Student’s perception on teaching and learning methods in pharmacology and changes recommended

Background: Understanding the changing trends in medical education technology helps to improve the teaching learning methods for medical graduates which can further help to improve the quality of health-care system. Apart from the conventional methods, several new methods of teaching are being introduced according to the changing medical curriculum. Most of these techniques are well accepted by the medical students. Aim and Objectives: The aim of the study was to collect feedback from the students to understand their perception on teaching and learning methods in the subject of pharmacology. Materials and Methods: This observational, cross-sectional, and questionnaire-based study was conducted in the Department of Pharmacology at Government Medical College, Thrissur, during the period 2017–2018. Pre-validated questionnaire was distributed among 2nd-year MBBS students, attending pharmacology classes and responses were collected and analyzed using a 5-point Likert scale. Results: Major responses from students perspective regarding teaching and learning methods in Pharmacology subject were that learning pharmacology is very important before going to clinics (96.5%), brief description about the clinical scenario is essential before discussing about the drugs (95.5%), knowledge of pharmacy and drug dispensing methods are necessary for patient care (94.5%). Pharmacology should be taught along with clinical subjects (93%) and also problem-based learning and prescriptions are extremely useful in clinics (90.5%). Conclusion: Regular and systematic feedback from the learners side can significantly improve the quality of medical education and health-care system. Clinically oriented teaching methods can impart more interest in studying Pharmacology.

Adverse drug reaction profile of patients taking amantadine for traumatic brain injury in a tertiary care hospital

Background: Amantadine is found to be effective for the treatment of complications associated with traumatic brain injury. Drug-related side effects are common with Amantadine especially when combined with other drugs. Comprehensive information about the incidence and severity of these adverse effects is not available. Aim and Objectives: The aim of the study was to analyze the pattern of occurrence of adverse drug reactions (ADRs) in patients receiving Amantadine for traumatic brain injury in a tertiary care hospital. We also assessed the causality, severity and preventability of ADRs. Materials and Methods: This prospective cohort study was conducted among patients taking Amantadine for a continuous period of 1 month for traumatic brain injury in neurosurgery department between June 2020 and December 2020. Tools used were ADR Reporting form of National Pharmacovigilance Centre, WHO causality scale, Hartwig and Siegel scale, and Schumock and Thornton scale. Descriptive statistics were used and the values were expressed in numbers and percentages. Results: ADRs were experienced in 55 patients (36.7%) out of 150 patients and all the patients were on combination therapy. ADR was present more in male patients (63.6%) compared to females (36.4%). The most common ADRs were headache, ankle edema and dry mouth. Majority of ADRs belonged to the possible category according to the WHO causality assessment scale. Majority of the ADRs (61.9%) were mild level 1 according to severity scale. All the ADRs came under the definitely or probably preventable category. Conclusion: ADRs with Amantadine are common but mild and preventable.

The impact of maternal morbidity on cesarean section rates: exploring a Latin American network of sentinel facilities using the Robson's Ten Group Classification System

Background: Latin America has the highest Cesarean Section Rates (CSR) in the world. Robson's Ten Group Classification System (RTGCS) was developed to enable understanding the CSR in different groups of women, classified according to obstetric characteristics into one of ten groups. The size of each CS group may provide helpful data on quality of care in a determined region or setting. Data can potentially be used to compare the impact of conditions such as maternal morbidity on CSR. The objective of this study is to understand the impact of Severe Maternal Morbidity (SMM) on CSR in ten different groups of RTGCS. Methods: Secondary analysis of childbirth information from 2018 to 2021, including 8 health facilities from 5 Latin American and Caribbean countries (Bolivia, Guatemala, Honduras, Nicaragua, and the Dominican Republic), using a surveillance database (SIP-Perinatal Information System, in Spanish) implemented in different settings across Latin America. Women were classified into one of RTGCS. The frequency of each group and its respective CSR were described. Furthermore, the sample was divided into two groups, according to maternal outcomes: women without SMM and those who experienced SMM, considering Potentially Life-threatening Conditions, Maternal Near Miss and Maternal Death as the continuum of morbidity. Results: Available data were obtained from 92,688 deliveries using the Robson Classification. Overall CSR was around 38%. Group 5 was responsible for almost one-third of cesarean sections. SMM occurred in 6.7% of cases. Among these cases, the overall CSR was almost 70% in this group. Group 10 had a major role (preterm deliveries). Group 5 (previous Cesarean section) had a very high CSR within the group, regardless of the occurrence of maternal morbidity (over 80%). Conclusion: Cesarean section rate was higher in women experiencing SMM than in those without SMM in Latin America. SMM was associated with higher Cesarean section rates, especially in groups 1 and 3. Nevertheless, group 5 was the major contributor to the overall CSR. (AU)

