Trends in Venous Thromboembolism Readmission Rates after Ischemic Stroke and Intracerebral Hemorrhage / 대한뇌졸중학회지

Background@#and Purpose Venous thromboembolism (VTE) is a life-threatening complication of stroke. We evaluated nationwide rates and risk factors for hospital readmissions with VTE after an intracerebral hemorrhage (ICH) or acute ischemic stroke (AIS) hospitalization. @*Methods@#Using the Healthcare Cost and Utilization Project (HCUP) Nationwide Readmission Database, we included patients with a principal discharge diagnosis of ICH or AIS from 2016 to 2019. Patients who had VTE diagnosis or history of VTE during the index admission were excluded. We performed Cox regression models to determine factors associated with VTE readmission, compared rates between AIS and ICH and developed post-stroke VTE risk score. We estimated VTE readmission rates per day over a 90-day time window post-discharge using linear splines. @*Results@#Of the total 1,459,865 patients with stroke, readmission with VTE as the principal diagnosis within 90 days occurred in 0.26% (3,407/1,330,584) AIS and 0.65% (843/129,281) ICH patients. The rate of VTE readmission decreased within first 4–6 weeks (P<0.001). In AIS, cancer, obesity, higher National Institutes of Health Stroke Scale (NIHSS) score, longer hospital stay, home or rehabilitation disposition, and absence of atrial fibrillation were associated with VTE readmission. In ICH, longer hospital stay and rehabilitation disposition were associated with VTE readmission. The VTE rate was higher in ICH compared to AIS (adjusted hazard ratio 2.86, 95% confidence interval 1.93–4.25, P<0.001). @*Conclusions@#After stroke, VTE readmission risk is highest within the first 4–6 weeks and nearly three-fold higher after ICH vs. AIS. VTE risk is linked to decreased mobility and hypercoagulability. Studies are needed to test short-term VTE prophylaxis beyond hospitalization in high-risk patients.

Congenital ocular toxoplasmosis in consecutive siblings / Toxoplasmose ocular congênita em irmãos consecutivos

ABSTRACT Toxoplasma gondii infection can cause ocular manifestations after acquired and congenital disease. We report two cases of symptomatic congenital toxoplasmosis with ocular involvement in non-twin siblings, with a 2-year interval between pregnancies. Vertical transmission of toxoplasmosis in successive pregnancies, which was once considered impossible, is now found to be plausible even in immunocompetent subjects.

RESUMO A infecção pelo Toxoplasma gondii pode causar manifestações oculares tanto após a sua forma congênita quanto a sua forma adquirida. Reportamos aqui dois casos de toxoplasmose congênita sintomática com envolvimento ocular em irmãos não gêmeos, com intervalo de 2 anos entre gestações. A transmissão vertical da toxoplasmose em gestações sucessivas, outrora considerada impossível, é um evento plausível mesmo em indivíduos imunocompetentes.

Global Impact of the COVID-19 Pandemic on Cerebral Venous Thrombosis and Mortality / 대한뇌졸중학회지

Background@#and Purpose Recent studies suggested an increased incidence of cerebral venous thrombosis (CVT) during the coronavirus disease 2019 (COVID-19) pandemic. We evaluated the volume of CVT hospitalization and in-hospital mortality during the 1st year of the COVID-19 pandemic compared to the preceding year. @*Methods@#We conducted a cross-sectional retrospective study of 171 stroke centers from 49 countries. We recorded COVID-19 admission volumes, CVT hospitalization, and CVT in-hospital mortality from January 1, 2019, to May 31, 2021. CVT diagnoses were identified by International Classification of Disease-10 (ICD-10) codes or stroke databases. We additionally sought to compare the same metrics in the first 5 months of 2021 compared to the corresponding months in 2019 and 2020 (ClinicalTrials.gov Identifier: NCT04934020). @*Results@#There were 2,313 CVT admissions across the 1-year pre-pandemic (2019) and pandemic year (2020); no differences in CVT volume or CVT mortality were observed. During the first 5 months of 2021, there was an increase in CVT volumes compared to 2019 (27.5%; 95% confidence interval [CI], 24.2 to 32.0; P<0.0001) and 2020 (41.4%; 95% CI, 37.0 to 46.0; P<0.0001). A COVID-19 diagnosis was present in 7.6% (132/1,738) of CVT hospitalizations. CVT was present in 0.04% (103/292,080) of COVID-19 hospitalizations. During the first pandemic year, CVT mortality was higher in patients who were COVID positive compared to COVID negative patients (8/53 [15.0%] vs. 41/910 [4.5%], P=0.004). There was an increase in CVT mortality during the first 5 months of pandemic years 2020 and 2021 compared to the first 5 months of the pre-pandemic year 2019 (2019 vs. 2020: 2.26% vs. 4.74%, P=0.05; 2019 vs. 2021: 2.26% vs. 4.99%, P=0.03). In the first 5 months of 2021, there were 26 cases of vaccine-induced immune thrombotic thrombocytopenia (VITT), resulting in six deaths. @*Conclusions@#During the 1st year of the COVID-19 pandemic, CVT hospitalization volume and CVT in-hospital mortality did not change compared to the prior year. COVID-19 diagnosis was associated with higher CVT in-hospital mortality. During the first 5 months of 2021, there was an increase in CVT hospitalization volume and increase in CVT-related mortality, partially attributable to VITT.

