A Study to Assess the Prevalence of Selfitis Among Undergraduate I Year Students of Selected Arts and Commerce Colleges of Bhopal City, Madhya Pradesh

Selfies are exploding social media all over the world. The number of self-portrait photos posted online has grown rapidly as a function of the simultaneous growth of social networking and smart phone use. It has triggered a number of risk taking and offensive public behaviour, pushing the boundaries of safety and decorum. Hence, the following study was undertaken to assess the prevalence of Selfitis in the upcoming generation of today's world, whose life mostly revolves around social media and friends. To assess the prevalence of Selfitis among undergraduate I year students. To associate the prevalence of Selfitis among undergraduate I year students with selected socio-demographic variables. Non-experimental univariate descriptive survey approach was used to determine the prevalence of Selfitis among undergraduate I year students of Arts and Commerce Colleges (n=200). Selection of the institution was done by non-probability convenient sampling technique and undergraduate I year students were selected by non-probability purposive sampling technique from Bhopal city, Madhya Pradesh. The modified Selfitis Behaviour Scale developed by Janarthanan Balakrishnan and Mark D. Griffiths was used for data collection. The findings revealed that the overall prevalence of Selfitis was 97.5% (195) and 2.5% (5) of individuals did not have Selfitis and prevalence of acute Selfitis was higher i.e. 76.92% (150) and that of chronic Selfitis and borderline Selfitis was 11.28% (22) and 11.8% (23) respectively. The mean and standard percentage of the score was 49.3850 and 15.05357 respectively. The prevalence of Selfitis was higher in males (52.82%) as compared to females (47.18%). Hence, it is evident that there is significant prevalence of Selfitis among undergraduate I year students. Except gender none of the socio-demographic variables influenced the prevalence of Selfitis. The craze of selfies is turning out to be very harmful for adolescents because it is at this age that identity of an individual develops and if these unreal standards of appearance are bombarded on the young mind, it will have a catastrophic effect on the whole generation.

Changing hygiene behaviours: a cluster-randomized trial, Ethiopia

Objective To investigate vaccine hesitancy leading to underimmunization and a measles outbreak in Rwanda and to develop a conceptual, community-level model of behavioural factors. Methods Local immunization systems in two Rwandan communities (one recently experienced a measles outbreak) were explored using systems thinking, human-centred design and behavioural frameworks. Data were collected between 2018 and 2020 from: discussions with 11 vaccination service providers (i.e. hospital and health centre staff); interviews with 161 children's caregivers at health centres; and nine validation interviews with health centre staff. Factors influencing vaccine hesitancy were categorized using the 3Cs framework: confidence, complacency and convenience. A conceptual model of vaccine hesitancy mechanisms with feedback loops was developed. Findings: A comparison of service providers' and caregivers' perspectives in both rural and peri-urban settings showed that similar factors strengthened vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community. Factors identified as increasing vaccine hesitancy (e.g. service accessibility and inadequate follow-up) differed between service providers and caregivers and between settings. The conceptual model could be used to explain drivers of the recent measles outbreak and to guide interventions designed to increase vaccine uptake. Conclusion :The application of behavioural frameworks and systems thinking revealed vaccine hesitancy mechanisms in Rwandan communities that demonstrate the interrelationship between immunization services and caregivers' vaccination behaviour. Confidence-building social structures and context-dependent challenges that affect vaccine uptake were also identified.