Parche de sangre cervical para tratamiento de síndrome de hipotensión/ hipovolumen de líquido cefalorraquídeo espontáneo. Reporte de un caso / Cervical blood patch for the treatment of spontaneous cerebrospinal fluid hypotension/hypovolume syndrome. A case report

Presentamos el tratamiento eficaz de una filtración espontánea de líquido cefalorraquídeo (LCR) asociada a un síndrome de hipoten-sión/hipovolumen de LCR a nivel cervical alto, caracterizado por delirio y hematomas subdurales secundarios, refractarios al drenaje quirúrgico, que se resolvió con dos parches de sangre epidurales cervicales consecutivos.

We present the case of a cerebrospinal fluid (CSF) hypotension/hypovolume syndrome due to a spontaneous CSF fistula at the upper cervical level characterized by loss of consciousness and bilateral subdural hematomas refractory to two drainage surgeries that resolved with two consecutive blood patches on the leak site.

Enterocolitis necrosante posterior a evento aislado de taquicardia supraventricular: reporte de un caso de presentación neonatal atípica / Necrotizing enterocolitis after an isolated event of supraventricular tachycardia. Case report of atypical neonatal presentation

La taquicardia supraventricular (TSV) es la principal taquiarritmia en el recién nacido (RN) que requiere una resolución urgente. Por su parte, la enterocolitis necrosante (ECN) es la emergencia gastrointestinal más común que afecta principalmente a RN prematuros. Aunque estas se reconocen como patologías distintas, la bibliografía sugiere que los episodios de TSV pueden predisponer a los pacientes a la ECN a través de alteraciones en el flujo sanguíneo mesentérico y una disminución de la perfusión tisular. Se presenta aquí el caso clínico de un neonato prematuro que desarrolló un cuadro de ECN luego de un evento aislado de TSV con bajo gasto cardíaco

Supraventricular tachycardia (SVT) is the main tachyarrhythmia in the newborn (NB) that requires urgent resolution. Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency that mainly affects premature infants. Although these conditions are recognized as distinct pathologies, literature reports suggest that episodes of SVT may predispose patients to NEC secondary to disturbances in mesenteric blood flow and a decrease in tissue perfusion. We present here the clinical case of a premature neonate who developed NEC after an isolated SVT event with low cardiac output

Prescription pattern and rationality of fixed dose combinations in a tertiary care hospital – Record-based cross-sectional study

Background: Fixed dose combinations (FDCs) are combinations of two or more active drugs in a single pharmaceutical formulation. The rationality of FDC is a controversial and challenging issue in today’s practice of medicine. Aims and Objectives: The aim of the study was to assess the prescription pattern and rationality of FDCs in a tertiary care hospital. Materials and Methods: This is a record-based cross-sectional study conducted in the Department of Pharmacology, Government Medical College, Thrissur. The data were collected from the case records of 183 patients admitted under various departments during the month of January 2019. The FDCs prescribed were listed and the prescription pattern was assessed. All the FDCs were evaluated for rationality with the help of a comprehensive seven-point criteria by Panda et al. The data were analyzed using Epi info 7. Descriptive statistics were used to analyze the data. Results: Out of 183 case records, 39.3% contained at least one FDC, 13.1% contained two FDCs, and 4.4% contained three FDCs. The different drug classes prescribed as FDCs include anti-infective drugs 45%, vitamins and minerals 33%, analgesics 9%, and miscellaneous drug combinations 13%. The most prescribed anti-infective drug FDC is amoxicillin with clavulanic acid combination (56%). In our study, 92.5% of the antibacterial FDCs prescribed were rational and 7.5% irrational. According to the World Health Organization rationality criteria, 62% of the FDCs prescribed were rational and 38% were irrational. Conclusion: The present study showed the increased use of FDCs in tertiary care teaching hospital and most of the FDCs prescribed were rational (62%).

