Mindfulness skills and experiential avoidance as therapeutic mechanisms for treatment-resistant depression through mindfulness-based cognitive therapy and lifestyle modification.

Background/objective: The COVID-19 pandemic and consequent physical distancing has made it difficult to provide care for those with Treatment-Resistant Depression (TRD). As a secondary analysis of a clinical trial, the aim of this study was to explore potential mechanisms through which three online-delivered approaches, added to treatment as usual, improve depressive symptoms in TRD patients. Methods: The three approaches included (a) Minimal Lifestyle Intervention (MLI), (b) Mindfulness-Based Cognitive Therapy (MBCT), and (c) Lifestyle Modification Program (LMP). Sixty-six participants with TRD completed assessments pre-post intervention (mindfulness skills [FFMQ]; self-compassion [SCS]; and experiential avoidance [AAQ-II]) and pre-intervention to follow-up (depressive symptoms [BDI-II]). Data were analyzed using within-subjects regression models to test mediation. Results: Mindfulness skills mediated the effect of MBCT on depressive symptoms (ab = -4.69, 95% CI = -12.93 to-0.32), whereas the lack of experiential avoidance mediated the effect of LMP on depressive symptoms (ab = -3.22, 95% CI = -7.03 to-0.14). Conclusion: Strengthening mindfulness skills and decreasing experiential avoidance may promote recovery in patients with TRD, MBCT, and LMP have demonstrated that they may help increase mindfulness skills and decrease experiential avoidance, respectively. Future work will need to unpick the components of these interventions to help isolate active ingredients and increase optimization.

Biomarkers of sequela in adult patients convalescing from COVID-19.

Different biomarkers for SARS-CoV-2 have been linked to detection, diagnosis, treatment, disease progression, and development of new drugs and vaccines. The objective of this research was to evaluate various hematological, biochemicals, immunological, radiological and spirometric parameters in 20 adult patients convalescing from COVID-19 and their possible relationship with the clinical course of the disease. The frequencies of categorical variables were compared using the chi-square and Fisher's exact test. The levels of statistical significance were denoted in each figure legend. Two-dimensional clustering analysis was performed using MeV software from TIGR. The tests with P value of ≤ 0.05 were considered statistically significant. Most of the patients studied presented alterations in dissimilar laboratory, radiological and spirometric parameters, which were related to the clinical evolution of the disease. The results obtained show that certain hematological, biochemical, immunological and radiological parameters can be considered as biomarkers of sequela in adult COVID-19 patients, which allows their stratification, according to the degree of involvement or sequela, into three groups: I (mild degree of involvement or sequela), without lung lesions on computerized axial tomography (CT scan) and high values of IgG, C3 and hemoglobin, II (moderate degree of involvement or sequel), without lung lesions on CT scan, characterized by high levels of CD3+/CD4+ T lymphocytes and the rest of the variables with low values and III (severe degree of involvement or sequela), with lung lesions on CT scan and high values of erythrocyte sedimentation rate, monocytes and neutrophils, associated with lymphopenia and decreased concentrations of IgG and C3.

Nasopharyngeal neuroglial heterotopy - Choristoma: Case report and review of the literature.

We describe the case of a nine-month-old patient with a nasopharyngeal choristoma. The case presented includes the retrospective review of the historical, radiological, surgical and histological assessment of this pathology as well as a literature review of this entity. This case was presented in an infant with difficulty feeding, nasal obstruction and failure to thrive, evaluated with flexible nasal endoscopy, CT and MRI. The lesion was then surgically removed without complications. Nasopharyngeal choristoma is a rare congenital non-malignant mass, which may present within a range of symptoms and severity according to its size, growth and location.

Effectiveness of a healthy lifestyle promotion program as adjunctive teletherapy for treatment-resistant major depression during COVID 19 pandemic: A randomized clinical trial protocol.