Objectif Déterminer si une intervention au niveau de l'eau, de l'assainissement et de l'hygiène pourrait avoir une influence sur les comportements en la matière, considérés comme importants dans la lutte contre le trachome. Méthodes Nous avons mené un essai randomisé par grappes dans les régions rurales d'Éthiopie entre le 9 novembre 2015 et le 5 mars 2019. Nous avons réparti aléatoirement 20 échantillons où l'intervention consistait à développer les infrastructures d'assainissement et d'approvisionnement en eau et à promouvoir l'hygiène, et 20 échantillons n'ayant fait l'objet d'aucune intervention. Tous les échantillons du groupe d'intervention ont suivi une formation sur l'hygiène à l'école primaire, disposaient d'un point d'eau communautaire, d'un poste de lavage par ménage, de savon à domicile, et recevaient des visites de la part de travailleurs chargés d'enseigner les bonnes pratiques en matière d'hygiène. Nous avons évalué le niveau d'observance des mesures en effectuant des enquêtes annuelles au sein des foyers. Résultats En l'espace de 3 ans, le nombre de postes de lavage, de savons et de latrines dans les ménages a davantage augmenté dans le groupe d'intervention que dans le groupe de contrôle: la différence de risque s'élevait à 47 points de pourcentage (intervalle de confiance de 95%, IC: 41­53) pour les postes de lavage, à 18 points de pourcentage (IC de 95%: 12­24) pour le savon et à 12 points de pourcentage (IC de 95%: 5­19) pour les latrines. La proportion de gens déclarant se laver le visage au savon était plus grande dans le groupe d'intervention (différence de risque de 21 points de pourcentage; IC de 95%: 15­27 pour les enfants de 0 à 5 ans), tout comme celle mentionnant l'usage de latrines (différence de risque de 9 points de pourcentage; IC de 95%: 2­15 pour les enfants de 6 à 9 ans). Pour de multiples indicateurs, il a fallu attendre minimum un an après l'instauration du programme pour que les variations observées entre les groupes d'intervention et de contrôle deviennent statistiquement significatives; ces variations se sont ensuite maintenues lors des visites ultérieures. Conclusion Intervenir à l'école et au sein de la communauté a permis d'améliorer l'accès à l'hygiène et les comportements en la matière. Néanmoins, cette évolution prend du temps et plusieurs années d'intervention sont nécessaires.

El lóbulo de la ínsula: Parte 2 - Anatomía microquirúrgica y correlación clínico-quirúrgica / The lobe of the insula: Part 2 - Microsurgical anatomy and clinical-surgical correlation

Introducción: El conocimiento profundo de la anatomía microquirúrgica del lóbulo de la ínsula es crucial para operar pacientes con tumores en esta región. Objetivo: El objetivo de la segunda parte de este estudio es correlacionar la anatomía microquirúrgica con casos ilustrativos retirados de nuestra casuística de 35 pacientes en los cuales fueron realizados 44 cirugías de tumores en relación con el lóbulo de la ínsula. Material y Métodos: A lo largo de marzo de 2007 y agosto de 2014, 44 microcirugías fueron realizadas en 35 pacientes portadores de tumores insulares y los hallazgos de las cirugías y mapeo cerebral se correlacionaron con la anatomía microquirúrgica. Resultados: De una serie de 44 pacientes con tumores de la ínsula, la mayoría de los casos eran gliomas de bajo grado de malignidad (29 casos). El inicio de los síntomas en 34 pacientes fue epilepsia, siendo esta refractaria al tratamiento medicamentoso en 12 casos. El grado de resección fue subtotal o total en la mayoría de los casos de la serie. La mejoría en la calidad de vida (epilepsia, etc.) estuvo presente en más de la mitad de los pacientes. El déficit neurológico permanente estuvo presente en tres pacientes. Conclusión: En los tumores insulares, es tan importante el conocimiento profundo de la anatomía, como el saber utilizar e interpretar en tiempo real las observaciones de la monitorización neurofisiológica intraoperatoria.

Introduction: The deep knowledge of the microsurgical anatomy of the insular lobe is crucial to operate patients with tumors in this region. Objectives: Our purpose in this second part is to correlate insular surgical anatomy with illustrative cases from 4 surgeries performed on 35 patients with insular tumors. Materials and Methods: From March 2007 to August 2014, 44 microsurgeries were performed on 35 patients with insular glioma tumors. Of these, 29 cases were low-grade gliomas. Seizures were the first symptom in most cases. Total, or near total tumor resection was achieved in most of the patients. Improvement in quality of life was achieved in more than half of the patients after surgery. Moderate and permanent neurological deficits were present in 3 patients. Results: The majority of cases were low grade malignancy gliomas (29 cases). The onset of symptoms in 34 patients was epilepsy, being refractory to drug treatment in 12 cases. The degree of resection was subtotal or total in most cases of this series. The improvement in the quality of life (epilepsy, etc.) was present in more than half of the patients. Permanent neurological deficit was present in three patients. Conclusion: For insular tumors, microsurgical anatomy knowledge is as important as cortical and subcortical mapping