Giant cell myocarditis causing sudden death in a patient with sarcoidosis

Giant cell myocarditis (GCM) is a rare and rapidly fatal cardiovascular condition most often seen in young adults. It is characterized microscopically by myocardial necrosis with multinucleated giant cells in the absence of well-defined granulomas. This disorder has typically been attributed to manifest as heart failure, but in some individuals, GCM may present as sudden cardiac death. Herein, we present a fatal case of GCM in a 36-year-old male with a history of autoimmune disorders. The decedent presented to the emergency room due to vomiting and was treated for nausea due to suspected dehydration. He was discharged that night and found dead on his bathroom floor the following day. Postmortem examination revealed psoriasis and granulomatous lesions in the lungs consistent with sarcoidosis, further supporting circumstantial evidence existing between GCM and autoimmune disorders. Additionally, this case provides an opportunity to distinguish GCM from the distinct clinical entity of cardiac sarcoidosis (CS), especially in the setting of systemic sarcoidosis. We hope to raise awareness of this rare disease process and its potential to cause sudden cardiac death so that it may be considered in a differential diagnosis as immunosuppression and early cardiac transplantation largely determine the prognosis.

Anesthesia for the patient with a recently diagnosed concussion: think about the brain! / 대한마취과학회지

Some patients require emergent, urgent, or elective surgery in the time period immediately following diagnosis of concussion. However, changes in brain homeostatic mechanisms following a concussion and concern for secondary brain injury can complicate the decision as to whether or not a surgery should proceed or be postponed. Given the paucity of available evidence, further evaluation of the use of anesthesia in a patient with concussion is warranted. This article summarizes what is currently known about the relevant pathophysiology of concussion, intraoperative anesthesia considerations, and effects of anesthesia on concussion outcomes in an attempt to help providers understand the risks that may accompany surgery and anesthesia in this patient population. While most contraindications to the use of anesthesia in concussed patients are relative, there are nonetheless pathophysiologic changes associated with a concussion that can increase risk of its use. Understanding these changes and anesthetic implications can help providers optimize outcomes in this patient population.

Cardiology training in Brazil and developed countries: some ideas for improvement / Residência em cardiologia no Brasil e em países desenvolvidos: ideias para melhoria

ABSTRACT: Huge variations exist in cardiology training programs across the world. In developing (middle-income) countries, such as Brazil, to find the right balance between training improvements and social and economic conditions of the country may be a difficult task. Adding more training years or different mandatory rotations, for instance, may be costly and not have an immediate direct impact on enhancing patient care or public health. In this text, we compare the Brazilian cardiology training system with other proposals implemented in developed countries from North America and Europe, aiming to point out issues worth of future discussion. Factors such as training rotations and competencies, and program duration and distribution across the countries are presented. The number of first year cardiology trainees per inhabitants is similar between Brazil and the United States (0.24 medical residents/100,000 inhabitants in Brazil and 0.26 medical residents/100,000 inhabitants in the USA). These numbers should be analyzed considering the inequality in training program distribution across Brazil, since most centers are located in the Southeast and South regions. Having more residency programs in distant areas could improve cardiovascular care in these areas. Duration of cardiology Residency Training is shorter in Brazil (two years) in comparison with developed countries (> 3 years). Brazilian residency programs give less emphasis to scientific research and diagnostic methods. Unifying minimum training requirements across the globe would facilitate the development of international learning opportunities and even professional exchange around the world.