Prevalence of burnout syndrome in university students: A systematic review / Prevalencia del síndrome de burnout en estudiantes universitarios: Una revisión sistemática

Abstract Introdution Burnout syndrome is a social and health problem in college students. Objective To synthesize evidence from previous studies on the prevalence of burnout syndrome in university students in their three-dimensional approach. Method The search strategies followed the PRISMA guidelines and were based on the following descriptive terms: "burnout," "studies," "prevalence," "students." Pubmed, Web of Science Core Collection, PsicINFO, and Scielo were consulted. An evaluation of the quality of the information was carried out applying the STROBE positioning guidelines. Results We found 1,406 studies that were reduced to 46 studies for final analysis using the STROBE statement, eventually leaving 20 studies. One study (5%) was conducted in North America, five (25%) in Asia, nine (45%) in Latin America, and five (25%) in Europe. Of the 20 studies evaluated in the systematic review, those that had the best overall evaluation in the STROBE analysis were selected for discussion, corresponding to 10 (out of 75% of STROBE). Overall prevalence of each dimension of the syndrome was estimated at 55.4% for emotional exhaustion, 31.6% for cynicism, and 30.9% for academic efficacy. Discussion and conclusion Moderate levels of burnout syndrome prevail in the different populations of university students of different careers worldwide. In only a few studies is the prevalence low and this could be due to multiple evaluative variables.

Resumen Introducción El síndrome de burnout es un problema social y de salud en los estudiantes universitarios. Objetivo Sintetizar las pruebas de estudios anteriores sobre la prevalencia del síndrome de burnout en estudiantes universitarios en su enfoque tridimensional. Método Las estrategias de búsqueda siguieron las pautas de PRISMA y se basaron en los siguientes términos descriptivos: "burnout", "estudios", "prevalencia", "estudiantes". Se consultaron Pubmed, Web of Science Core Collection, PsicINFO y Scielo. Se llevó a cabo una evaluación de la calidad de la información aplicando las directrices de posicionamiento de STROBE. Resultados Se encontraron 1,406 estudios que se redujeron a 46 estudios para el análisis final utilizando la declaración STROBE, con lo que quedaron finalmente 20 estudios. Un estudio (5%) se llevó a cabo en América del Norte, cinco (25%) en Asia, nueve (45%) en América Latina y cinco (25%) en Europa. De los 20 estudios evaluados en la revisión sistemática, se seleccionaron para su discusión aquellos que tuvieron la mejor evaluación general en el análisis de la STROBE, correspondientes a 10 (de un 75% de la STROBE). La prevalencia general de cada dimensión del síndrome se estimó en un 55.4% para el agotamiento emocional, un 31.6% para el cinismo y un 30.9% para la eficacia académica. Discusión y conclusión Los niveles moderados del síndrome de burnout prevalecen en las diferentes poblaciones de estudiantes universitarios de distintas carreras en todo el mundo. En sólo unos pocos estudios la prevalencia es baja y esto podría deberse a múltiples variables evaluativas.