Parte I: Anatomía microquirúrgica tridimensional de la ínsula / Part I: Three-dimensional microsurgical anatomy of the insula

Introducción: El lóbulo de la ínsula, o ínsula, se encuentra oculto en la superficie lateral del cerebro. La ínsula está localizada profundamente en el surco lateral o cisura silviana, recubierta por los opérculos frontal, parietal y temporal. Objetivo: Estudiar la compleja anatomía del lóbulo de la ínsula, una de las regiones de mayor complejidad quirúrgica del cerebro humano, y su correlación anatómica con casos quirúrgicos. Material y Métodos: En la primera parte de este estudio presentamos los resultados de nuestras disecciones microquirúrgicas en fotografías 2 D y 3D; en la segunda parte de nuestro trabajo, la correlación anatómica con una serie de 44 cirugías en pacientes con tumores de la ínsula, principalmente gliomas, operados entre 2007 y 2014. Resultados: Extenso conjunto de fibras subcorticales, incluyendo el fascículo uncinado, fronto-occipital inferior y el fascículo arcuato, conectan la ínsula a las regiones vecinas. Varias estructuras anatómicas responsables por déficits neurológicos severos están íntimamente relacionadas con la cirugía de la ínsula, tales como lesiones de la arteria cerebral media, cápsula interna, áreas del lenguaje en el hemisferio dominante y arterias lenticuloestriadas. Conclusión: El entrenamiento en laboratorio de neuroanatomía, estudio de material impreso en 3D, el conocimiento sobre neurofisiología intra-operatoria y el uso de armamento neuroquirúrgico moderno son factores que influencian en los resultados quirúrgicos

Introduction: The insular lobe, or insula, is the cerebral lobe sitting deep in the sylvian fissure and hidden by the lateral surface of the brain. It is covered by the frontal, parietal and temporal operculum. Objectives: To study the anatomy of the insular lobe, one of the most complex parts of the human brain, and to correlate this anatomy with intraoperative findings. Materials and Methods: In the first part of this article we show the results of our dissections, documented in 2D and 3D, and focus on microsurgical anatomy. In the second part we correlate the anatomical structures with intraoperative findings from 44 insular tumor surgeries, mainly gliomas, of patients operated on from 2007 to 2014. Results: Huge bundles of subcortical fibers, like uncinate, inferior fronto-occipital and arcuate fascicles, connect the insula to the neighboring structures. Several anatomical structures related to neurological disabilities are closely related to insular surgery, like the middle cerebral artery, internal capsule, lenticulostriate arteries and cortical and subcortical language circuits. Conclusions: Microsurgical laboratory training, 3D documentation, knowledge of brain mapping and modern neurosurgical armamentarium are important factors in achieving good results with insular glioma tumors.

Evaluation of Urinary Sphincter Function by Rapid Magnetic Resonance Diffusion Tensor Imaging / 대한배뇨장애요실금학회지

Purpose@#This study aimed to assess the feasibility of a rapid diffusion tensor imaging (DTI) for evaluation of the female urinary sphincter function based on differentiation between rest and muscle contraction. @*Methods@#Magnetic resonance imaging (MRI) of the lower pelvis was performed at 3 Tesla in 10 healthy female volunteers (21–36 years; body mass index, 20.8±3.6 kg/m2) between June and July 2019. High-resolution T1- and T2-weighted images were acquired for anatomical reference, and following DTI performed in 4 experiment phases: twice during rest (denoted rest-1, rest-2) and contraction (contraction-1, contraction-2). Manual segmentation of the urinary sphincter and the levator ani muscles were performed by 2 independent readers. Mean diffusivity (MD) and fractional anisotropy (FA) values derived from DTI volumes were compared in search for significant differences between the experiment phases. Interreader agreement was assessed by intraclass correlation coefficient (ICC). @*Results@#Kruskal-Wallis test showed significant differences between MD values among all the experiment phases, by both independent readers (1st: X2 [3,76]=17.16, P<0.001 and 2nd: X2 [3,76]=15.88, P<0.01). Post hoc analysis revealed differences in MD values by both readers between: rest-1 vs. contraction-1 (least P<0.05), rest-1 vs. contraction-2 (P<0.01), rest-2 vs. contraction-1 (P<0.03), rest-2 vs. contraction-2 (P=0.02) with overall mean ‘rest’ to ‘contraction’ ΔMD=20.6%. No MD or FA differences were found between rest-1 vs. rest-2 and contraction-1 vs. contraction-2 among all the experiment phases, and interreader agreement was ICC=0.85 (MD) and ICC=0.79 (FA). @*Conclusions@#Rapid DTI might prospectively act as a supporting tool for the evaluation of female pelvic floor muscle function, and incontinence assessment.