RESUMO: Existe enorme variação nos programas de residência em cardiologia no mundo. Em países em desenvolvimento, tal como o Brasil, encontrar o equilíbrio correto entre melhorias nos programas de residência e condições socioeconômicas do país pode ser uma tarefa difícil. Aumentar a duração dos programas ou o número de estágios obrigatórios, por exemplo, pode ter um custo elevado e não ter um impacto imediato na melhoria do cuidado do paciente ou na saúde pública. Neste texto, comparamos o sistema de residência em cardiologia brasileiro com outras propostas implementadas em países desenvolvidos da América do Norte e Europa, com objetivo de indicar questões para discussões futuras. Apresentamos fatores como rodízios por estágios e competências, duração e distribuição dos programas pelos países. O número de alunos no primeiro ano de Residência em cardiologia por número de habitantes é similar entre o Brasil e os Estados Unidos (0,24 médicos residentes/100 mil habitantes no Brasil e 0,26 médicos residentes/100 mil habitantes nos EUA). Esses números devem ser analisados considerando a desigualdade na distribuição dos programas pelo país, uma vez que a maioria dos centros localiza-se nas regiões sul e sudeste do país. A existência de mais programas de residência em áreas distantes melhoraria o cuidado cardiovascular nessas áreas. O período de treinamento é menor no Brasil (dois anos) em comparação a países desenvolvidos (>3 anos). Os programas de residência no Brasil dão menos ênfase em pesquisa científica e métodos diagnósticos. O estabelecimento de exigências mínimas que sejam padronizadas a todos os países facilitaria o desenvolvimento de oportunidades de aprendizagem e mesmo o intercâmbio de profissionais pelo mundo.

Influence of Work Characteristics on the Association Between Police Stress and Sleep Quality

BACKGROUND: Police officers' stress perception, frequency of stressful events (stressors), and police work characteristics may contribute to poor sleep quality through different mechanisms. METHODS: We investigated associations of stress severity (measured by stress rating score) and frequency of stressors with sleep quality and examined the influence of police work characteristics including workload, police rank, prior military experience, and shift work on the associations. Participants were 356 police officers (256 men and 100 women) enrolled in the Buffalo Cardio-Metabolic Occupational Police Stress Study from 2004 to 2009. A mean stress rating score and mean frequency of stressors occurring in the past month were computed for each participant from the Spielberger Police Stress Survey data. Sleep quality was assessed using the global score derived from the Pittsburgh Sleep Quality Index survey. Linear associations of the stress rating score and frequency of stressors with sleep quality (Pittsburgh Sleep Quality Index global score) were tested. Age, sex, race/ethnicity, and smoking status were selected as potential confounders. RESULTS: The stress rating score was positively and independently associated with poor sleep quality (β = 0.17, p = 0.002). Only workload significantly modified this association (β = 0.23, p = 0.001 for high workload group; p-interaction = 0.109). The frequency of stressors was positively and independently associated with poor sleep quality (β = 0.13, p = 0.025). Only police rank significantly modified the association (β = 0.007, p = 0.004 for detectives/other executives; p-interaction = 0.076). CONCLUSION: Both police officers' perception of stress severity and the frequency of stressors are associated with poor sleep quality. Stress coping or sleep promotion regimens may be more beneficial among police officers reporting high workloads.

Declarations of conflict of interest are still inadequate

Declaration of conflicts of interest (COI, understood mainly as financial) in medical publications is long established. Most journals refer only to the guidelines of the International Committee of Medical Journal Editors (ICMJE) but not to those of the WAME (World Association of Medical Editors). We surveyed 17 journals and found only one (BJOG), which explicitly mentioned “religious interest” as an example of a possible COI and one other journal included “personal belief” (Journal of Obstetrics and Gynaecology of India) as a COI. Of the other 15 journals, 10 used the ICJME as their COI model. They were the general journals, NEJM, JAMA, Lancet, BMJ and JIM (Journal of Internal Medicine); the pediatric/neonatology journals Pediatrics and Journal of Pediatrics (this also mentions WAME) but not Acta Paediatrica, which mentions COPE; the obstetrics/gynaecology journals AJOG and IJOG; and the British Journal of Haematology but not Blood, which uses the American Society of Hematology’s own COI model. Neither EJOG, JOG, IndianObs Gyn, nor J Obstet Gynaecol India clearly specified a COI model. Yet the ICMJE COI guidelines fail to include involvement in religious and/or secular groups which take sides on the subject being discussed, while the WAME guidelines specifically do so. Instead the ICMJE uses the vaguer phrase “intellectual beliefs”. The actual ICJME COI-form does not itemise religion. To maintain their scientific credibility, medical journals must start requiring disclosure of such ties. A typical example where current ICMJE rules fall short is the ongoing heated debates over the ethics of prenatology and of physician assisted suicide.

