Comparison of clinical and cognitive characteristics of a Mexican adult clinical population with and without ADHD / Comparación de las características clínicas y cognitivas de una población clínica adulta mexicana con y sin TDAH

Abstract Introduction Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting approximately 5% of the world population, with symptoms that may persist into adulthood. Despite the findings on the clinical course of this disorder, information regarding comorbidity patterns, psychosocial and executive functioning in adult life in those with and without ADHD in Latin American samples is scarce. Objective The aim of this study is to compare the comorbidity pattern, psychosocial, and executive functioning of adults with and without ADHD from a clinical sample. Method One hundred and fifty-one patients between 20 and 45 years, with screened positively on ASRS-V1.1, were invited to continue an evaluation process as part of clinical research program (PROMETEO): 1) K-SADS-PL Mx interview, 2) MINI-Plus interview, ASRS-V1-1 18 item version, BRIEF self-reported questionnaire, SCQA-ADHD, and 3) Individual case review by clinical expert in ADHD. Results Individuals in the ADHD group had a higher average of comorbid disorders (2.5 SD 1.1 vs. 1.3 SD 1.0 respectively, F = .439; t = -6.621; df = 149; p < .001), more likelihood of procrastinating (OR = 6.5; 95% CI[2.6, 16.2]; z = 4.0) and were more likely to present difficulties in both the behavior regulation index (OR = 104.9; 95% CI[31.8, 345.7]; z = 7.65) and the metacognitive index (OR = 94.79; 95% CI[29.10, 308.76]; z = 7.56) compared to the non-ADHD group, regardless of gender. Discussion and conclusions Our results indicate that the ADHD adult group presented with more comorbidity, and worse psychosocial and executive functioning than non-ADHD adults.

Resumen Introducción El trastorno por déficit de atención con hiperactividad (TDAH) es un trastorno del neurodesarrollo que afecta aproximadamente al 5% de la población mundial, persistiendo hasta la adultez. A pesar de los hallazgos acerca del curso clínico de este trastorno, la información es escasa con respecto a los patrones de comorbilidad, funcionamiento psicosocial y ejecutivo en la vida adulta entre aquellos con y sin TDAH en muestras latinoamericanas. Objetivo Comparar el patrón de comorbilidad, el funcionamiento psicosocial y ejecutivo de adultos con y sin TDAH de una muestra clínica. Método Ciento cincuenta y un pacientes entre 20 y 45 años, quienes inicialmente presentaron un tamizaje positivo del ASRS-V1.1, fueron evaluados dentro de un programa de investigación clínica (PROMETEO) con los siguientes instrumentos: 1) la entrevista K-SADS-PL-Mx, 2) la entrevista MINI-Plus, la version de 18 items del ASRS-V1-1, y los cuestionarios autoaplicados BRIEF y SCQA-ADHD y 3) Revisión de cada caso por un clínico experto en el diagnóstico de TDAH. Resultados El grupo de TDAH comparado con aquel sin TDAH presentó un mayor promedio de trastornos comórbidos (2.5 DE 1.1 vs 1.3 DE 1.0 respectivamente, F = .439; t = -6.621; gl = 149; p < .001), mayor probabilidad de procrastinar (OR = 6.5; 95% IC[2.6, 16.2]; z = 4.0), y mayor probabilidad de presentar dificultades tanto en el índice de regulación de la conducta (OR = 104.9; 95% IC[31.8, 345.7]; z = 7.65) como en el índice metacognitivo (OR = 94.79; 95% IC[29.10, 308.76]; z = 7.56) independientemente del sexo. Discusión y conclusión Nuestros resultados señalan que los adultos con TDAH presentan mayor comorbilidad y peor funcionamiento psicosocial y ejecutivo que los adultos sin TDAH.

Menopausia y terapia hormonal de la menopausia. Las recomendaciones 2018 de la Unidad de Endocrinología Ginecológica de Clínica Alemana de Santiago -Sociedad Italiana de la Menopausia y la Sociedad Chilena de Endocrinología Ginecológica / Menopause and menopausal hormone therapy. The 2018 recommendations of the Gynecological Endocrinology Unit of Clínica Alemana de Santiago -Italian Society of Menopause and the Chilean Society of Gynecological Endocrinology

ABSTRACT In the last decade, the risk benefits ratio of MHT has been evaluated mainly in terms of cardiovascular risk. Present Consensus Statement is largely inspired by the Global Consensus on Menopausal Hormone Therapy in 2013 and 2016 by leading global menopause societies (The American Society for Reproductive Medicine, The Asia Pacific Menopause Federation, The Endocrine Society, The European Menopause and Andropause Society, The International Menopause Society, The International Osteoporosis Foundation and The North American Menopause Society). The aim of these Recommendations is to provide a simple and updated reference on postmenopausal MHT. The term MHT typically includes estrogen replacement therapy (ERT) and estrogen-progestogen therapy (EPT). EPT can be sequential (Seq) when progestogen is added to ERT for 10-14 days a month, or continuous combined (CC) when progestogen is administered continuously every day along with a fixed amount of estrogen. MHT also includes Tibolone and the Tissue Selective Estrogen Complex (TSEC).

