Perfeccionismo, estrés académico y ansiedad social en mujeres estudiantes de medicina y riesgo de padecer un trastorno alimentario: un modelo multivariado / Perfectionism, academic stress and social anxiety in female medical students and the risk for eating disorders

BACKGROUND: Both perfectionism and social anxiety have been described in patients with eating disorders (ED) and medical students. Academic stress also can increase the risk of developing ED. AIM: To analyze the dimensions of perfectionism, social anxiety, and academic stress associated with the risk of developing ED in female medical students. MATERIAL AND METHODS: The Multidimensional Perfectionism Scale, the Liebowitz Social Anxiety Scale, the SISCO academic stress inventory and the Eating Attitudes Test-26, were applied to 163 female medical students from all levels of the career. The groups with and without risk of ED were compared according to these variables. Results: Twenty-four percent of respondents were at risk of ED. There were significant differences between scores of perfectionism, social anxiety, and academic stress between respondents with and without risk for ED. In general, there was a significant correlation among the variables. In a multivariate analysis, the predictors of ED risk were the perception of academic stress (Odds ratio (OR) 1.09; 95% confidence intervals (CI) 1.03-1.16) and personal standards in the context of perfectionism (OR 1.16; 95% CI 1.06-1.27). CONCLUSIONS: A substantial proportion of female medical students were at risk for ED. The risk of ED was determined mainly by academic stress and personal standards in the context of perfectionism. In this sample, social anxiety did not play a relevant role.

Macrólidos para el tratamiento de COVID-19: una revisión sistemática viva / Macrolides for the treatment of COVID-19: a living, systematic review

OBJETIVO Proporcionar un resumen oportuno, riguroso y continuamente actualizado de la evidencia disponible sobre el papel de los macrólidos para el tratamiento de pacientes con COVID-19. DIDEÑO Revisión Sistemática Viva. BASE DE DATOS: La búsqueda de evidencia se realizó en el repositorio centralizado L·OVE (Living OVerview of Evidence) COVID-19; una plataforma que mapea las preguntas PICO para identificar la evidencia en la base de datos Epistemonikos. En respuesta a la emergencia de COVID-19, L·OVE se adaptó para ampliar el rango de evidencia que cubre y hoy se mantiene a través de búsquedas regulares en 39 bases de datos. MÉTODOS: Se incluyeron estudios experimentales que evaluaban el efecto de los macrólidos, como monoterapia o en combinación con otros fármacos, versus placebo o ningún tratamiento en pacientes con sospecha o confirmación de COVID-19. Se buscó identificar experimentos clínicos aleatorizados que evaluaran macrólidos en infecciones causadas por otros coronavirus, como MERS-CoV y SARS-CoV. Dos revisores examinaron de forma independiente la elegibilidad de cada estudio, extrajeron los datos y evaluaron el riesgo de sesgo. Se evaluó el efecto de los macrólidos sobre la mortalidad por todas las causas; necesidad de ventilación mecánica invasiva; oxigenación por membrana extracorpórea, duración de la estancia hospitalaria, insuficiencia respiratoria, eventos adversos graves, tiempo hasta la negatividad de la RT-PCR del SARS-CoV-2. La certeza de la evidencia para cada desenlace se evaluó siguiendo la aproximación GRADE. Esta revisión se mantendrá viva y disponible abiertamente durante la pandemia de COVID-19. Se someterán actualizaciones de su publicación cada vez que cambien las conclusiones o cuando haya actualizaciones sustanciales. RESULTADOS: Se identificó un experimento clínico aleatorio que evaluó el uso de azitromicina en combinación con hidroxicloroquina en comparación con el uso de hidroxicloroquina sola, en pacientes hospitalizados por COVID 19. Las estimaciones para todos los resultados evaluados resultaron en un poder estadístico insuficiente para llegar a conclusiones válidas. La calidad de la evidencia para los resultados principales fue baja a muy baja. CONCLUSIONES: El uso de macrólidos en el tratamiento de pacientes con COVID 19 no ha mostrado efectos beneficiosos en comparación con el tratamiento estándar. La evidencia para todos los desenlaces no es concluyente. Se necesitan estudios sobre un mayor número de pacientes con COVID 19, para determinar los efectos del uso de macrólidos sobre los desenlaces relacionados con la enfermedad.