Reappraising the dimensional structure of the PTSD Checklist: lessons from the DSM-IV-based PCL-C

Objective: The dimensional structure of posttraumatic stress disorder (PTSD) has been extensively debated, but the literature is still inconclusive and contains gaps that require attention. This article sheds light on hitherto unvisited methodological issues, reappraising several key models advanced for the DSM-IV-based civilian version of the PTSD Checklist (PCL-C) as to their configural and metric structures. Methods: The sample comprised 456 women, interviewed at 6-8 weeks postpartum, who attended a high-complexity facility in Rio de Janeiro, Brazil. Confirmatory factor analysis (CFA) and exploratory structural equation models (ESEM) were used to evaluate the dimensional structure of the PCL-C. Results: The original three-factor solution was rejected, along with the four-factor structures most widely endorsed in the literature (PTSD-dysphoria and PTSD-numbing models). Further exploration supported a model comprised of two factors (re-experience/avoidance and numbing/hyperarousal). Conclusion: These findings are at odds with the dimensional structure proposed in both DSM-IV and DSM-5. This also entails a different presumption regarding the latent structure of PTSD and how the PCL should be operationalized.

Response: Iodine Status in Filipino Women of Childbearing Age (Endocrinol Metab 2018;33:372-9, Michael E. Serafico et al.)

No abstract available.

Iodine Status in Filipino Women of Childbearing Age

BACKGROUND: Iodine deficiency (ID) has become a concern not only among pregnant women, but in women of childbearing age as well. In fact, a recent report suggested that women with moderate to severe ID may experience a significantly longer time to conceive. This study aimed to investigate iodine status in Filipino women of childbearing age. METHODS: The iodine status of 6,194 Filipino women aged 15 to 45 years old was assessed through urinary iodine analysis. A casual spot urine sample was collected from women in households participating in the eighth National Nutrition Survey conducted by the Food and Nutrition Research Institute. The sample was analyzed using ammonium persulfate digestion followed by the Sandell-Kolthoff colorimetric reaction. A median urinary iodine concentration (UIC) of less than 100 µg/L was used to define ID. RESULTS: The median UIC was 123 µg/L, indicative of adequate iodine nutrition; however, 21.5% of participants had a UIC below 50 µg/L. The median UIC of women who lived in urban areas (142 µg/L), belonged to the middle to richest class (>124 µg/L), had reached a college education (136 µg/L), and used iodized salt (15 ppm and above; 148 to 179 µg/L) reflected adequate iodine nutrition. ID was found to have been eliminated in the regions of Central Luzon, Eastern Visayas, Calabarzon, Mimaropa, and the National Capital, while mild ID was identified in Western Visayas, Southern and Western Mindanao, and in the Autonomous Region in Muslim Mindanao. CONCLUSION: Pockets of ID among women of childbearing age exist in the Philippines. Proper information through education and the use of adequately iodized salt are key measures for improving the iodine status of the studied population.

Associations Between Body Fat Percentage and Fitness among Police Officers: A Statewide Study

BACKGROUND: Police work is generally sedentary although there may be situations that require physical endurance and strength, such as foot chases and arresting suspects. Factors such as excessive body fat can impede an officer's physical ability to deal with such occurrences. Our objective was to examine associations between officers' body fat percentage (BF%) and performance on a standardized fitness protocol. METHODS: Data were obtained from fitness screening among 1,826 male and 115 female officers in a large US police agency. The screening consisted of a 2.4-km run, push-ups, sit-ups, and sit-and-reach test. Sex-specific body fat percentages were estimated from skinfold thickness measured using calipers. Linear regression models were used to examine unadjusted and adjusted mean scores of fitness tests across BF% tertiles. RESULTS: The prevalence of overall fitness was 4.3 times greater in male officers and 3.6 times greater in female officers having the lowest BF% tertile compared with the highest tertile (30.3% vs 7.1% and 46.0% vs 12.8%, respectively). BF% was linearly and positively associated with the time of 2.4-km run (p < 0.001), and linearly and inversely associated with the number of push-ups (p < 0.001), sit-ups (p < 0.001), and the distance of sit-and-reach (p < 0.001) in men. Similar associations were observed in women with the exception of sit-and-reach (p = 0.122). Associations were independent of age, race/ethnicity, rank, and duty station. CONCLUSION: Overall, BF% was inversely associated with fitness levels in male and female officers. Future longitudinal studies should be initiated to explore the potentially causal relationship between BF% and fitness in law enforcement officers.