Caso clínico: aproximación a la vía aérea difícil en neonatología. Síndrome de Treacher-Collins / Clinical case: approach to the difficult airway in neonatology. Treacher-Collins syndrome

Cuando los recién nacidos presentan obstrucción de la vía aérea, requieren un manejo urgente y experto para evitar la mortalidad y la morbilidad. La definición de vía aérea difícil se relaciona con problemas en la intubación endotraqueal o en la ventilación a presión positiva con bolsa y máscara o reanimador de pieza en T. El manejo debe basarse en la comprensión del mecanismo fisiopatológico responsable de la vía aérea difícil. Las causas en el recién nacido pueden ser congénitas y/o adquiridas.Se presenta el caso de una recién nacida con síndrome de Treacher-Collins tipo 1 [OMIM #154500] con una disostosis mandibulofacial, micrognatia, hipoplasia malar, paladar hendido, sin cardiopatía congénita, asociado con intubación extremadamente difícil

f newborns have an airway obstruction, they require urgent and expert management to avoid mortality and morbidity. The definition of difficult airway includes problems in endotracheal intubation or positive pressure ventilation with bag and mask or T-piece resuscitator. Management should be based on an understanding of the pathophysiological mechanism responsible for difficult airway. The causes of difficult airway in the newborn can be congenital or acquired.We present the case of a newborn with Treacher-Collins syndrome Type 1 [OMIM # 154500] with a mandibulofacial dysostosis, micrognathia, malar hypoplasia, cleft palate, without congenital heart disease, associated with extremely difficult intubation

Amphibians of Serra das Torres Natural Monument: a reservoir of biodiversity in the Atlantic Forest of southeastern Brazil / Anfíbios do Monumento Natural Serra das Torres: um reservatório da biodiversidade da Mata Atlântica no sudeste do Brasil

Abstract The Brazilian Atlantic Forest holds a major part of the country's amphibian species richness and high rates of endemism. In this study, we conducted surveys using the Rapid Assessment (RA) method to sample the amphibian fauna of the Serra das Torres Natural Monument (MONAST), an Atlantic Forest remnant in southeastern Brazil. We sampled actively with a 6-10-person team to collect standard samples from 09:00 to 12:00 hours for the daytime period, and from 18:00 to 22:00 hours for the crepuscular/nighttime period, with a total of approximately 1,320 hours of sampling effort. We supplemented these data with 720 hours of passive sampling, using pitfall traps with drift fences (30 bucket-days). We recorded 54 amphibian species (two gymnophionans and 52 anurans), and the species richness estimated by the Bootstrap method indicates that a slightly larger number of species (n = 60) may occur in the study area. The most speciose family was Hylidae (n = 21), followed by Brachycephalidae (n = 8). Overall, 25% of the species (n = 13) were recorded only once (singletons) and 15% (n = 8) only twice (doubletons). Most amphibians recorded in this study (71%, n = 37 species) were restricted to the Atlantic Forest biome, two species (Euparkerella robusta and Luetkenotyphlus fredi) are endemic to the Espírito Santo state, and one of them, the leaf litter species E. robusta, is endemic to the MONAST. Euparkerella robusta is currently listed as Vulnerable by the IUCN and is classified as Critically Endangered in the Espírito Santo State red list, while L. fredi has yet to be evaluated due to its recent description. Thoropa lutzi is currently listed as Endangered (EN) by both the IUCN and in the State list. Nine species are listed as Data Deficient (DD) and populations of 13 species are considered to be declining by the IUCN. We extend the geographical distribution of two anuran species (Hylodes babax and Phasmahyla lisbella) and fill an important gap in the distribution of Siphonops hardyi. Amphibians associated with the forest floor represented 42% of the species richness from MONAST, and 43% of these species inhabit the leaf litter exclusively. Our study revealed that Serra das Torres preserves a considerable diversity of Atlantic Forest amphibians, which reinforces the need for the conservation of this forest remnant.

