Adicción al tabaco y adolescencia: riesgos psicobiológicos / Psychobiological risks of tobacco during adolescence. A narrative review

Resumen La investigación moderna, tanto en humanos como preclínica, que utiliza modelos animales indica que fumar durante la edad adolescente resulta en cambios cerebrales y psicológicos a corto y largo plazo en el fumador, así como en un aumento significativo en los riesgos de desarrollar adicción al tabaco durante la vida. Por lo tanto, en la presente revisión narrativa se describirán y profundizarán los hallazgos investigativos modernos de la psicobiología de la adolescencia y los efectos del tabaco en el desarrollo, con un énfasis particular en la comprensión de los efectos psicológicos y cerebrales del consumo de tabaco durante la adolescencia, tanto a corto como a largo plazo. Se considerarán de manera detallada los avances investigativos sobre la psicobiología de la adolescencia y sus riesgos en las adicciones desde los aspectos: conductual, cognitivo, reactividad al estrés y psicobiología. Sobre esta base, se revisará la investigación sobre la psicobiología de la adolescencia y la evidencia de vulnerabilidad a la adicción durante esta etapa. Al final, se abordarán los efectos del tabaco en el cerebro y conducta durante el desarrollo adolescente y vida posterior, ya que se ha encontrado evidencia relacionada con alteraciones cerebrales crónicas en los sistemas colinérgicos y regiones cerebrales asociadas con la dependencia de la nicotina. Se espera que la revisión y divulgación de esta información en el idioma español sea de valor para la comprensión de los problemas de vulnerabilidad y predisposiciones a la adicción al tabaco en el contexto de Latinoamérica.

Abstract Tobacco use and its harmful health-related problems have become one of the largest modern preventable public health issues. Current research strongly suggests that smoking during adolescence enhances addictive smoking behaviors during life, which can be related to adolescence as a critical ontogenetic period characterized by behaviors that can increase the probability of risk-related behaviors such as sensation and novelty seeking. Adolescent development is also a period of maturation of frontal and subcortical neural systems, brain changes that underlie higher impulsivity tendencies to promote adequate learning and adaptations necessary to succeed the novel challenges of the adult life, but those changes also enhance vulnerabilities to the addictive effects of drugs. Consistent with this, tobacco use affects brain development processes which underlie long-term psychobiological alterations and the enhanced risks for tobacco addiction during adult life. Thus, the present review describes current psychobiological approaches to understand general addiction processes and tobacco addiction, highlighting the behavioral and neural short-term effects of tobacco use during adolescence and its long-term effects during adulthood. Current research has advanced on four aspects for the understanding of both the psychobiology of adolescent development and the effects of drugs of abuse during this time. The first aspect is behavioral, as adolescence is related to important changes on motivational and emotional behaviors such as sensation seeking. Other important behavioral changes are social approach, a higher variety of opportunity for personal choices, and development of personal independence. Research on a second aspect has focused on cognition. A review of research is presented showing enhanced abilities during adolescence development for reading, abstract and logical thinking, and novel problem solving. Stress reactivity is the third aspect of reviewed psychobiological mechanisms. The stress biological system undergoes important changes during adolescence, including changes on stress-related hormones and neural architecture. An important issue is that exposure to early and/or chronic stressful circumstances during adolescence could be related to higher risk to the start and maintenance of addiction states, as suggested by research assessing the disruptive effects of stress on psychobiological homeostatic processes needed to maintain stable biological and emotional regulation. The fourth aspect is psychobiology. In this section research is reviewed related to the development of monoaminergic brain circuits underlying motivation, novelty-seeking, impulsivity, and addiction processes. Using as model the previous review integration, the effects of nicotine are discussed, the essential addictive component of tobacco, on the neurochemical systems underlying tobacco addiction. Following this, important research is introduced that describes psychobiological changes during adolescence and evidence of vulnerability to addiction during this life stage. Then, current research on both short-term and long-term effects of tobacco or nicotine administration during adolescence on the brain, behavior, and cognition is introduced. The current research advances and discussions on the psychobiology of addictions in general, and tobacco addiction in particular, have been possible to a large extent from the use of animal models and preclinical research, since animal models have become crucial to identify learning, motivational, emotional, and cognitive mechanisms that underlie addictive processes, and making possible to perform experimental procedures to discover the functioning and participation of biological components. One example of such components is the cholinergic system, which is activated by nicotine and is part of the neurochemical machinery on different brain areas important for both tobacco addiction and adolescence development such as the dorsal striatum, amygdala, ventral tegmental area, nucleus accumbens, prefrontal cortex, and hippocampus. The present review and research divulgation written in Spanish are expected to clarify modern research on addiction and encourage current scientific education on the vulnerabilities and predispositions for tobacco abuse in Latin-American countries.