Association of Inflammatory Bowel Disease (IBD) with Depressive Symptoms in the United States Population and Independent Predictors of Depressive Symptoms in an IBD Population: A NHANES Study

BACKGROUND/AIMS: There is a paucity of population-based studies on the association between inflammatory bowel disease (IBD) and depression in the U.S. population. We sought to study this association using the National Health and Nutrition Examination Survey (NHANES) database. METHODS: We used NHANES data from 2009 to 2010. Our study included 190,269,933 U.S. adults without IBD and 2,325,226 with IBD. We sought to determine whether IBD is an independent risk factor for depressive symptoms (DS) in the U.S. population and studied the independent predictors of DS in IBD population. RESULTS: DS was present in 49% of the IBD population versus 23% of the non-IBD population (p<0.001). During the multivariate analysis, we found that IBD was independently associated with DS in the U.S. population (p=0.002). The independent predictors of DS in the IBD population were older age (p=0.048) and divorced/separated/widowed status (p=0.005). There was nonsignificant increase in suicidal risk in IBD population with DS versus that in non-IBD population with DS (27% vs 12%, respectively, p=0.080). Only 36% of IBD individuals with DS visited mental health professional or psychiatrist within the past year. CONCLUSIONS: IBD is independently associated with DS in the U.S. population. Further research is warranted on risk stratification, screening and management of those with IBD who are at risk of depression.

Validade da estrutura fatorial da escala de capital social utilizada na linha de base no ELSA-Brasil / Factor structure validity of the social capital scale used at baseline in the ELSA-Brasil study / Validez de la estructura factorial de la escala de capital social, utilizada en la línea de base del ELSA-Brasil

Resumo: Esta pesquisa tem por objetivo estudar a estrutura fatorial da versão brasileira da escala Resource Generator (RG), utilizando dados da linha de base do Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Realizou-se validade cruzada com três subamostras aleatórias. A análise fatorial exploratória usando modelos de equação estrutural exploratória foi realizada nas duas primeiras subamostras para diagnóstico da estrutura fatorial e, na terceira, a análise fatorial confirmatória foi utilizada para corroborar o modelo definido pelas análises exploratórias. Com base nos 31 itens iniciais, o modelo de melhor ajuste contemplou 25 itens distribuídos em três dimensões. Todas apresentaram validade convergente (valores acima de 0,50 para a variância extraída) e precisão (valores acima de 0,70 para a confiabilidade composta) satisfatórias. Todas as correlações fatoriais foram abaixo de 0,85, indicando plena validade fatorial discriminante. A escala RG apresenta propriedades psicométricas aceitáveis e pode ser utilizada em populações com características semelhantes.

Abstract: This study aims to analyze the factor structure of the Brazilian version of the Resource Generator (RG) scale, using baseline data from the Brazilian Longitudinal Health Study in Adults (ELSA-Brasil). Cross-validation was performed in three random subsamples. Exploratory factor analysis using exploratory structural equation models was conducted in the first two subsamples to diagnose the factor structure, and confirmatory factor analysis was used in the third to corroborate the model defined by the exploratory analyses. Based on the 31 initial items, the model with the best fit included 25 items distributed across three dimensions. They all presented satisfactory convergent validity (values greater than 0.50 for the extracted variance) and precision (values greater than 0.70 for compound reliability). All factor correlations were below 0.85, indicating full discriminative factor validity. The RG scale presents acceptable psychometric properties and can be used in populations with similar characteristics.

Resumen: Esta investigación tiene por objetivo estudiar la estructura factorial de la versión brasileña de la escala Resource Generator (RG), utilizando datos de la línea de base del Estudo Longitudinal de Saúde do Adulto (ELSA-Brasil). Se realizó una prueba de validación cruzada con tres sub-muestras aleatorias. El análisis factorial exploratorio, usando modelos de ecuación estructural exploratorio, fue realizado en las dos primeras sub-muestras para diagnóstico de la estructura factorial y, en la tercera, el análisis factorial confirmatorio fue utilizado para corroborar el modelo definido por los análisis exploratorios. A partir de los 31 ítems iniciales, el modelo de mejor ajuste contempló 25 ítems distribuidos en tres dimensiones. Todos presentaron validez convergente (valores por encima de 0,50 para la variancia extraída) y precisión (valores por encima de 0,70 para la confiabilidad compuesta) satisfactorias. Todas las correlaciones factoriales estuvieron por debajo de 0,85, indicando plena validez factorial discriminante. La escala RG presenta propiedades psicométricas aceptables y puede ser utilizada en poblaciones con características semejantes.