Resumo A Mata Atlântica brasileira guarda importante porção da riqueza de anfíbios e altas taxas de endemismos. Neste estudo, nós realizamos pesquisas usando o Método de Avaliação Rápida (RA) com o objetivo de inventariar a fauna de anfíbios de um remanescente da Mata Atlântica no sudeste do Brasil, o Monumento Natural Serra das Torres (MONAST). Amostramos ativamente com uma equipe de 6 a 10 pessoas para coletar amostras padronizadas entre 09:00 e 12:00 horas durante o peíodo diurno e entre 18:00 e 22:00 duranto período crepuscular/noturno, totalizando aproximadamente 1320 horas de esforço amostral. Complementamos estes dados com 720 horas de amostragem passiva usando armadilhas de queda com cercas-guia (30 dias de balde). Registramos 54 espécies de anfíbios (dois gimnofionos e 52 anuros) e a riqueza de espécies estimada pelo Bootstrap indicou um número relativamente maior de espécies (n = 60). A família mais especiosa foi Hylidae (n = 21), seguida por Brachycephalidae (n = 8). No geral, 25% das espécies (n = 13) foram registradas apenas uma vez - singletons e 15% (n = 8) apenas duas vezes (doubletons). A maioria dos anfíbios registrados neste estudo (71%, n = 37 espécies) esteve restrita ao bioma Mata Atlântica, duas espécies (Euparkerella robusta e Luetkenotyphlus fredi) são endêmicas do estado do Espírito Santo, sendo uma delas, a espécie de serapilheira E. robusta, endêmica do MONAST. Euparkerella robusta está atualmente listada como Vulnerável pela IUCN e classificada como Criticamente Ameaçada na lista vermelha do estado do Espírito Santo, enquanto L. fredi ainda não foi avaliada devido a sua descrição ser muito recente. Thoropa lutzi está atualmente listada como Ameaçada (EN) pela IUCN e na lista estadual. Nove espécies estão listadas como Deficiente de Dados (DD) e as populações de 13 espécies são consideradas em declínio pela IUCN. Estendemos a distribuição geográfica de duas espécies de anuros (Hylodes babax e Phasmahyla lisbella) e preenchemos uma importante lacuna na distribuição de Siphonops hardyi. Os anfíbios associados ao chão da floresta representaram 42% das espécies do MONAST e 43% destas espécies habitavam exclusivamente a serapilheira. Nosso estudo revelou que a Serra das Torres preserva diversidade considerável de anfíbios da Mata Atlântica, o que reforça a necessidade de conservação desse remanescente florestal.

Clinical findings of equine leukoencephalomalacia

ABSTRACT: Equine leukoencephalomalacia (LEM) is a disease caused by the ingestion of food, especially corn, contaminated by fumonisin, a Fusarium verticillioides (synonymous with F. moniliforme) metabolite. The clinical signs of brain injuries have an acute onset and rapid evolution. This study aimed to describe the clinical findings in 11 animals diagnosed with LEM, including cerebrospinal fluid (CSF) analysis. Of these animals, 91% (10/11) were horses, and only 9% (1/11) were asinine. The clinical localization of the lesions was 64% (7/10) cerebral, manifested mainly by altered mental state and behavioral disturbance, and 36% (4/11) were brainstem lesions, manifested by incoordination, head tilt, nystagmus, facial hypoalgesia, difficulty in apprehension, chewing, and swallowing food. Postmortem findings revealed that 82% (9/11) of the lesions were in the cerebrum and 18% (2/11) in the brainstem. CSF findings, such as xanthochromia (43%, 3/7), hyperproteinorrachia (50%, 3/6), and pleocytosis (43%, 3/7) were observed. The affected animals showed neurological signs that were compatible with cerebral and/or brainstem injuries. The CSF from animals with LEM may present with xanthochromia, hyperproteinorrachia, and pleocytosis, reinforcing the fact that this disease should be included in the differential diagnosis of encephalomyelopathies.