INTRODUCTION: Treatment-resistant depression (TRD) has a high prevalence and can be exacerbated by poor physical health and economic hardships, which have become common stressors during the current COVID-19 pandemic. The therapeutic approaches used to treat these patients are not always available, may be not be accepted by some patients, and often require face-to-face interactions. OBJECTIVE: The main aim of this study will be to evaluate the effectiveness of an Internet-based adjuvant lifestyle-based intervention for patients with TRD. METHODS: This will be a parallel, randomized, and controlled clinical trial. A total of 180 patients with TRD will be randomly allocated (1:1:1) to 1 of 3 groups: treatment prescribed by the mental health team and written suggestions for lifestyle changes (placebo control group); treatment prescribed by the mental health team, written suggestions for lifestyle changes, and an 8-week mindfulness-based cognitive therapy program (active control group); or treatment prescribed by the mental health team, written suggestions for lifestyle changes, and an 8-week lifestyle change promotion program (intervention group). We will perform this study during the COVID-19 pandemic, and will administer interventions by teletherapy, and contact participants by telephone calls, text messages, and/or teleconferences. We will collect patient data using questionnaires administered at baseline, immediately after the intervention, and after 6 and 12 months. The primary outcome will be score on the Beck Depression Inventory-II. The secondary outcomes will be score on the Clinical Global Impressions Scale (used to quantify and track patient progress and treatment response over time) and health-related quality of life measured using the European Quality of Life-5 Dimensions Questionnaire. DISCUSSION: Patients with TRD are especially vulnerable when face-to-face psychotherapy is unavailable. The main strength of the proposed study is the novelty of the intervention to be used as an adjuvant therapy. Our results may provide guidance for treatment of patients with TRD in future situations that require lockdown measures. CLINICALTRIALS REGISTRATION NUMBER: NCT04428099.

Reporte de caso de Síndrome de Kartagener / Kartageners syndrome: a Case Report

Se presenta el caso de un paciente de 58 años con antecedentes de dextrocardia, así como de Asma Bronquial persistente de difícil control, rinitis y otros cuadros respiratorios a repetición. Después de los 20 años de edad se hicieron más frecuentes estos episodios, presentando infecciones respiratorias recurrentes, acompañadas de expulsión de sangre roja y rutilante por la boca en varias ocasiones, diagnosticándosele bronquiectasia, recibiendo tratamiento sintomático y con antibióticos frecuentemente, sin mejorar totalmente. El paciente refería, además, historia de infertilidad y dolores del tipo sacrolumbalgia a repetición, así como disminución de la audición en ambos oídos y del olfato. Acudió a consulta de Medicina Interna en agosto de 2012. En esta ocasión se le realizó una radiografía simple de tórax postero-anterior, en la que se visualizó dextrocardia, acompañada de una acentuación de la trama broncovascular bibasal, a predominio de la base derecha y cámara gástrica a la derecha. El Rx de senos paranasales evidenció engrosamiento mucoso de senos maxilares y agenesia de los frontales; se realizó electrocardiograma y ecocardiograma, confirmando la dextrocardia, así como ultrasonido abdominal, donde se observó vísceras en sentido opuesto a lo habitual. Una historia de infertilidad referida por el paciente, el antecedente de dextrocardia, los episodios de obstrucción nasal y rinitis recurrentes, los cuadros respiratorios bajos y los hallazgos imagenológicos despertaron la sospecha clínica de una discinesia ciliar primaria y, en especial, de un Síndrome de Kartagener (AU)

A case of a 58-year-old male patient with antecedents of dextrocardia, persistent bronchial asthma of difficult control, rhinitis and other respiratory symptoms is presented. After being 20 years old, these episodes became more frequent, presenting recurrent respiratory infections accompanied by red and rutilant blood discharge through the mouth several times. He was diagnosed with bronchiectasis and he received a symptomatic treatment with frequent antibiotics without a total recovery. Besides, the patient had a history of infertility and repeated sacrolumbar pain, as well as reduction of hearing from both ears and reduction of smell. The patient presented to the Internal Medicine Department in August, 2012. By that time a simple postero-anterior chest X-ray was performed and it showed a dextrocardia accompanied by increased bibasal bronchovascular markings, prevailing in the right base and a gastric chamber to the right. A paranasal sinus X-ray revealed mucosal enlargement of the maxillary sinuses and agenesis of the frontal sinuses. An electrocardiogram and an echocardiogram were performed, confirming the dextrocardia. An abdominal ultrasound showed viscera opposed to the usual way. The history of infertility, the antecedent of dextrocardia, the episodes of nasal obstruction and the recurrent rhinitis, the low respiratory symptoms and the radiological findings led to the suggestion of a primary ciliary dyskinesia and, specially, of a Kartageners syndrome (AU)

Tumores intracraneales: hallazgos tomográficos más frecuentes / Intracranial Tumors: most Frequent Tomographyc Findings