Changes in Hospital Admissions and Mortality for Complications of Cirrhosis: Implications for Clinicians and Health Systems

No abstract available.

Separate and Joint Associations of Shift Work and Sleep Quality with Lipids

BACKGROUND: Shift work and/or sleep quality may affect health. We investigated whether shift work and sleep quality, separately and jointly, were associated with abnormal levels of triglycerides, total cholesterol (TC), and low-and high-density lipoprotein cholesterol in 360 police officers (27.5% women). METHODS: Triglycerides, TC, and high-density lipoprotein were analyzed on the Abbott Architect; low-density lipoprotein was calculated. Shift work was assessed using City of Buffalo payroll work history records. Sleep quality (good, ≤ 5; intermediate, 6-8; poor, ≥ 9) was assessed using the Pittsburgh Sleep Quality Index questionnaire. A shift work + sleep quality variable was created: day plus good sleep; day plus poor sleep; afternoon/night plus good; and poor sleep quality. Mean values of lipid biomarkers were compared across categories of the exposures using analysis of variance/analysis of covariance. RESULTS: Shift work was not significantly associated with lipids. However, as sleep quality worsened, mean levels of triglycerides and TC gradually increased but only among female officers (age- and race-adjusted p = 0.013 and 0.030, respectively). Age significantly modified the association between sleep quality and TC. Among officers ≥ 40 years old, those reporting poor sleep quality had a significantly higher mean level of TC (202.9 ± 3.7 mg/dL) compared with those reporting good sleep quality (190.6 ± 4.0 mg/dL) (gender- and race-adjusted p = 0.010). Female officers who worked the day shift and also reported good sleep quality had the lowest mean level of TC compared with women in the other three categories (p = 0.014). CONCLUSION: Sleep quality and its combined influence with shift work may play a role in the alteration of some lipid measures.

Monitoreo de Ehrlichia canis, Anaplasma phagocytophilum, Borreliaburgdorferi, y Dirofilaria immitis en perros de tres ciudades enColombia / Surveillance for Ehrlichia canis, Anaplasma phagocytophilum, Borreliaburgdorferi, and Dirofilaria immitis in Dogs From Three Cities in Colombia

Emerging infectious and zoonotic diseases are made up in large proportion by vector-borne diseases (VBD). Dogs are parasitized by disease vectors such as ticks and mosquitoes, making dogs adequate reservoirs for zoonoses. Risk of exposure to VBD exists for the US military personnel and Military Working Dogs (MWD) when deployed globally. The importance of canine VBD surveillance relates to veterinary and public health significance for the host nations as well as for the US troops and MWDs. The objective of this work was to survey dogs from the cities of Medellin, Barranquilla, and Cartagena in Colombia to determine prevalence of heartworm disease (Dirofilaria immitis), ehrlichiosis (Ehrlichia canis), Lyme disease (Borrelia burgdorferi), and anaplasmosis (Anaplasma phagocytophilum). Canine (n=498) blood samples (1-3cc) were collected during July 2011 from Medellin (n=175), Barranquilla (n=223), and Cartagena (n=100). Samples were tested on-site using IDEXX SNAP® 4Dx® Test Kits. The overall combined sample prevalence of E. canis, A. phagocytophilum, D. immitis, and B. burgdorferi was 62%, 33%, 1.6%, and 0%. In Medellin, 26% of the samples were positive for E. canis, 12% for A. phagocytophilum, and 0% for D. immitis. In Barranquilla, sample prevalence for E. canis, A. phagocytophilum, and D. immitis were 83%, 40%, and 2%. In Cartagena, E. canis, A. phagocytophilum, and D. immitis sample prevalence were 80%, 51%, and 3%. In conclusion, E. canis and A. phagocytophilum are present in all three surveyed cities. There is a higher prevalence for E. canis and A. phagocytophilum than D. immitis. In addition, the prevalence for these organisms is higher in Barranquilla and Cartagena than in Medellin. Overall, this study emphasizes the value of surveillance for VBDs in order to determine disease prevalence, develop risk assessments, and to implement control measures.