OBJECTIVE This living, systematic review aims to provide a timely, rigorous, and continuously updated summary of the evidence available on the role of macrolides for treating patients with COVID-19. DESIGN: a living, systematic review. DATABASE: We conducted searches in the centralized repository L·OVE (Living OVerview of Evidence). L·OVE is a platform that maps PICO questions to evidence from the Epistemonikos database. In response to the COVID-19 emergency, L·OVE was adapted to expand the range of evidence it covers and customized to group all COVID-19 evidence in one place. Today it is maintained through regular searches in 39 databases.METHODS: We included randomized trials evaluating the effect of macrolides ­ as monotherapy or in combination with other drugs ­ versus placebo or no treatment in patients with COVID-19. Randomized trials evaluating macrolides in infections caused by other coronaviruses, such as MERS-CoV and SARS-CoV, and non-randomized studies in COVID-19 were searched in case we found no direct evidence from randomized trials. Two reviewers independently screened each study for eligibility, extracted data, and assessed the risk of bias. Measures included all-cause mortality; the need for invasive mechanical ventilation; extracorporeal membrane oxygenation, length of hospital stay, respiratory failure, serious adverse events, time to SARS-CoV-2 RT-PCR negativity. We applied the GRADE approach to assess the certainty of the evidence for each outcome. A living, web-based version of this review will be openly available during the COVID-19 pandemic. We will resubmit it every time the conclusions change or whenever there are substantial updates. RESULTS: The search in the L·OVE platform retrieved 424 references. We considered 260 as potentially eligible and were reviewed in full texts. We included one randomized clinical trial that evaluated the use of azithromycin in combination with hydroxychloroquine compared to hydroxychloroquine alone in hospitalized patients with COVID 19. The estimates for all outcomes evaluated resulted in insufficient power to draw conclusions. The quality of the evidence for the main outcomes was low to very low. CONCLUSIONS: Macrolides in the management of patients with COVID 19 showed no beneficial effects compared to standard of care. The evidence for all outcomes is inconclusive. Larger trials are needed to determine the effects of macrolides on pulmonary and other outcomes in COVID-19 patients.

Rasgos de personalidad del grupo C y trastorno por déficit de atención en estudiantes de medicina: estudio transversal analítico

Background: Attentional deficit hyperactivity disorder (ADHD) in adults is associated with borderline personality characteristics or cluster B (emotional instability), but in certain populations, such as medical students, it might be associated with cluster C traits (perfectionism, dependency, anxiety). This may be compensatory to ADHD. Aim: To analyze the association between ADHD and cluster C personality traits in medical students. Material and Methods: Biodemographic characteristics, the presence of ADHD and personality traits according to clusters A, B and C were evaluated in medical students. These characteristics were compared between students with unlikely diagnosis of ADHD (Group 1) and likely or very likely diagnosis of ADHD (Group 2). Results: We included 336 participants (44% women). A likely or very likely diagnosis of ADHD was present in 64% (Group 2). Concerning personality traits, 45% exhibited traits of cluster A, 57% of cluster B, and 67% of cluster C. Compared to their counterparts of Group 1, participants in Group 2 were more likely to have a history of psychiatric/psychological care, previous diagnosis of ADHD and traits of cluster B (37 and 68% respectively) and C (55 and 74% respectively). The odds ratio of having A, B or C traits when a likely or very likely ADHD was present, were 1.29 95% confidence interval (CI) [0.8-2.07], 3.79 95% CI [2.3-6.22] and 2.4 95% CI [1.46-3.96], respectively. Conclusions: Cluster C personality traits were frequent among medical students and were significantly associated with ADHD.

Ensayos clínicos con análisis secuencial y su interrupción precoz ¿cómo interpretarlos? / How to interpret clinical trials with sequential analysis that were stopped early

El análisis secuencial de ensayos clínicos permite el monitoreo continuo de los datos emergentes para el investigador, así como una mayor seguridad para evitar someter a los participantes a una terapia inferior o fútil en términos de eficacia o seguridad, antes que esta sea evidente, mientras se controla la tasa de error general. Si bien ha sido extensamente empleado desde su desarrollo, no está exento de problemas. Entre ellos se puede mencionar el balance entre seguridad y eficacia, el sesgo condicional y la sobrestimación del tamaño del efecto de las intervenciones. En esta revisión se desarrollan distintos aspectos de esta metodología y el impacto que tiene la inclusión de ensayos clínicos precozmente interrumpidos en las revisiones sistemáticas con metanálisis.