RESUMO: A leucoencefalomalácia (LEM) é uma enfermidade que acomete equídeos causada pela ingestão de milho e seus derivados e feno contaminados pela micotoxina fumonisina, um metabólito do fungo Fusarium verticillioides (sinônimo para F. moniliforme). Os sinais clínicos apresentam início agudo e evolução rápida e são decorrentes de lesões encefálicas. O objetivo deste estudo é descrever os achados clínicos de 11 equídeos diagnosticados com LEM, incluindo a análise do líquido cefalorraquidiano (LCR). 91% dos animais afetados eram equinos e somente 9% (1/11) era asinino. A localização clínica das lesões era 64% (7/10) cerebrais, manifestadas por alterações no estado mental e comportamento e 36% (4/10) no tronco encefálico, manifestadas por incoordenação, desvio lateral de cabeça, nistagmo, hipoalgesia da face e dificuldade de apreensão, mastigação e deglutição de alimentos. Comparativamente, os achados post mortem revelaram que 82% (9/11) das lesões eram no cérebro e 18% (2/11) no tronco encefálico. Alterações no LCR, tais como xantocromia (43%, 3/7), hiperproteinorraquia (50%, 3/6) e pleocitose (43%, 3/7), foram observadas. Os animais afetados apresentaram sinais clínicos compatíveis com lesões encefálicas e/ou de tronco cerebral. O LCR de animais com LEM pode apresentar xantocromia, hiperproteinorraquia, e pleocitose, reforçando que esta doença deve ser incluída como diagnóstico diferencial de encefalomielites.

Clinical findings of equine leukoencephalomalacia / Achados clínicos de leucoencefalomalácia equina

Equine leukoencephalomalacia (LEM) is a disease caused by the ingestion of food, especially corn, contaminated by fumonisin, a Fusarium verticillioides (synonymous with F. moniliforme) metabolite. The clinical signs of brain injuries have an acute onset and rapid evolution. This study aimed to describe the clinical findings in 11 animals diagnosed with LEM, including cerebrospinal fluid (CSF) analysis. Of these animals, 91% (10/11) were horses, and only 9% (1/11) were asinine. The clinical localization of the lesions was 64% (7/10) cerebral, manifested mainly by altered mental state and behavioral disturbance, and 36% (4/11) were brainstem lesions, manifested by incoordination, head tilt, nystagmus, facial hypoalgesia, difficulty in apprehension, chewing, and swallowing food. Postmortem findings revealed that 82% (9/11) of the lesions were in the cerebrum and 18% (2/11) in the brainstem. CSF findings, such as xanthochromia (43%, 3/7), hyperproteinorrachia (50%, 3/6), and pleocytosis (43%, 3/7) were observed. The affected animals showed neurological signs that were compatible with cerebral and/or brainstem injuries. The CSF from animals with LEM may present with xanthochromia, hyperproteinorrachia, and pleocytosis, reinforcing the fact that this disease should be included in the differential diagnosis of encephalomyelopathies.(AU)

A leucoencefalomalácia (LEM) é uma enfermidade que acomete equídeos causada pela ingestão de milho e seus derivados e feno contaminados pela micotoxina fumonisina, um metabólito do fungo Fusarium verticillioides (sinônimo para F. moniliforme). Os sinais clínicos apresentam início agudo e evolução rápida e são decorrentes de lesões encefálicas. O objetivo deste estudo é descrever os achados clínicos de 11 equídeos diagnosticados com LEM, incluindo a análise do líquido cefalorraquidiano (LCR). 91% dos animais afetados eram equinos e somente 9% (1/11) era asinino. A localização clínica das lesões era 64% (7/10) cerebrais, manifestadas por alterações no estado mental e comportamento e 36% (4/10) no tronco encefálico, manifestadas por incoordenação, desvio lateral de cabeça, nistagmo, hipoalgesia da face e dificuldade de apreensão, mastigação e deglutição de alimentos. Comparativamente, os achados post mortem revelaram que 82% (9/11) das lesões eram no cérebro e 18% (2/11) no tronco encefálico. Alterações no LCR, tais como xantocromia (43%, 3/7), hiperproteinorraquia (50%, 3/6) e pleocitose (43%, 3/7), foram observadas. Os animais afetados apresentaram sinais clínicos compatíveis com lesões encefálicas e/ou de tronco cerebral. O LCR de animais com LEM pode apresentar xantocromia, hiperproteinorraquia, e pleocitose, reforçando que esta doença deve ser incluída como diagnóstico diferencial de encefalomielites.(AU)