La Tomografía Axial Computarizada (TAC) es la técnica de neuroimagen más ampliamente utilizada para el diagnóstico de los tumores intracraneales. Se ha estimado que con este estudio se pueden detectar hasta el 90 por ciento de las neoplasias intracraneales. En tal sentido se realizó un estudio descriptivo, retrospectivo en 24 pacientes atendidos en el Hospital Pediátrico Provincial Octavio de la Concepción y la Pedraja de Holguín, con diagnóstico de tumores intracraneales, en el período comprendido de enero 2006 a diciembre 2011, a los cuales se les realizó TAC de cráneo, con el objetivo de describir los hallazgos tomográficos más incidentes. Se tomaron en consideración la edad, sexo, tipo histológico, hallazgos tomográficos directos e indirectos y la localización tumoral. Se encontró que los tumores intracraneales se presentaron más frecuentemente en pacientes entre los 5 y 9 años, predominando el sexo masculino. Los Astrocitomas fueron los más representados (62.5 por ciento). Como hallazgos tomográficos indirectos predominaron la dilatación ventricular (62.5 por ciento) y el efecto de masa (58.3 por ciento). El 66.6 por ciento presentó localización infratentorial intraaxial. La mayoría de las lesiones se observaron hipodensas y homogéneas. Se recomendó evaluar la correlación entre los tipos histológicos y los hallazgos imagenológicos, para su posible empleo como guías para el diagnóstico (AU)

The Computerized Tomography (CT) is the neuroimaging technique most widely used to diagnose intracranial tumors. With this study, more than 90 percent of intracranial tumors can be detected; because of that, a descriptive and retrospective study was carried out in 24 patients assisted and diagnosed with intracranial tumors at Octavio de la Concepción y la Pedraja provincial pediatric hospital from Holguín from January, 2006 to December, 2011. A cranial CT study was made to every patient with the objective to describe the most frequent tomography findings. Age, sex, histological type, direct and indirect tomographic findings and tumoral localization were taken into consideration. The intracranial tumors were more frequent between 5 and 9 years of age, mainly in males. The astrocytomas were the most represented lesions (62.5 percent). As indirect tomographic findings, the ventricular dilation (62.5 percent) and the mass effect (58.3 percent) were the most common ones. An infra tentorial and intra axial localization was present in 66.6 percent of the cases. Most of the lesions were hypo dense and homogeneous. It was recommended to evaluate the correlation between the histological types and the tomographic findings to be used as possible diagnostic guides (AU)

Los tumores de la mama: hallazgos ecográficos más frecuentes en el policlínico Gustavo Aldereguía Lima Las Tunas / Breast tumors: Most Frequent Echographic Findings in Gustavo Aldereguía Lima Policlinic in Las Tunas

Se realizó un estudio descriptivo de corte transversal de pacientes femeninas que presentaron ecografía de mamas con resultado patológico, en el policlínico Gustavo Aldereguía Lima de la ciudad de Las Tunas, en el período comprendido de enero a diciembre de 2011. El universo de estudio estuvo conformado por 277 mujeres, a las que se les realizó algún ultrasonido de las mamas, quedando constituida la muestra por 95 pacientes, que presentaron imágenes ultrasonográficas de aspecto sólido. La información se obtuvo de la revisión del libro de registros de resultados de ultrasonidos, los informes correspondientes y de las historias clínicas de salud individual. Para procesarla se utilizó la estadística descriptiva. Las lesiones benignas se comportaron en su mayoría con baja ecogenicidad, homogéneas y de contornos regulares; las malignas, como imágenes complejas de contornos irregulares. Las histologías más diagnosticadas fueron los tumores benignos y dentro de ellos los fibroadenomas. Se recomendó continuar utilizando la ecografía de las mamas como método efectivo para el estudio de las lesiones tumorales de esta glándula y como complemento de gran valor para diagnosticar precozmente las lesiones malignas de este órgano (AU)

A transversal and descriptive study was done in female patients who presented breast echography with pathologic results in Gustavo Aldereguía Lima policlinic from Las Tunas city, from January to December, 2011. The universe was made up by 277 women to whom breast echographic tests had been made, and the population sample by 95 patients with sonographic images of solid aspect. The information was obtained from the ultrasound diagnosis book, the medical reports and the past medical histories. The descriptive statistics was used to process the information. The benign lesions mainly performed with low echogenicity, homogeneity and regular contours. The malignant lesions performed as complex images of irregular contours. The benign tumors were the most frequent histology and among them, the fibroadenomas. It was recommended to continue using the breast echography as an effective method to study breast tumor lesions and as a high valuable complement to diagnose the malignant breast lesion precociously (AU)