Sequential analysis of clinical trials allows researchers a continuous monitoring of emerging data and greater security to avoid subjecting the trial participants to a less effective therapy before the inferiority is evident, while controlling the overall error rate. Although it has been widely used since its development, sequential analysis is not problem-free. Among them main issues to be mentioned are the balance between safety and efficacy, overestimation of the effect size of interventions and conditional bias. In this review, we develop different aspects of this methodology and the impact of including early-stopped clinical trials in systematic reviews with meta-analysis.

Uso de revisiones Cochrane en guías de práctica clínica desarrolladas a nivel nacional en América Latina / Use of Cochrane reviews in nationally-developed clinical practice guidelines in Latin America

INTRODUCCIÓN: Las revisiones Cochrane, reconocidas como el punto de referencia para resúmenes de alta calidad, facilitan la toma de decisiones en atención médica reuniendo toda la evidencia disponible sobre una intervención. Hasta la fecha, se desconoce su inclusión en las guías latinoamericanas. OBJETTIVO: Evaluar el uso de revisiones Cochrane en guías de práctica clínica desarrolladas a nivel nacional en América Latina. Métodos: Realizamos una búsqueda manual en sitios web oficiales del gobierno y bases de datos biomédicas entre octubre y diciembre de 2019, incluyendo guías de práctica clínica patrocinadas por los gobiernos nacionales con recomendaciones tanto para el manejo de condiciones de salud como para un estilo de vida saludable de los últimos diez años. RESULTADOS: Se incluyeron 408 guías de práctica clínica de diez países. Encontramos que 69,8% de ellas citó revisiones Cochrane en sus recomendaciones y 76,1% de ellas también las utilizó en sus recomendaciones clave. Las guías de práctica clínica que no utilizaron revisiones Cochrane cubrieron una amplia gama de temas, para los cuales se pueden encontrar varias revisiones Cochrane. Los países que utilizan el enfoque Grading of Recommendations, Assessment, Development and Evaluation (GRADE), tenían más probabilidades de utilizar las revisiones Cochrane en un porcentaje más alto de sus guías (79,4% frente a 61,8%; odds ratio: 2,3; intervalo de confianza del 95%: 1,5 a 3,7, p = 0,0001). CONCLUSIONES: Más de dos tercios de las guías de práctica clínica en América Latina utilizan revisiones Cochrane para enmarcar sus recomendaciones. Es necesario incrementar el uso de las revisiones Cochrane en la región para el desarrollo de guías de práctica clínica.

INTRODUCTION: Cochrane reviews, recognized as the benchmark for high-quality summaries, facilitates healthcare decision-making bringing together all the evidence on an intervention. To date, their inclusion in the Latin American guidelines remains unknown. OBJECTIVE: To evaluate the use of Cochrane reviews in nationally-developed clinical practice guidelines in Latin America. METHODS: We conducted a hand search in official government websites and biomedical databases between October 2019 and December 2019, including government-sponsored clinical practice guidelines with recommendations for both the management of health conditions or a healthy lifestyle of the last ten years. RESULTS: We included 408 clinical practice guidelines from ten countries. We found that 69.8% of them cited Cochrane reviews in their recommendations, and 76.1% of those also used them in their key recommendations. Clinical practice guidelines that did not use Cochrane reviews covered a wide range of topics for which several Cochrane reviews can be found. Countries using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach for grading recommendations were more likely to use Cochrane reviews in a higher percentage of their guidelines (79.4% vs. 61.8%; odds ratio: 2.3; 95% confidence interval: 1.5 to 3.7, p = 0.0001). CONCLUSIONS: Over two-thirds of clinical practice guidelines in Latin America use Cochrane reviews to frame their recommendations. It is necessary to increase the uptake of Cochrane reviews in the region for the development of clinical practice guidelines.