Evaluation of Urinary Sphincter Function by Rapid Magnetic Resonance Diffusion Tensor Imaging / 대한배뇨장애요실금학회지

Purpose@#This study aimed to assess the feasibility of a rapid diffusion tensor imaging (DTI) for evaluation of the female urinary sphincter function based on differentiation between rest and muscle contraction. @*Methods@#Magnetic resonance imaging (MRI) of the lower pelvis was performed at 3 Tesla in 10 healthy female volunteers (21–36 years; body mass index, 20.8±3.6 kg/m2) between June and July 2019. High-resolution T1- and T2-weighted images were acquired for anatomical reference, and following DTI performed in 4 experiment phases: twice during rest (denoted rest-1, rest-2) and contraction (contraction-1, contraction-2). Manual segmentation of the urinary sphincter and the levator ani muscles were performed by 2 independent readers. Mean diffusivity (MD) and fractional anisotropy (FA) values derived from DTI volumes were compared in search for significant differences between the experiment phases. Interreader agreement was assessed by intraclass correlation coefficient (ICC). @*Results@#Kruskal-Wallis test showed significant differences between MD values among all the experiment phases, by both independent readers (1st: X2 [3,76]=17.16, P<0.001 and 2nd: X2 [3,76]=15.88, P<0.01). Post hoc analysis revealed differences in MD values by both readers between: rest-1 vs. contraction-1 (least P<0.05), rest-1 vs. contraction-2 (P<0.01), rest-2 vs. contraction-1 (P<0.03), rest-2 vs. contraction-2 (P=0.02) with overall mean ‘rest’ to ‘contraction’ ΔMD=20.6%. No MD or FA differences were found between rest-1 vs. rest-2 and contraction-1 vs. contraction-2 among all the experiment phases, and interreader agreement was ICC=0.85 (MD) and ICC=0.79 (FA). @*Conclusions@#Rapid DTI might prospectively act as a supporting tool for the evaluation of female pelvic floor muscle function, and incontinence assessment.

Electronic health records and outpatient cardiovascular disease care delivery: Insights from the American College of Cardiology’s PINNACLE India Quality Improvement Program (PIQIP)

Background There has been a push toward implementation of electronic health records (EHRs) in federally-funded hospitals under the current policies initiated by the Indian government, with a lack of evidence supporting their adoption. We analyzed data from the American College of Cardiology’s PINNACLE (Practice Innovation and Clinical Excellence) India Quality Improvement Program (PIQIP) to evaluate the association between EHR use and quality of cardiovascular disease care in India. Methods and Results Between 2011–2016, we collected data on performance measures for patients with coronary artery disease (CAD), heart failure (HF) and atrial fibrillation (AF) among 17 participating practices in PIQIP. There were 19,035 patients with CAD, 9,373 patients with HF, and 1,127 patients with AF. Documentation of co-morbidity burden in patients with CAD was lower among practices with EHR—hypertension (49.8% vs. 52.1%, p = 0.003), diabetes (34.9% vs. 38.3%, p < 0.001), and hyperlipidemia (0.2 vs. 3.9%, p < 0.001). On the contrary, documentation of medication prescription was higher in CAD patients seen at practices with EHR—aspirin (63.2% vs. 17.8%, p < 0.001), clopidogrel (41.7% vs. 27.4%, p < 0.001), beta-blockers (61.4% vs. 9.8%, p < 0.001), and ACE-i or ARBs (53.9% vs. 16.4%, p < 0.001). Similarly, documentation of receipt of beta-blockers (43.8% vs. 10.7%, p < 0.001), ACE-i or ARBs (40.8% vs. 16.1%, p < 0.001), and beta-blockers + ACE-i or ARBs (36.4% vs. 3.6%, p < 0.001) was also significantly higher in patients with HF seen at practices with EHR. Among patients with AF, documentation of oral anticoagulation use was significantly higher among EHR practices—warfarin (42.5% vs. 26.1%, p < 0.001). Conclusions Documentation of receipt of guideline-directed medical therapy in CAD, HF, and AF was significantly higher in practices with EHRs in India compared with sites without EHRs. Our findings shed a spotlight on the value of EHRs in future health care policy-making in India with regard to widespread adoption of EHRs in primary and advanced specialty care settings across public and private sectors.