Dolor abdominal como motivo de consulta pediátrica durante la pandemia del SARSCoV- 2 (COVID-19) en Guayaquil, Ecuador / Abdominal pain as a reason for pediatric visiting during the SARS-CoV-2 (COVID-19) pandemic in Guayaquil, Ecuador

Objetivo: el objetivo de este estudio fue describir los casos de pacientes con dolor abdominal y diagnóstico confirmado de COVID-19. En países de Latinoamérica la pandemia ha tenido un gran impacto por el alto índice de mortalidad. Ecuador es el quinto país más afectado en la región en número de casos confirmados con una tasa de 223 fallecidos por cada millón de habitantes, ubicándose en el primer lugar de letalidad. En la población pediátrica el comportamiento del COVID-19 sigue siendo inespecífico. Materiales y métodos: se realizó un estudio observacional, descriptivo y retrospectivo en el cual se incluyó a todos los pacientes menores de 18 años exceptuando neonatos, que ingresaron por dolor abdominal a un hospital pediátrico de la ciudad de Guayaquil entre los meses de abril y mayo de 2020 y obtuvieron diagnóstico confirmado COVID-19. Resultados: fueron incluidos 30 pacientes con diagnóstico confirmado de COVID-19 y dolor abdominal. La edad promedio fue 8,46 años a predomino del sexo masculino (70%). En la valoración del dolor 19 (63%) tuvieron un EVA moderado-severo y 11 (37%) EVA leve. 7 pacientes (23.33%) requirieron intervención quirúrgica, 21 (70%) necesitaron de unidad de cuidados críticos, y 1 (3.33%) falleció.Conclusiones: el dolor abdominal constituye un desafío diagnóstico en este tiempo de pandemia y debería ser considerado dentro de las posibles manifestaciones clínicas de COVID-19 en la población pediátrica..Au

Objective: the objective of this study was to describe the cases of paediatric patients with abdominal pain and confirmed diagnosis of COVID-19. In Latin American countries the pandemic has had a major impact from the high mortality rate. Ecuador is the fifth most affected country with a rate of 223 deaths per million inhabitants, ranking at the top of the fatality. In the paediatric population, the behavior of COVID-19 remains nonspecific. Materials and methods: an observational, descriptive and retrospective study was conducted, in which patients under the age of 18 were included except for newborns, admitted by abdominal pain and who obtained a confirmed diagnosis COVID-19. Results: 30 patients with confirmed diagnosis of COVID-19 and abdominal pain were included. The average age was 8.46 years at the predomin of the male sex (70%). In the pain assessment 19 (63%) had a moderate-severe EVA and 11 (37%) Mild EVA. 7 (23.33%) required surgery, 21 (70%) needed a critical care unit, and 1 (3.33%) Died. Conclusions: abdominal pain is a diagnostic challenge in this time of pandemic and should be considered within the possible clinical manifestations of COVID-19 in the paediatric population..Au

Habitat use, fruit consumption, and population density of the black-headed night monkey, Aotus nigriceps, in southeastern Peru