Sintomatologia depresiva y control metabólico en pacientes ambulatorios portadores de diabetes mellitus tipo 2 / Association between depressive symptoms and metabolic control in patients with type 2 diabetes mellitus: a cross-sectional study

Background: Patients with diabetes mellitus show a higher risk of developing depressive symptoms when compared to healthy people, hampering the management and prognosis of both diseases. However, national studies on the topic are scarce. Aim: To study the frequency and severity of depressive symptoms in patients with type 2 diabetes. Material and Methods: Beck Depression Inventory-IA and Morisky Green Levine scale were administered to diabetic patients under control at a primary care center. Pharmacological compliance was evaluated using glycosylated hemoglobin levels obtained from their clinical records. Results: We included 323 patients aged 64 ± 12 years (49% women). The frequency of depressive symptoms was 34.7%. Compared with their counterparts without depressive symptoms, patients with depression showed higher glycosylated hemoglobin levels (7.2 ± 1.7 and 6.7 ± 1.3% respectively), a higher frequency of non-compliance with treatment (63 and 43% respectively) and a higher frequency of metabolic decompensation (38 and 23% respectively). Depressive symptomatology was more common among women. Conclusions: Patients with type 2 diabetes mellitus and depressive symptoms exhibit a poorer treatment compliance and worse metabolic control as compared to their non-depressive counterparts.

Caracterización fenomenológica de las conductas repetitivas impulsivas orientadas hacia el cuerpo y el trastorno por excoriación en estudiantes universitarios / Phenomenological characterization of body-focused repetitive impulsive behaviours and excoriation disorder in college students

Resumen Introducción: Las conductas repetitivas impulsivas orientadas hacia el cuerpo (CRIOC) se caracterizan por el rascado, mordido y/o remoción de uñas, pelos y piel, pudiendo llegar a constituir un desorden mental. El trastorno por excoriación (TE) o dermatilomanía ha sido recientemente incorporado como desorden específico al DSM-5 como parte del espectro obsesivo-compulsivo. Su fenomenología describe una conducta reactiva a la ansiedad, seguida de tensión psíquica progresiva y luego placentera al realizarla, finalizando muchas veces en culpa. Se ha reportado una mayor incidencia de TE en estudiantes universitarios, sin embargo, los estudios en Latinoamérica son escasos. Objetivos: Establecer la frecuencia y las características fenomenológicas de las CRIOC y del TE en población universitaria. Métodos: Se realizó un estudio transversal mediante la aplicación de un cuestionario de autorreporte sobre aspectos relacionados con el TE en estudiantes universitarios. Resultados: 440 estudiantes fueron incluidos. Un 22,2% sintió siempre o casi siempre el impulso de rascar su piel hasta lesionarse; 13,2% ejecutó estas acciones varias veces al día y 4,3% desplegó mucho esfuerzo en resistirlas. Los afectos más frecuentemente asociados fueron culpa, vergüenza, arrepentimiento y autorreproche. Un 24,1% creyó que estos comportamientos fueron anormales y 6,1% que constituyeron una patología. Según criterios DSM-5 y establecidos por los autores, se hallaron cuatro casos compatibles con TE (0,91%), al descartar patologías psiquiátricas y médicas comórbidas. Conclusión: Aunque las CRIOC fueron frecuentes en población universitaria, la frecuencia de TE fue similar a la de la población general, describiendo una fenomenología característica congruente con la reportada por la literatura.

Introduction: Body-focused repetitive impulsive behaviors (BFRIB) are characterized by skin, nail and hair removing, scratching and/or biting, that configurate a mental disorder in some cases. Excoriation disorder (ED) or dermatillomania has been recently added as a specific disorder in DSM-5 obsessive-compulsive spectrum. Its phenomenology describes a behavior that emerges from anxiety, followed by a progressive psychic tension and then a pleasurable sensation, concluding in many times in guilt. Evidence has reported a greater incidence of ED in college students; however, studies in Latin America are scarce. Objective: To establish frequence and phenomenological features of BFRIB and ED in college students. Methods: We performed a cross-sectional study through the application of a self-administered questionnaire about ED aspects in college students. Results: 440 students were included; 22.2% felt always or almost always the impulse to scratch their skin until they were injured; 13.2% made these actions many times a day and 4.3% deployed considerable efforts in resisting them. Most frequent reported affects were guilt, shame, repentance, and self-reproach; 24.1% thought these behaviors were abnormal and 6.1% considered they constitute a pathology. According to DSM-5 and authors' criteria, four cases of ED were found (0.91%), when psychiatric and medical comorbidities were discarded. Conclusion: Although BFRIB were frequent in college students, dermatillomania frequency was similar to general population. A characteristic phenomenology was described, similar to the evidence reported one.