Lymphomatoid granulomatosis: A case series from South India

Context: Lymphomatoid granulomatosis (LYG) is a rare B-lymphoproliferative disorder characterised by an angiocentric and angiodestructive pattern along with Epstein - Barr virus (EBV) association. It is one of the diagnostic challenges in lymphoma pathology. Deregulation of EBV immune surveillance is one of the narrated hypotheses in the literature. Extrapulmonary manifestations are rare with LYG. Morphological grading is done based on the number of EBV-positive B cells, which is useful to strategize treatment protocol. Aims: We report here a series of nine cases of LYG to discuss the clinical, histological, and immunohistochemistry findings. Settings and Design: This is the first case series from India in published literature. Subjects and Methods: We reviewed cases of LYG diagnosed at our center for the past 11 years (2006-2016). A total of nine cases were included in this study. Histomorphology was studied in conjunction with immunohistochemistry and clinical details. Cases without classical morphology and negative for EBV immunostain were excluded from the study. Results: There were nine patients in our study (7 males and 2 female; M:F ratio 3.5:1). The age of these patients ranged from 4 years to 57 years (mean age: 30 years). The most common site involved was the lung (4, 44%), followed by the skin (2, 22%), central nervous system (2, 22%) and lymph node (1, 11%). One patient had primary immunodeficiency. Another patient had undergone renal transplant 11 years before the development of the lesion. Angiocentricity and angioinvasion were appreciated in all nine cases (9/9) with necrosis in four cases (44%) and ill-defined histiocytic aggregates in three cases (33%). The histological features were as follows: Grade 1(4 cases, 44%), Grade 2(2 cases, 22%), and Grade 3(3 cases, 33%). Conclusion: LYG is a rare EBV driven angiodestructive disease with predominantly lung involvement as well as isolated extrapulmonary sites as seen in our study. It is often progressive and ultimately fatal in the absence of appropriate treatment. Grading of the lesion helps to initiate the appropriate treatment of choice.

Diffusion tensor imaging of brain white matter in Huntington gene mutation individuals / Imagem por tensor de difusão em indivíduos com mutação do gene da doença de Huntington

ABSTRACT Objective To evaluate the role of the involvement of white matter tracts in huntingtin gene mutation patients as a potential biomarker of the progression of the disease. Methods We evaluated 34 participants (11 symptomatic huntingtin gene mutation, 12 presymptomatic huntingtin gene mutation, and 11 controls). We performed brain magnetic resonance imaging to assess white matter integrity using diffusion tensor imaging, with measurement of fractional anisotropy. Results We observed a significant decrease of fractional anisotropy in the cortical spinal tracts, corona radiate, corpus callosum, external capsule, thalamic radiations, superior and inferior longitudinal fasciculus, and inferior frontal-occipital fasciculus in the Huntington disease group compared to the control and presymptomatic groups. Reduction of fractional anisotropy is indicative of a degenerative process and axonal loss. There was no statistically significant difference between the presymptomatic and control groups. Conclusion White matter integrity is affected in huntingtin gene mutation symptomatic individuals, but other studies with larger samples are required to assess its usefulness in the progression of the neurodegenerative process.