Las nuevas enfermedades infecciosas y enfermedades zoonóticas son en su mayor proporción el resultado o causa de enfermedades transmitidas por vectores (VBD: Vector-Borne Diseases). Perros que han sido infectados por enfermedades vectores como mosquitos y garrapatas, se convierten en fuentes adecuadas para enfermedades zoonóticas. Existe un riesgo ante la exposición a VBD en el personal de las Fuerzas Armadas Americanas y los perros del servicio militar (MWD: Military Working Dogs) cuando estos se encuentran trabajando fuera de los Estados Unidos. Tanto como para la Veterinaria, la Salud pública de las Naciones anfitrionas y de las Fuerzas Armadas Americanas y de sus perros militares es de gran importancia el seguimiento y vigilancia de VBD en los perros. El objetivo de este trabajo fué el monitoreo e investigación de perros en las ciudades de Medellin, Barranquilla y Cartagena en Colombia y determinar la existencia de enfermedades como la enfermedad del gusano del corazón ("heartworm disease" -Dirofilaria immitis), ehrlichiosis (Ehrlichia canis), Lyme disease (Borrelia burgdorferi) y anaplasmosis (Anaplasma phagocytophilum). Perros (n=498) muestras de sangre (1-3cc) recolectadas durante Julio 2011. En Medellín (n=175) Barranquilla (n= 223) y Cartagena (n= 100). Muestras fueron utilizadas en sitio por medio de IDEXX SNAP® 4Dx® Test Kits. La convinación total de las pruebas muestran una prevalencia de E. canis, A.phagocytophilum, D. immitis, y B. burgdorferi fue de un 62%, 33%, 1.6% y de un 0% En Medellin, 26% de las pruebas fueron positivas para E. canis, 12% para A. phagocytophilum, y 0% para D. immitis. En Barranquilla, las muestras demostraron una prevalencia para E. canis, A. phagocytophilum y D. immitis fue de un 83%, 40% y 2%. En Cartagena, E. canis, A. phagocytophilum, y D. immitis mostraron una prevalencia del 80%, 51% y 3%. En conclusión, E. canis y A. phagocytophilum estan presentes en las tres ciudades. Hay una mayor prevalencia para E. canis y A. phagocytophilum y también la presencia de estos organismos es mayor en Barranquilla y Cartagena comparado con los resultados de Medellín. Este estudio tiene como propósito enfatizar el valor e importancia del monitoreo y estudio de VBDs con el fin de determinar la prevalencia de las enfermedades, el desarrollo de sus causas y determinar medios para prevenir y controlar el esparcimiento de estas enfermedades.

Transtorno do estresse pós-traumático no puerpério em uma maternidade de alto risco fetal no Município do Rio de Janeiro, Brasil / Trastorno de estrés postraumático en el puerperio de una maternidad de alto riesgo fetal en el municipio de Río de Janeiro, Brasil / Postpartum posttraumatic stress disorder in a fetal high-risk maternity hospital in the city of Rio de Janeiro, Brazil

Resumo O objetivo deste artigo é estimar a magnitude de transtorno do estresse pós-traumático (TEPT) no puerpério em uma maternidade de referência para agravos perinatais e identificar subgrupos vulneráveis. Trata-se de um estudo transversal realizado uma maternidade de alto risco fetal no Rio de Janeiro, Brasil, com 456 mulheres que realizaram o parto na instituição. O Trauma History Questionnaire e o Post-Traumatic Stress Disorder Checklist foram utilizados para captar experiências traumáticas e sintomas de TEPT, respectivamente. A prevalência geral de TEPT foi de 9,4%. O TEPT mostrou-se mais prevalente entre mulheres com três ou mais partos, que tiveram recém-nascido com Apgar no 1º minuto menor ou igual a sete, com histórico de agravo mental antes ou durante a gravidez, com depressão pós-parto, que sofreram violência física ou psicológica perpetrada por parceiro íntimo na gravidez, que tiveram experiência sexual não desejada e que foram expostas a cinco ou mais traumas. Rápido diagnóstico e tratamento são fundamentais para melhorar a qualidade de vida da mulher e a saúde do recém-nascido.

Resumen El propósito de este artículo es estimar la magnitud del trastorno de estrés postraumático (TEPT) en el período post-parto, en una maternidad de referencia para los problemas perinatales e identificar subgrupos vulnerables. Se trata de un estudio transversal, realizado en una maternidad de alto riesgo fetal de Río de Janeiro, Brasil, a con 456 mujeres que habían realizado parto en la institución. Trauma History Questionnaire y Post-Traumatic Stress Disorder Checklist se utilizaron para capturar experiencias traumáticas y síntomas de TEPT, respectivamente. La prevalencia global de TEPT fue del 9,4%. El TEPT fue más frecuente entre las mujeres con tres o más partos, que tuvieron niños con Apgar en el minuto 1 inferior o igual a siete, con un historial de lesión mental antes o durante el embarazo, con depresión posparto, que sufrieron violencia física o psicológica perpetrada por su pareja durante el embarazo, que tuvieron experiencia sexual no deseada durante la infancia y que fueron expuestas a cinco o más traumas. Diagnóstico precoz y el tratamiento son fundamental para mejora en la calidad de las mujeres de la vida y la salud del recién nacido.