Cuestionario de actividades de la vida diaria (T-ADLQ): utilidad en pacientes con accidente cerebrovascular menor / Usefulness of the activities of daily living questionnaire (T-ADLQ) in patients with minor stroke

Background: The inability to carry out activities of daily living (ADL) is prevalent in elderly people and it is associated with hypertension and stroke. Aim: To evaluate ADLs using the T-ADLQ in hypertensive patients with minor stroke. Subjects and Methods: T-ADLQ, Cognitive tests (Minimental and Addenbrooke), and Hamilton depression test were applied to 100 hypertensive ambulatory patients (55 without symptomatic stroke and 45 with ischemic stroke, Rankin ≤ 2). Results: In stroke patients the ability to perform ADL was significantly reduced compared with hypertensive patients without stroke. Cognitive dysfunction and depressive symptoms were associated with a lower ADL performance. Conclusions: The T-ADLQ is useful to evaluate ADL in hypertensive ambulatory patients with ischemic stroke.

Editoriales predadoras: un cebo para investigadores novatos y expertos por igual / Predatory editors: bait for beginners and experts both

La autora realiza una revisión sobre las editoriales predadoras y su relación con los sistemas Open Access. Describe la naturaleza predadora y elabora en forma breve el concepto de "vulnerabilidad" de los autores, en particular de los autores de países en desarrollo. Finalmente, propone algunas soluciones a la problemática predadora, destacando la comunicación efectiva.

Funcionamiento psicosocial en pacientes agudos y crónicos no psiquiátricos en régimen hospitalario: depresión, alexitimia y falta de asertividad / Psychosocial functioning in non-psychiatric acute and chronic inpatients: depression, alexithymia and lack of assertiveness

Background: Depression, alexithymia, and lack of assertiveness interfere with individual psychosocial functioning and may result in longer hospitalization stay and poorer therapeutic results. Aim: To analyze the psychosocial functioning in acute and chronic patients and its association with psychological, clinical and sociodemographic variables. Material and Methods: We performed a cross-sectional study that included 80 inpatients of both sexes with organic pathology, aged between 18 to 70 years old, without any current psychiatric disorder. Clinical and sociodemographic data were collected from a semi-structured interview and hospital records. Beck Depression Inventory-IA, Toronto Alexithymia Scale-20 and Rathus Assertiveness Scale were administered. Results: Fifty five percent of patients had some degree of depression, 33% alexithymia and 34% lack of assertiveness. The levels of depression, alexithymia and lack of assertiveness in chronic patients were significantly higher than those observed in acute patients. Women and participants older than 60 years exhibited the highest degrees of depression. Alexithymia and lack of assertiveness were associated with a lower educational level. A negative significant correlation between alexithymia and assertiveness scores was observed among acute patients. Conclusions: Participants with chronic diseases had a lower psychosocial functioning. Less educated patients showed more alexithymic and less assertive features. We emphasized the need of a better management of these aspects by the health team, since social functioning might interfere with the outcome of physical illnesses.

Ten years after the FDA black box warning for antidepressant drugs: a critical narrative review

ABSTRACT Background The United States Food and Drug Administration (FDA) has warned about the increased suicidality risk associated with the use of selective serotonin reuptake inhibitors (SSRI) and venlafaxine in children and adolescents. Objectives To critically appraise the available evidence supporting the FDA Black box warning concerning to the use of antidepressants in child and adolescents. Methods A critical review of articles in Medline/PubMed and SciELO databases regarding the FDA Black box warning for antidepressants, and the impact of FDA warnings on antidepressant prescriptions and suicide rates. Results The warning was based on surveys that did not report either cases of suicide nor a significant difference supporting an increased suicidality rate. The concept was defined in an ambiguous way and there is currently more available evidence to support such definition. The use of SSRI and venlafaxine has been associated to lower suicidality rates, but the prescription fall due to the warning increased suicide rates. Discussion Suicidality is an inherent feature of depressive disorders so it would be desirable to consider how much of the phenomenon may be attributed to antidepressants per se. It would be appropriate to consider that suicide rates might increase also as a consequence of the warning.