RESUMO Objetivo Avaliar o envolvimento da substância branca (SB) cerebral em indivíduos com mutação do gene da huntingtina. Métodos Foram avaliados 34 indivíduos: 11 com mutação do gene da huntingtina sintomática, 12 assintomáticos com mutação do gene da huntingtina e 11 indivíduos controles. Realizamos ressonância magnética cerebral para avaliar a integridade da SB usando o tensor de difusão (DTI), com medição da anisotrofia fracionada (FA). Resultados Observamos uma diminuição da FA no trato corticoespinhal, coroa radiada, corpo caloso (joelho, corpo e esplênio), cápsula externa, radiações talâmicas, fascículo longitudinal superior e inferior, e fascículo frontal-occipital inferior no grupo dos indivíduos com mutação sintomática. A redução da FA é indicativa de processo degenerativo e perda axonal. Não houve diferença estatística entre os grupos controle e pré-sintomático. Conclusão Houve comprometimento da integridade da SB em indivíduos com mutação no gene da Huntingtina sintomática, mas outros estudos são necessários para avaliar a sua utilidade na progressão do processo neurodegenerativo.

Identification of a type I nitroreductase gene in non-virulent Trypanosoma rangeli

ABSTRACT Trypanosomatid type I nitroreductases (NTRs), i.e., mitochondrial enzymes that metabolise nitroaromatic pro-drugs, are essential for parasite growth, infection, and survival. Here, a type I NTR of non-virulent protozoan Trypanosoma rangeli is described and compared to those of other trypanosomatids. The NTR gene was isolated from KP1(+) and KP1(-) strains, and its corresponding transcript and 5' untranslated region (5'UTR) were determined. Bioinformatics analyses and nitro-drug activation assays were also performed. The results indicated that the type I NTR gene is present in both KP1(-) and KP1(+) strains, with 98% identity. However, the predicted subcellular localisation of the protein differed among the strains (predicted as mitochondrial in the KP1(+) strain). Comparisons of the domains and 3D structures of the NTRs with those of orthologs demonstrated that the nitroreductase domain of T. rangeli NTR is conserved across all the strains, including the residues involved in the interaction with the FMN cofactor and in the tertiary structure characteristics of this oxidoreductase protein family. mRNA processing and expression were also observed. In addition, T. rangeli was shown to be sensitive to benznidazole and nifurtimox in a concentration-dependent manner. In summary, T. rangeli appears to have a newly discovered functional type I NTR.

Possible local anesthetic resistance in Emery–Dreifuss muscular dystrophy during regional anesthesia / 대한마취과학회지

No abstract available.

In vivo measurement and characterization of a novel formulation of [[177]Lu]-DOTA-octreotate

Objective[s]: Lutetium-177 can be made with high specific activity and with no other isotopes of lutetium present, referred to as "No Carrier Added" [NCA] [177]Lu. We have radiolabelled DOTA-conjugated peptide DOTA-[Tyr[3]]-octreotate with NCA 177Lu ["NCA-LuTATE"] and used it in nearly 40 therapeutic administrations for subjects with neuroendocrine tumours or meningiomas. In this paper, we report on our initial studies on aspects of the biodistribution and dosimetry of NCA-LuTATE from gamma camera 2D whole body [WB] and quantitative 3D SPECT [qSPECT] [177]Lu imaging

Methods: Thirteen patients received 39 NCA-LuTATE injections. Extensive WB planar and qSPECT imaging was acquired at approximately 0.5, 4, 24 and 96 h to permit estimates of clearance and radiation dose estimation using MIRD-based methodology [OLINDA-EXM]

Results: The average amount of NCA-Lutate administered per cycle was 7839 +/- 520 MBq. Bi-exponential modelling of whole body clearance showed half lives for the fast and slow components of t[1/2]=2.1 +/- 0.6 h and t[1/2]=58.1 +/- 6.6 h respectively. The average effective dose to kidneys was 3.1 +/- 1.0 Gy per cycle. In eight patients completing all treatment cycles the average total dose to kidneys was 11.7 +/- 3.6 Gy

Conclusions: We have shown that NCA-LuTATE has an acceptable radiation safety profile and is a suitable alternative to Carrier-Added [177]Lu formulations. The fast component of the radiopharmaceutical clearance was closely correlated with baseline renal glomerular filtration rate, and this had an impact on radiation dose to the kidneys. In addition, it has less radioactive waste issues and requires less peptide per treatment