The black-headed night monkey, Aotus nigriceps, has one of the largest distribution ranges of the 11 night monkey species found across Central and South America. Yet, only three studies have focused on their ecology, describing considerable variation in habitat, group composition, and population density. Therefore, we analyzed habitat use, group composition, population density, and diet of 14 groups at two field sites in southeastern Peru. All sampled groups were found in secondary tropical rainforest, often dominated by native bamboo species. Half of the observed sleeping sites were in bamboo stands, though groups also emerged from cane thickets and lianas. This contrasts with other Aotus studies which have found groups living in tree cavities and lianas. Population density estimates for both sites were 19 and 50 individuals per km2, outside the range previously reported for A. nigriceps (31−34 individuals per km2). We recovered seeds of 12 species from fecal samples over the course of two field seasons, belonging mainly to Cecropiaceae, Piperaceae and Moraceae. Our results suggest that the black-headed night monkey in Peru can survive and even thrive in secondary forest, feeding extensively on pioneer species, occupying a range of forest types, all while living near human settlements. (AU)

Tuberculosis de la mano en mujer embarazada: raro caso de manifestación extrapulmonar / Tuberculosis of the hand in pregnant women: A rare extrapulmonary manifestation

Introducción Se presentaron 8,6 millones de nuevos casos de tuberculosis en 2013 según la OMS. La incidencia de tuberculosis en mujeres embarazadas se calcula en 60 casos por cada 100.000 habitantes en países endémicos. El compromiso musculoesquelético representa el 10-20% de los casos y el de la mano y el pie, el 1-2% de los casos. Materiales y métodos Paciente femenina de 42 años con 23 semanas de embarazo que consulta por cuadro de 5 meses de evolución de dolor, edema y eritema en mano derecha. Se diagnostica inicialmente síndrome del túnel carpiano. Después de 15 días vuelve a consultar por persistencia de los síntomas. Se inicia manejo antibiótico con diagnóstico de celulitis. Después de 7 semanas se evidencia lesión con absceso de 3×4 cm, reactantes de fase aguda elevados y se realiza drenaje quirúrgico, tras el cual se obtienen 8 ml de pus. Se procede a manejo antibiótico. Se realiza resonancia magnética y baciloscopia de secreción en la mano positiva para tuberculosis. Reporte de cultivo positivo para Mycobacterium tuberculosis. Resultados Después del manejo tetraconjugado, presenta mejoría de los síntomas; 6 meses después se realiza artrodesis de la muñeca como consecuencia de las alteraciones articulares en los huesos del carpo. Discusión El compromiso del aparato musculoesquelético por la tuberculosis es infrecuente. Las manifestaciones clínicas se pueden confundir con otros diagnósticos. Por su baja incidencia, pasa inadvertida y el diagnóstico es tardío. El pronóstico y las secuelas dependen del inicio precoz del tratamiento. Por tanto, debe sospecharse en pacientes que presenten factores de riesgo, como inmunosupresión, y en el embarazo. Nivel de evidencia clínica. Nivel IV.

Background A total of 8.6 million new cases of tuberculosis were reported in 2013, according to the WHO, with the incidence of tuberculosis in pregnant women is estimated at 60 cases per 100,000 inhabitants in endemic countries. Skeletal muscle involvement represents 10% to 20% of cases, with hand and foot in 1% to 2% of cases. Materials and methods A 42-year-old female patient in her 23rdweek of pregnancy who consulted due to pain, oedema, and erythema after 5 months of the onset of symptoms in the right hand. She was initially diagnosed with a carpal tunnel syndrome. After 15 days, she returned to the clinic with persistence of the symptoms. Antibiotic management was started with the diagnosis of cellulitis. Seven weeks later she had a 3×4cm abscess, with elevated acute phase reactants. Surgical drainage was performed, obtaining 8 ml of pus, and antibiotic management was re-started. A magnetic resonance scan was performed, and a smear was taken for microscopy of the secretion, with a hand tuberculosis abscess being confirmed. Positive culture reports for Mycobacterium tuberculosis were also conclusive in diagnosis. Results After surgery and tetra-conjugate antibiotic management, the symptoms improved. After 6 months, an arthrodesis of the wrist was performed as a consequence of the articular alterations in the carpal bones. Discussion The involvement of the musculoskeletal system due to tuberculosis is uncommon. Clinical findings may be confusing, and a diagnostic bias could easily occur. Due to its low incidence, it is usually unnoticed and the diagnosis is often delayed. Nevertheless, the prognosis and sequelae depend on the early onset of treatment, and it should be suspected in patients with risk factors such as immunosuppression and pregnancy in endemic populations. Evidence level. IV.