Antipsicóticos y suicidio / Antipsychotics and suicide

La relación entre antipsicóticos y suicidio es controversial debido a las diferencias expuestas en la literatura acerca de su acción específica. Uno de los puntos de discusión ha sido el aumento de la sintomatología depresiva y el impacto de algunos efectos secundarios sobre la suicidalidad, principalmente acinesia, acatisia y disquinesia tardía. Otro elemento controvertido es el efecto paradójico producto de la aminoración de los síntomas positivos al incrementar paralelamente la instrospección. Se revisará críticamente la principal evidencia disponible en torno al uso de antipsicóticos en relación al suicidio en el contexto de trastornos psicóticos y afectivos. No existe evidencia directa que avale una disminución en las tasas de suicidio con el uso de antipsicóticos de primera generación en trastornos psicóticos, probablemente por fallas metodológicas y por la multifactorialidad del fenómeno. En relación a los de segunda generación, podrían participar como protectores frente al riesgo suicida. En los trastornos esquizofrénicos se ha considerado a la clozapina como un fármaco antisuicida, debido a una acción antidepresiva directa y un efecto indirecto mediado por un mejoramiento en las funciones cognitivas. El mayor uso de antipsicóticos en los trastornos afectivos se observa en el espectro bipolar, sin reportarse mayor efectividad en el manejo del suicidio al compararse con estabilizadores del ánimo. Es crucial identificar el mecanismo de acción específico de los antipsicóticos para evaluar su real efecto sobre la suicidalidad.

The opinions about the relationship between antipsychotics and suicide are controversial due to differences on reported evidence about their specific action. One ofthe most discussed topics is the increase of depressive symptomatology and the impact of some secondary effects on suicidality, mainly akinesia, akathisia and tardive diskynesia. Another polemical topic is the paradoxical effect due to the decrease ofpositive symptoms when increasing insight. We performed a critical review of the available literature concerning to the use of antipsychotics in relation to suicide in the context of psychotic and affective disorders. When appraising psychotic disorders, there was no direct evidence to support a reduction in suicide rates when using first-generation antipsychotics, probably due to methodological issues and multifactoriality ofthe phenomenon. Nevertheless, second-generation antipsychotics could be protective against suicide risk, specifically clozapine, which is considered as an antisuicidal drug on schizophrenic disorders due to a direct antidepressant action and an indirect effect mediated by an improvement in cognitive functions. On the other hand, when appraising affective disorders, bipolar spectrum has demonstrated the greatest use of antipsychotics drugs, showing effectiveness in the management ofsuicide not greater than mood stabilizers. It becomes essential to identify the specific mechanism of action of antipsychotic drugs to assess their real effect on suicidality.

Programa API (Apoyo Psiquiatría Infantil): Programa piloto de colaboración en Salud Mental Infanto-Juvenil en el Servicio de Salud Valparaíso-San Antonio: 12 meses de funcionamiento / Program API (Support Child Psychiatry): Mental Health adolescent collaboration pilot program in the San Antonio-Valparaíso Health Service: 12 months of operating

El Programa API (Apoyo Psiquiatría Infantil), es un sistema colaborativo multimodal (telefónico y presencial), entre nivel primario (7 Consultorios) y secundario (Hospital Salvador, Valparaíso) de salud. Se presentan los resultados del estudio descriptivo prospectivo del Programa API durante 12 meses de funcionamiento, obtenidos desde los registros de consultoría telefónica y presencial. En un periodo de 12 meses se recibieron 105 llamadas telefónicas. De estas, 87% fueron hechas por psicólogos/as. Se indicó atención conjunta en 59% y derivación a nivel secundario en 16% de los llamados. Los psicólogos de los equipos de salud mental participantes, coinciden en ser quienes dirigen y recurren más a este sistema. Se resuelven la mayoría de las dudas, a través de sugerencia de hipótesis diagnósticas y de manejo. Se concluye que los profesionales de los CESFAM les interesa el apoyo del programa, facilitando el trabajo con niños y adolescentes con problemas de salud mental. Palabras claves: programa colaborativo, salud mental, telepsiquiatría, psiquiatría infantojuvenil

The API PROGRAM (Child Psychiatry Support) is a multimodal collaborative program (giving phonecall support and face-to-face collaboration), between 7 primary healthcare centers (PHC) and secondary level healthcare centers (Hospital del Salvador, Valparaiso. The objective of this study is to describe the API Program after 12 months of implementation. This is a descriptive and prospective study with follow up calls and face to face collaboration. After 12 months, 105 phone calls were received. Of these , 87% were made by psychologists. Joint consultation in PHC was suggested in 59% of calls and referral to secondary level was indicated in 16% of the incoming calls. Psychologists belonging to mental health teams were the professionals with the highest disposition to use the program. Most doubts are solved by telephone, through the suggestion of diagnostic hypotheses and management. PHC professionals seem very interested in the support provided by the API Program, facilitating their work with children and adolescents with mental health problems.Key words: mental Health, collaborative program, telepsychiatry, Child-juvenil Psychiatry