Multicultural Evidence-Based Assessment Using the Achenbach System Of Empirically Based Assessment (ASEBA) For Ages ½-90+ / Evaluación multicultural Basada en evidencia usando el achenbach system of empirically based assessment (ASEBA) para edades ½ - 90+

Evidence-based assessment is a prerequisite for evidence-based mental health services. This article reviews the development, components, and multicultural applications of the Achenbach System of Empirically Based Assessment (ASEBA). The ASEBA includes standardized forms for obtaining self-and collateral-reports of evidence for behavioral, emotional, social, and thought problems and strengths. The problems are scored on empirically based syndromes and DSM-oriented scales. The syndromes have been supported by confirmatory factor analyses of ASEBA data from 54 societies. The strengths are scored on competence, adaptive functioning, and personal strengths scales. Translations of ASEBA forms are available in more than 100 languages. Reports of the ASEBA's use have been published for more than 100 societies and cultural groups. Multicultural norms incorporate data from population samples in 54 societies. ASEBA software enables users to systematically compare data from self- and informant-reports regarding the person being assessed. The Multicultural Family Assessment Module (MFAM) compares scores for children and their parents in relation to norms for age, gender, the type of informant, and user-selected societies. Standardized multicultural evidence-based assessment facilitates communication and collaboration between mental health providers and researchers around the world.

Geometric morphometric analysis of cyclical body shape changes in color pattern variants of Cichla temensis Humboldt, 1821 (Perciformes: Cichlidae) demonstrates reproductive energy allocation

Previously recognized color and pattern variants of adult Cichla temensis in Amazon flood pulse river environments reflect the cycling of individuals through seasonal sexual maturity and spawning. Individuals also vary in shape from blocky to fusiform. To determine if shape differences are related to patterns of fat reserve deposition and utilization, and to quantify the relationship of shape with color and pattern variation and life history status, specimens in each of four previously defined grades of color and pattern variation were compared using geometric morphometric techniques. Progressive shape changes occurred between grades independent of sex and correlated to gonosomatic index (GSI). Thin plate spline deformation visualizations indicate that the observed shape differences are related to fat deposition patterns. The seasonal timing of shape change and its link to color pattern variation, sexual maturity and local water level conditions suggests a relationship between the physiological and behavioral characteristics of C. temensis and the cyclical flood pulse pattern of its habitat.

As variantes de cor e padrão previamente reconhecidos dos adultos de Cichla temensis em ambientes alagáveis amazônicos refletem o ciclo de indivíduos durante o período de maturidade sexual e desova. Indivíduos também variam na forma de oblonga a fusiforme. Para determinar se as diferenças de forma estão relacionadas aos padrões de deposição e utilização das reservas de gordura e quantificar a relação da forma com cor, variação de padrão e status da história de vida, espécimes de cada quatro níveis de cor e variação de padrão previamente definidos foram comparados usando técnicas de morfometria geométrica. Mudanças progressivas ocorreram na forma entre os níveis independentes do sexo e correlacionadas ao índice gonadossomático (IGS). Visualizações de finas deformações na placa da espinha indicam que as diferentes formas observadas estão relacionadas aos padrões de deposição de gordura. O período de mudança de forma e sua ligação com a variação do padrão de cor, maturidade sexual e as condições do nível da água local sugerem uma relação entre as características fisiológicas e comportamentais de Cichla temensis e o padrão de inundação cíclico do seu habitat.

New insights into HIV epidemic in South Africa: key findings from the national HIV prevalence: incidence and behaviour burvey; 2012