Resultados del tratamiento de pie equinovaro congénito con el método de Ponseti / Outcomes of congenital clubfoot treatment using the Ponseti method

Introducción El pie equinovaro congénito es la deformidad congénita más frecuente del pie. Actualmente, el método Ponseti es el método de referencia para el tratamiento de esta anomalía, pues provee de una corrección completa de las deformidades con buena movilidad y función del pie. Existen muchos estudios en el mundo que muestran resultados funcionales del método. Sin embargo, en Colombia no hay publicaciones de este tipo con el método Ponseti. Materiales y métodos Este es un estudio descriptivo, retrospectivo, de tipo serie de casos en pacientes entre 0 y 12 años diagnosticados con pie equinovaro congénito, tratados con el método Ponseti entre julio de 2002 y diciembre de 2015. Con un seguimiento mínimo de menos 6 meses, se midió la gravedad según la escala de Dimeglio y la funcionalidad según la escala de Laaveg-Ponseti. Resultados 123 pacientes (183 pies) con un seguimiento medio de 8 años. Edad de inicio del tratamiento: entre 0 y 24 meses. Según la clasificación del grado de gravedad de Dimeglio, el 6,5% eran leves, el 74% moderados, el 13% graves y el 6,5%, muy graves. La mayoría de los pies estudiados era de origen idiopático (96%). El 20% presentaron recidiva. Los resultados funcionales según la escala de Laaveg-Ponseti fueron excelentes (71%), buenos (23%) o regulares (6%). Discusión Nuestros resultados con desenlaces buenos y excelentes del 94% son similares a reportes previos. Con una recidiva del 17,8%, en la bibliografía se reportan el 20 y el 40%, respectivamente. Este estudio, a diferencia de los demás, no encontró relación directa entre el uso del aparato de abducción y la recidiva. No hubo sobrecorrecciones y ningún paciente tuvo un resultado malo según la escala de Laaveg-Ponseti. Nivel de evidencia clínica Nivel IV.

Background Congenital clubfoot is the most common congenital deformity of the foot. The Ponseti method is currently the gold standard for the treatment of this anomaly, as it provides a complete correction of the deformities with good foot mobility and function. There are many studies from all over the world that present the functional results of the method. However, in Colombia there are no publications of this type using the Ponseti method. Materials and methods This is a descriptive, retrospective, case series-type study in patients between 0 and 12 years old diagnosed with clubfoot, and treated using the Ponseti method between July 2002 and December 2015, and with a minimum follow-up of at least 6 months. Severity was measured according to the Dimeglio scale, and functionality with the Laaveg-Ponseti scale. Results The study included a total of 123 patients (183 feet) with a mean follow-up of 8 years. Treatment was started between 0 and 24 months. According to Dimeglio severity rating, 6.5% were mild, 74% moderate, 13% severe, and 6.5% very severe. Most (96%) of the studied feet were of idiopathic origin. There was a relapse in 17.8%. The functional results, according to the Laaveg-Ponseti scale were excellent in 71%, good in 23%, and average in 6%. Discussion The results with good and excellent outcomes of 94% are similar to previous studies. With a relapse rate of 17.8%, compared to the 20% and 40%, respectively, reported in the literature. This study, unlike the others, found no direct relationship between the use of the abduction apparatus and relapse. There were no over-corrections and no patient had a poor outcome according to the Laaveg-Ponseti scale. Evidence level IV.