Abstract The objectives of this study were to estimate the prevalence of postpartum posttraumatic stress disorder (PTSD) in a maternity hospital for fetal high-risk pregnancies and to identify vulnerable subgroups. This was a cross-sectional study at a fetal high-risk maternity hospital in Rio de Janeiro, Brazil, with a sample of 456 women who had given birth at this hospital. The Trauma History Questionnaire and Post-Traumatic Stress Disorder Checklist were used to screen for lifetime traumatic events and PTSD symptoms, respectively. Overall prevalence of PTSD was 9.4%. Higher PTSD prevalence was associated with three or more births, a newborn with a 1-minute Apgar score of seven or less, history of mental disorder prior to or during the index pregnancy, postpartum depression, physical or psychological intimate partner violence during the pregnancy, a history of unwanted sexual experience, and lifetime exposure to five or more traumas. Rapid diagnosis and treatment of PTSD are essential to improve the mother’s quality of life and the infant’s health.

Prostate laser vaporization is safe and effective in elderly men

There are few data on the safety and efficacy of laser photoselective vaporization [LVP] in elderly men. We compared the safety and efficacy of LVP for the treatment of symptomatic benign prostatic hyperplasia [BPH] in men >/= 75 years, who we defined as elderly, to those <75 years. Safety and efficacy outcomes in elderly men undergoing LVP for lower urinary tract symptoms secondary to BPH from 2005 to 2012 were compared with men <75 years. Differences between-groups in demographics, perioperative outcomes, complications, and postoperative changes in International Prostate Symptom Score [I-PSS] were calculated. Of 202 patients, 49 [24%] were elderly [range: 75-95 years] and 153 [76%] were <75 years. Preoperatively, elderly men were more likely to have heart disease [35% vs. 20%, P = 0.03], gross hematuria [6.1% vs. 0.7%, P = 0.05], urinary retention [57% vs. 41%, P = 0.07], and take anti-coagulants [61% vs. 35%, P = 0.002]. Elderly men had a longer median length of stay [1 day vs. 0 day, P = 0.001]. There were no significant between-group differences in transfusion frequency [4.4% vs. 0.7%, P = 0.14] or Clavien III complications [2% vs. 2.6%, P = 1.0]. One month postsurgery, elderly patients reported smaller median decreases in I-PSS [5.5 vs. 9, P = 0.02] and urinary bother [1 point vs. 2, P = 0.03] compared with preoperative values. At till 9 months follow-up, there were no significant between-group differences in median I-PSS or urinary bother scores. Despite a higher prevalence of preoperative comorbidity and urinary retention, elderly LVP patients experienced perioperative safety and shorter term efficacy outcomes comparable to younger men

Shift Work and Occupational Stress in Police Officers

BACKGROUND: Shift work has been associated with occupational stress in health providers and in those working in some industrial companies. The association is not well established in the law enforcement workforce. Our objective was to examine the association between shift work and police work-related stress. METHODS: The number of stressful events that occurred in the previous month and year was obtained using the Spielberger Police Stress Survey among 365 police officers aged 27-66 years. Work hours were derived from daily payroll records. A dominant shift (day, afternoon, or night) was defined for each participant as the shift with the largest percentage of total time a participant worked (starting time from 4:00 AM to 11:59 AM, from 12 PM to 7:59 PM, and from 8:00 PM to 3:59 AM for day, afternoon, and night shift, respectively) in the previous month or year. Analysis of variance and covariance were used to examine the number of total and subscale (administrative/professional pressure, physical/psychological danger, or organizational support) stressful events across the shift. RESULTS: During the previous month and year, officers working the afternoon and night shifts reported more stressful events than day shift officers for total stress, administrative/professional pressure, and physical/psychological danger (p < 0.05). These differences were independent of age, sex, race/ethnicity, and police rank. The frequency of these stressful events did not differ significantly between officers working the afternoon and night shifts. CONCLUSION: Non-day shift workers may be exposed to more stressful events in this cohort. Interventions to reduce or manage police stress that are tailored by shift may be considered.