Infecciones osteoarticulares no vertebrales por Candida spp. en un hospital de alta complejidad en Medellín, Colombia / Non vertebral osteoarticular infections by Candida spp. in a hospital of high complexity in Medellín, Colombia / Infecções osteoarticulares não vertebrais por Cândida spp. num hospital de alta complexidade em Medellín, Colômbia

Objetivo: describir las características clínicas y demográficas de pacientes con osteomielitis por Candida spp. en el Hospital Pablo Tobón Uribe de Medellín. Metodología: observacional descriptiva. Resultados: se encontraron 30 pacientes con osteomielitis por Candida spp. El 70% está conformado por hombres, con una media de edad de 49.9 años. El 46% tenía como antecedente algún tipo de inmunosupresión. El 60% tenía osteomielitis por Candida spp. como único aislamiento y 40%, osteomielitis bacteriana concomitante. Un paciente tuvo candidemia. El 46% tenía previamente una intervención quirúrgica y el 26% algún tipo de material de osteosíntesis. 26 pacientes (86%) recibieron antibióticos previamente, y son los carbapenémicos, piperacilina, tazobactam y vancomicina los más utilizados. El hueso largo fue el segmento óseo más afectado: 33%. Candida no albicans estuvo en el 63% y Candida spp. en un 3.3%. De Candida no albicans la más frecuente fue Candida. parapsilosis en 57%. El 97% de los aislamientos fue sensible a fluconazol y voriconazol. El 46% completó tratamiento. De un 43% no se obtuvo el dato de seguimiento y el 6.6% no completó el tratamiento. Conclusiones: la osteomielitis por Candida es una entidad que está en aumento y crea la necesidad de realizar estudios analíticos para explorar los factores de riesgo relacionados. Además, se confirma el aumento de los aislamientos de Candida no albicans que se describe en la literatura y se encontró sólo un caso con sensibilidad intermedia a fluconazol.

Objective: To describe the clinical and demographical characteristics of patients with osteomyelitis due to Candida spp. in Hospital Pablo Tobón Uribe in Medellín. Methodology: Observational, descriptive study. Results: Thirty patients were found to have osteomyelitis due to Candida spp. Of these, 70% were male, with a mean age of 49.9 years. 46% had a history of some type of immunosuppression; 60% had osteomyelitis due to Candida spp. where it was the only microorganism isolated and 40% had concomitant bacterial osteomyelitis. One patient had candidemia. 46% had previously undergone surgery and 26% had had some type of osteosynthesis material. Twenty-six patients (86%) had previously received antibiotics, where carbapenems, piperacillin, tazobactam, and vancomycin were the most frequently used. The long bones were the most affected osseous segments (33%). Non-albicans Candida was 63% and Candida spp. 3.3%. The most frequent of non-albicans Candida was Candida parapsilosis in 57%. 97% of isolations were sensitive to fluconazole and voriconazole. 46% finished treatment. Follow-up data were not collected from 43%, while 6.6% did not finish treatment. Conclusions: As osteomyelitis due to Candida is increasing, analytic studies are warranted to explore associated risk factors. There was also an increase in non-albicans Candida compared to that which has been described in the literature, and only one case was found to have intermediate sensitivity to fluconazole.

Objetivo: descrever as características clínicas e demográficas de pacientes com osteomelite por Cândida spp. no Hospital Pablo Tobón Uribe de Medellín. Metodologia: observacional descritiva. Resultados: se encontraram 30 pacientes com osteomelite por Cândida spp. 70% está conformado por homens, com uma idade meia de 49.9 anos. 46% tinha como antecedente algum tipo de imunossupressão. 60% tinha osteomelite por Cândida spp. como único isolamento e 40%, osteomelite bacteriana concomitante. Um paciente teve candidemia. 46% tinha previamente uma intervenção cirúrgica e 26% algum tipo de material de osteosíntese. 26 pacientes (86%) receberam antibióticos previamente, e são os carbapenémicos, piperacilina, tazobactam e vancomicina os mais utilizados. O osso longo foi o segmento ósseo mais afetado: 33%. Cândida não albicans esteve em 63% e Cândida spp. em 3.3%. De Cândida não albicans a más frequente foi Cândida parapsilosis em 57%. 97% dos isolamentos foi sensível a fluconazol e voriconazol. 46% completou tratamento. De um 43% não se obteve dato de seguimento e 6.6% não completou o tratamento. Conclusões: a osteomielitis por Cândida é uma entidade que está em aumento e cria a necessidade de realizar estudos analíticos para explorar os fatores de risco relacionados. Ademais, se confirma o aumento dos isolamentos de Cândida não albicans que se descreve na literatura e se encontrou só um caso com sensibilidade intermedia a fluconazol.