Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention

This article continues our presentation of the Brazilian Psychiatric Association guidelines for the management of patients with suicidal behavior, with a focus on screening, intervention, postvention, prevention, and promotion. For the development of these guidelines, we conducted a systematic review of the MEDLINE (via PubMed), Cochrane Database of Systematic Reviews, Web of Science, and SciELO databases for research published from 1997 to 2020. Systematic reviews, clinical trials, and cohort/observational studies on screening, intervention, and prevention in suicidal behavior were included. This project involved 14 Brazilian psychiatry professionals and 1 psychologist selected by the Psychiatric Emergencies Committee of the Brazilian Psychiatric Association for their experience and knowledge in psychiatry and psychiatric emergencies. Publications were evaluated according to the 2011 Oxford Center for Evidence-Based Medicine (OCEBM) Levels of Evidence Classification. Eighty-five articles were reviewed (of 5,362 initially collected and 755 abstracts on the drug approach). Forms of screening, intervention, and prevention are presented. The intervention section presents evidence for psychotherapeutic and drug interventions. For the latter, it is important to remember that each medication is effective only for specific groups and should not replace treatment protocols. We maintain our recommendation for the use of universal screening plus intervention. Although the various studies differ in terms of the populations evaluated and several proposals are presented, there is already significant evidence for certain interventions. Suicidal behavior can be analyzed by evidence-based medicine protocols. Currently, the best strategy is to combine several techniques through the Safety Plan. Nevertheless, further research on the topic is needed to elucidate some approaches with particular potential for intervention and prevention. Systematic review registry number: CRD42020206517

Coeficiente de difusión aparente en tejido encefálico: valores de normalidad en población colombiana clínicamente sana / Apparent diffusion coefficient in brain tissue: values of normality in clinically healthy colombian population

Resumen Introducción: Las secuencias de difusión en resonancia magnética, incluido el coeficiente de difusión aparente (ADC), representan una herramienta fundamental para el radiólogo en el diagnóstico clínico. Sin embargo, no existe estandarización para las medidas entre los límites normales o un rango de valores normales del ADC. Objetivo: Determinar valores normales del ADC en el tejido encefálico para la población clínica y radiológicamente sana. Métodos: Estudio de corte transversal sobre datos retrospectivos, se midieron valores del ADC para 21 regiones encefálicas (sustancia gris frontal, parietal y temporal, sustancia blanca frontal y parietal, núcleo caudado, putamen, tálamo, cápsula interna, hemisferios cerebelosos bilateralmente y puente del tallo cerebral) en 90 sujetos clínica y radiológicamente sanos, en dos clínicas privadas de Bogotá. Resultados: Valores normales del ADC, en población clínica y radiológicamente sana, en 21 territorios encefálicos, análisis comparativo de los resultados según el sexo y edad de los pacientes, y correlación entre las mediciones realizadas por dos investigadores. Conclusiones: Los hallazgos sirven como referencia para la población colombiana y latinoamericana normal, establecen un punto de comparación para la evaluación de patologías intracraneanas, y abre la posibilidad a desarrollar nuevos proyectos de investigación que busquen determinar valores de ADC en población enferma.

Abstract Introduction: The diffusion sequences in magnetic resonance, including the apparent diffusion coefficient (ADC), represent a fundamental tool for the radiologist in the clinical diagnosis. However, there is no standardization for measurements between normal limits or a range of normal ADC values. Objective: To determine normal ADC values ​​in the brain tissue for the clinical and radiologically healthy population. Methods: Cross-sectional study on retrospective data, ADC values ​​were measured for 21 encephalic regions (frontal gray, parietal and temporal substance, frontal and parietal white matter, caudate nucleus, putamen, thalamus, internal capsule, cerebellar hemispheres bilaterally and bridge of the brainstem) in 90 clinically and radiologically healthy subjects, in two private clinics in Bogotá. Results: Normal ADC values, in a clinical and radiologically healthy population, in 21 encephalic territories, comparative analysis of the results according to the sex and age of the patients, and correlation between the measurements made by two researchers. Conclusions: The findings serve as a reference for the Colombian and normal Latin American population, establish a point of comparison for the evaluation of intracranial pathologies, and open the possibility to develop new research projects that seek to determine ADC values ​​in sick population.

Urine metabolomic analysis to detect metabolites associated with the development of contrast induced nephropathy

OBJECTIVE: Contrast induced nephropathy (CIN) is a result of injury to the proximal tubules. The incidence of CIN is around 11% for imaging done in the acute care setting. We aim to analyze the metabolic patterns in the urine, before and after dosing with intravenous contrast for computed tomography (CT) imaging of the chest, to determine if metabolomic changes exist in patients who develop CIN. METHODS: A convenience sample of high risk patients undergoing a chest CT with intravenous contrast were eligible for enrollment. Urine samples were collected prior to imaging and 4 to 6 hours post imaging. Samples underwent gas chromatography/mass spectrometry profiling. Peak metabolite values were measured and data was log transformed. Significance analysis of microarrays and partial least squares was used to determine the most significant metabolites prior to CT imaging and within subject. Analysis of variance was used to rank metabolites associated with temporal change and CIN. CIN was defined as an increase in serum creatinine level of ≥ 0.5 mg/dL or ≥ 25% above baseline within 48 hours after contrast administration. RESULTS: We sampled paired urine samples from 63 subjects. The incidence of CIN was 6/63 (9.5%). Patients without CIN had elevated urinary citric acid and taurine concentrations in the pre-CT urine. Xylulose increased in the post CT sample in patients who developed CIN. CONCLUSION: Differences in metabolomics patterns in patients who do and do not develop CIN exist. Metabolites may be potential early identifiers of CIN and identify patients at high-risk for developing this condition prior to imaging.

