciben tratamiento en tres centros de atención oncológica del distrito de Santa Marta, Magdalena (Colombia). El tipo de investigación es descriptivo, con un diseño transeccional, que utilizó un tipo de muestreo no probabilístico intencional, seleccionando a las 80 personas diagnosticadas con cáncer, mayores de 39 años de edad. Se aplicó el Cuestionario de Esquemas de Young, YSQ — L2, validado en población universitaria de la ciudad de Medellín (Colombia), por D. Castrillón, L. Chaves, A. Ferrer, N.H. Londoño, M. Schnitter, K. Maestre & C. Marín. Los resultados muestran como esquema maladaptativo temprano prevaleciente el de autosacrificio, y se encontró similitud con los hallados en estudios realizados en otros contextos (Moris & Greer, 1980; Eysenck, 1985; Contrada, Leventhal & O' Leary, 1990, Watson, 1998 citados en Ibáñez, 1991), que asocian los patrones cognitivos y emocionales que componen el esquema maladaptativo de autosacrificio con la evidencia teórica y/o científica que lo asocian con el llamado estilo de vida carcinógeno.

The study is part of the area of health psychology, from a cognitive approach, conducted with the objective of describing and establishing the prevalence of maladaptive Early Drawings (EMTs) in patients diagnosed with cancer, treated at three centers Oncology Care District of Santa Marta (Magdalena), COLOMBIA. This is a descriptive research with a design transectional Description, which used a type of intentional non-probability sampling because it was not possible to know the people, by choosing as subject to the 80 people diagnosed with cancer over 39 years of age, attending the Oncology Unit of the Caribbean Oftalmológica Foundation (FOCA), cancer specialist at the Center of the Caribbean (CECAC) and Blood Clinic - Oncology (CEMED Magdalena). We used the Young Schema Questionnaire, YSQ - L2, validated university population in the city of Medellin - Colombia, conducted by D. Castrillón, L. Chaves, A. Ferrer, N.H. Londoño, M. Schnitter, K. Maestre & C. Marín. The results show as the prevailing early maladaptive pattern of self, being similar to those found in studies in other contexts (Moris and Greer, 1980, Eysenck, 1985; Contrada, Leventhal & O 'Leary, 1990, Watson, 1998 cited in Ibanez , 1991), which combine cognitive and emotional patterns that make up the maladaptive pattern of self-evidence with theoretical and/ or scientific associate it with the so-called lifestyle carcinogen.