Identificación de factor de crecimiento vascular endotelial en células glandulares de tejido prostético maligno y benigno: Relación con la recidiva tumoral al año de la prostatectomía / Vascular endothelial growth factor in malignant and non malignant prostatic tissue: Association with tumor recurrence at one year after prostatectomy

Background: Prostate cancer (PC) is the second cause of death by cancer in men in Chile. Its behavior is so variable that it is necessary to search reliable prognostic markers. Vascular Endothelial Growth Factor (VEGF) is one of the most powerful pro-angiogenic factors. There is no agreement on its validity as a diagnostic or prognostic factor. Aim: To search for VEFG in prostatic tissue. Material and Methods: This study was performed in prostatectomy tissue coming from 41 patients with PC and 39 patients with benign prostatic hyperplasia (BPH). Specimens were studied using immunohistochemical staining for VEGF. The percentage of stained glandular cells per patient was calculated and associated with pathological diagnosis in cancer patients. Results: PC biopsies had a mean of 82% of VEGF (+) stained cells, while BPH had only 1.6% (p < 0.01). No relationship was found between the percentage of staining and recurrence at one year of follow-up in the case of PC. Conclusions: These results would rule out VEGF as a prognostic factor in this series of patients.

La hiponatremia al momento de ingreso como factor de riesgo de mortalidad hospitalaria / Hyponatremia on admission to the emergency room as a risk factor for hospital mortality

Background: Patients who develop hyponatremia during their hospitalization have higher hospital mortality. Aim: To determine if the presence of hyponatremia on admission to the emergency room is a risk factor for hospital mortality. Patients and Methods: Two hundred forty five patients consecutively admitted to the emergency room and then transferred to the Medicine Department, where they finally died, were matched for age and gender with 245 control subjects admitted to the emergency room and hospitalized in the Medicine Department at the same time, but survived. The dependent variable was death, and the exposure variable was hyponatremia. Admission diagnosis and Charlson comorbidity index was considered as confounding variables. Results: Hyponatremia at admission occurred in 30 and 17 percent of patients who died and survived, respectively, rendering an adjusted odds ratio for death of 2.13 (95 percent confidence intervals = 1.27-3.57). Charlson Comorbidity Index according to age score was higher in subjects with hyponatremia compared to those without hyponatremia (8.1 ± 3.1 and 7.2 ± 2.8; p = 0.01). Multivariate analysis showed that age, gender, length of stay, cause of hospitalization and chronic diseases did not significantly modify the effect of hyponatremia on hospital mortality. Conclusions: Hyponatremia on admission at emergency room had a significant association with hospital mortality. Subjects with hyponatremia had a higher Charlson Comorbidity Index score.

Oxidative stress is closely related to clinical severity of pre-eclampsia

Pre-eclampsia is a hypertensive disorder of pregnancy in which enzymatic antioxidant defenses fail and tissues are injured. This prospective case-control study evaluated whether pre-eclamptic women and their newborns show higher degrees of oxidative stress than normal pregnancies and sought to determine if this stress is related to clinical severity. Forty-four pre-eclamptic and thirty healthy pregnant women attending two hospitals in Valparaíso, Chile, were studied. The following plasmatic variables of antioxidant capacity were evaluated: glutathione peroxidase activity (GPx), total antioxidant capacity measured by oxidation of ABTS substrate (2,2'-azino-bis (3-ethylbenzthiazoline-6-sulfonic acid), and superoxide dismutase activity (SOD). malondialdehide (MDA) was measured to evaluate lipoperoxidation. The evaluation was performed at diagnosis of pre-eclampsia, delivery, 30 days and 120 days post delivery. Newborns were studied at delivery through umbilical cord blood samples. Our analysis shows that antioxidant enzyme activity (SOD, GPx, ABTS) was significantly decreased, while lipoperoxidation (MDA) was increased in both pre-eclamptic groups compared to normal pregnant women (p<0.01). Statistically significant difference was found between mild and severe pre-eclamptic groups (p<0.01), for all biochemical markers studied. Therefore, the clinical severity of this pathology is closely related to the degree of oxidative stress.