Síndrome de Guillain-Barré / Guillain-Barré syndrome

No presente relato, os autores descrevem um caso de paciente pediátrico com diagnóstico clínico de síndrome de Guillain-Barré (SGB). Esta doença é caracterizada por inflamação e desmielinização dos nervos periféricos, provavelmente secundária a processo imune contra antígenos mielínicos (1-3medst). Ocorre geralmente duas a três semanas após uma infecção viral inespecífica. Sumário do caso: menina com quatro anos de idade, branca, pais sadios e sem história de doença auto-imune, apresentou quedas repentinas ao caminhar, progredindo com dificuldade para deambular, diminuição de força em membros inferiores, sendo admitida no Hospital Nossa Senhora da Conceição

In the present story the authors describes a case of a pediatric patient with clinical diagnosis of Guillain-Barré Syndrome (GBS). This illness is characterized by peripheral nerves inflammation and desmyelinization, probably secondary to the action of antibodies against myelinic antigens (1-3medst). Generally it happens two to three weeks after a nonspecific viral infection. Description: a girl, four years old, white, whose parents were healthy and without story of auto-immune illness, started with sudden falls whenwalking, progressing to ramble difficulty, weakness of lower limbs, being admitted to Hospital Nossa Senhora da Conceição

Seroprevalence of Burkholderia pseudomallei in East Timorese refugees: implications for healthcare in East Timor.

Melioidosis is a disease with protean clinical manifestations caused by the bacterium Burkholderia pseudomallei. It is endemic in countries surrounding the newly independent East Timor, but has yet to be isolated or demonstrated serologically in that country. One illness that can be clinically indistinguishable from melioidosis is pulmonary tuberculosis, a condition with a very high prevalence in East Timor. We used an indirect hemagglutination test (IHA) to measure antibodies to B. pseudomallei in 407 East Timorese evacuated to Darwin, Australia, in September 1999. Assuming a positive IHA titer as > or = 1:40, the overall seroprevalence rate was 17.0%, in keeping with other seroprevalence studies from the region. The IHA titres ranged up to 1:320. After adjusting for age, females were 2.5 times more likely to be seropositive than males (p = 0.0001). There was an inverse relationship between seropositivity and age. This study shows that exposure to B. pseudomallei occurs in East Timor melioidosis is also likely to occur. Due to the lack of laboratory facilities at present, it may be some time before a laboratory-confirmed case proves that melioidosis occurs. In the meantime, clinicians in East Timor should include melioidosis in the differential diagnosis of the many conditions that it may mimic.

Transplantation of benthic species to mitigate impacts of coastal development in Jamaica

Maintaining regional competitiveness and economic viability for Port Bustamante - Kingston Harbour, Jamaica, required improved accessibility to "Post Panamax" (too large to pass through the Panama Canal) container vessels. Removal of the northern portion of the shallow coral reef at Rackham's Cay, which was partially obstructing the western end of the east ship channel, was proposed. This aesthetically valuable reef was used by local fishermen and comprises part of the declared Palisadoes - Port Royal Protected Area. The proposal to transplant certain of the benthic species was advanced to mitigate loss of viable reef components. Between December 2001 and February 2002, sixty thousand items, consisting of reef building massive and branching corals; gorgonians; urchins (Diadema and Tripneustes spp.) and Thalassia meristems were relocated. During dredging, sedimentation rates from suspended solids in the water column were 0.003 g/cm(2)/day at the control site and 0.008 g/cm(2)/day at the dredge site. Coral cover in the relocation area increased from 15% to 20% while bare substrate decreased from 27% to 21%. This paper documents the mitigation required; some factors controlling the ecology of Rackham's Cay reef, the methodology of the relocation process; and the level of post-dredging survivorship of relocated corals. Political and economic realities of some proposed developments often override ecological considerations. Transplantation of important marine benthic species although time consuming, technically challenging, and expensive, may be one way for developers and ecologists to achieve sometimes disparate goals. This project cost US$1.7 million. The "items" moved were neither unique nor endemic and remain vulnerable to natural and anthropogenic impacts. This project increased public awareness and interest regarding the ecological and economic importance of reef ecosystems. It is anticipated that future coastal and inland developments will benefit from the lessons taught by these mitigative interventions

HIV seropositivity and tuberculosis in a rural Malawi hospital

This study was undertaken to determine the extent to which human immunodeficiency virus (HIV) infection has increased hospital admissions for tuberculosis (TB) in a rural population of southern Malawi. The notes and chest X-rays of TB patients admitted to Malamulo hospital in 1983 and 1984; before the recognition of acquired immune deficiency syndrome (AIDS) in Malawi; were compared with those of patients admitted in 1987 and 1988. We found a 160 percent increase in TB admissions between the 2 periods. Extrapulmonary TB; especially pleural TB; was much commoner in 1987-1988 and occurred in a younger age group. HIV seroreactivity was measured in a third group of 152 tuberculosis patients admitted during 1988-1989. HIV seropositivity was found in 52 percent of all tuberculosis admissions and in 75 percent of those with extrapulmonary disease. There was no difference in clinical response to TB therapy between the HIV seropositive patients and those who were seronegative. Extrapulmonary TB should be considered in all HIV seropositive patients; especially in areas where the prevalence of TB is high. Health personnel involved in TB programmes where HIV and TB infections are prevalent should plan for a large increase in the TB case load secondary to the HIV pandemic