This article presents key findings from the 2012 HIV prevalence; incidence and behaviour survey conducted in South Africa and explores trends in the HIV epidemic. A representative household based survey collected behavioural and biomedical data among people of all ages. Chi-squared test for association and formal trend tests (2002; 2005; 2008 and 2012) were used to test for associations and trends in the HIV epidemic across the four surveys. In 2012 a total of 38 431 respondents were interviewed from 11 079 households; 28 997 (67.5%) of 42 950 eligible individuals provided blood specimens. HIV prevalence was 12.2% [95% CI: 11.4-13.1] in 2012 with prevalence higher among females 14.4% than males 9.9%. Adults aged 25-49 years were most affected; 25.2% [95% CI: 23.2-27.3]. HIV prevalence increased from 10.6% [95%CI: 9.8-11.6] in 2008 to 12.2% [95% CI: 11.4-13.1] in 2012 (p 0.001). Antiretroviral treatment (ART) exposure doubled from 16.6% in 2008 to 31.2% in 2012 (p 0.001). HIV incidence in 2012 among persons 2 years and older was 1.07% [95% CI: 0.87-1.27]; with the highest incidence among Black African females aged 20-34 years at 4.5%. Sexual debut before 15 years was reported by 10.7% of respondents aged 15-24 years; and was significantly higher among male youth than female (16.7% vs. 5.0% respectively; p 0.001). Reporting of multiple sexual partners in the previous 12 months increased from 11.5% in 2002 to 18.3% in 2012 (p 0.001). Condom use at last sex dropped from 45.1% in 2008 to 36.2% in 2012 (p 0.001). Levels of accurate HIV knowledge about transmission and prevention were low and had decreased between 2008 and 2012 from 31.5% to 26.8%. South Africa is on the right track with scaling up ART. However; there have been worrying increases in most HIV-related risk behaviours. These findings suggest that there is a need to scale up prevention methods that integrate biomedical; behavioural; social and structural prevention interventions to reverse the tide in the fight against HIV

A Pilot Study of Target Weight Guided Treatment in Acute Heart Failure Using Ultrafiltration or Usual Care: Effect on Sodium Removal

BACKGROUND AND OBJECTIVES: In the Ultrafiltration versus Intravenous Diuretics for Patients Hospitalized for Acute Decompensated Heart Failure trial, ultrafiltration (UF) removed volume more effectively than usual care (UC). Hypothetically, UF may be superior to UC due to increased sodium (Na) removal and less neurohormonal activation. We compared UF and UC in a randomized pilot trial of target weight guided therapy for acute decompensated heart failure (ADHF). SUBJECTS AND METHODS: Sixteen patients with ADHF were enrolled and target weights established prospectively, prior to randomization to UC or UF. UF patients did not receive diuretics and UC patients were all treated with a continuous furosemide drip. All urine and ultrafiltrate were collected and Na concentrations measured. RESULTS: Similar volumes were removed in UC and UF groups (110105 mL and 107415 mL, respectively) and the UF group also produced 45325 mL of urine. Na concentration was 138+/-6 meq/L in the ultrafiltrate, 85+/-73 meq/L in the UC group's urine, and 26+/-23 meq/L in the UF group's urine. Given the relevant associated volumes, total meq of the Na removed was similar (1168 in UC vs. 1216 in UF). The UF group produced isotonic ultrafiltrate and a higher volume of dilute urine than anticipated. CONCLUSION: In a randomized pilot study of target weight guided therapy with UC or UF for ADHF, there were no differences in total volumes or Na removed, and lengths of hospital stays were similar. Isotonic fluid loss by UF was accompanied by the production of very dilute urine.

Epidural catheterization in cardiac surgery: The 2012 risk assessment.

Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI) of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552). Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.

Anesthesia for off-pump coronary artery bypass surgery.

The evolution of techniques and knowledge of beating heart surgery has led anesthesia toward the development of new procedures and innovations to promote patient safety and ensure high standards of care. Off-pump coronary artery bypass (OPCAB) surgery has shown to have some advantages compared to on-pump cardiac surgery, particularly the reduction of postoperative complications including systemic inflammation, myocardial injury, and cerebral injury. Minimally invasive surgery for single vessel OPCAB through a limited thoracotomy incision can offer the advantage of further reduction of complications. The anesthesiologist has to deal with different issues, including hemodynamic instability and myocardial ischemia during aorto-coronary bypass grafting. The anesthesiologist and surgeon should collaborate and plan the best perioperative strategy to provide optimal care and ensure a rapid and complete recovery. The use of high thoracic epidural analgesia and fast-track anesthesia offers particular benefits in beating heart surgery. The excellent analgesia, the ability to reduce myocardial oxygen consumption, and the good hemodynamic stability make high thoracic epidural analgesia an interesting technique. New scenarios are entering in cardiac anesthesia: ultra-fast-track anesthesia with extubation in the operating room and awake surgery tend to be less invasive, but can only be performed on selected patients.