Prevalencia y asociación de factores de riesgo cardiovascular en hombres con disfunción eréctil / Prevalence and association with cardiovascular risk in men with erectile dysfunction

Resumen Objetivo: estimar la prevalencia de los factores de riesgo para enfermedad cardiovascular en hombres con disfunción eréctil atendidos en un centro especializado en diferentes ciudades de Colombia y evaluar su asociación con el grado de severidad de la enfermedad. Métodos: estudio de corte transversal analítico. Se revisaron los registros clínicos de pacientes con diagnóstico de disfunción eréctil que fueron atendidos durante el primer semestre del año 2018. Se analizaron las características sociodemográficas y clínicas de los pacientes, y se estimó la prevalencia de los factores de riesgo cardiovascular. Se exploró la asociación entre estos factores y el grado de severidad de la disfunción eréctil por medio de modelos multivariados logísticos ordinales. Resultados: se incluyeron 2.484 pacientes que cumplieron los criterios de selección, con una edad promedio de 48,7 años (± 14,1). 2.112 sujetos presentaron uno o más factores de riesgo cardiovascular, para una prevalencia global de 85,2%. La prevalencia estimada para factor evaluado fue la siguiente: sobrepeso y obesidad 70,9%, edad superior a 45 años 60,0%, hiperlipidemia 25,1%, hipertensión 21,4%, consumo de tabaco 17,7%, diabetes 16,7%, infarto agudo de miocardio 2,21% y antecedente de alguna enfermedad cardiovascular diferente a infarto 1,68%. En el análisis multivariado se observó que la diabetes y la edad son factores que aumentan el riesgo de severidad de la disfunción eréctil. Conclusiones: es alta la prevalencia de factores de riesgo cardiovascular en hombres colombianos con disfunción eréctil. En ese sentido, el sobrepeso u obesidad es el factor modificable más frecuente en esta población. El grado de disfunción puede estar asociado con la edad y la diabetes.

Abstract Objective: To estimate the prevalence of risk factors of cardiovascular disease in men with erectile dysfunction attending a specialist clinic in different cities in Colombia, as well as their association with the level of severity of the disorder. Methods: A cross-sectional analytical study was conducted using a review of the medical records of patients diagnosed with erectile dysfunction and seen during the first six months of 2018. An analysis was made of the socio-demographic and clinical characteristics of the patients, and the prevalence of cardiovascular risk factors was calculated. The association between these factors and the level of severity of the erectile dysfunction was determined using ordinal multivariate logistic models. Results: The study included a total of 2,484 patients that met the selection criteria. The mean age was 48.7 (± 14.1) years. The majority (2.112) of subjects had one or more cardiovascular risk factors, with an overall prevalence of 85.2%. The estimated prevalence for a factor evaluated was as follows: overweight and obesity; 70.9%, age greater than 45 years; 60.0%, hyperlipidaemia; 25.1%, hypertension; 21.4%, smoking; 17.7%, diabetes; 16.7%, acute myocardial infarction; 2.21%, and a history of any cardiovascular disease other than an infarction; 1.68%. In the multivariate analysis it was observed that diabetes and age are factors that increase the risk of severity of erectile dysfunction. Conclusions: The prevalence of cardiovascular risk factors is high in Colombian men with erectile dysfunction. As regards this, overweight or obesity is the most common modifiable factor in this population. The level of dysfunction may be associated with age and diabetes.

The Role of Patent Foramen Ovale Closure in the Secondary Prevention of Cryptogenic Stroke: a Meta-Analysis Report

Abstract Background: Patent foramen ovale (PFO) closure has been compared to medical therapy for secondary prevention of recurrent cryptogenic stroke. Objectives: To produce an updated meta-analysis including only data from the primary analyses of clinical trials and to evaluate the role of PFO closure in the secondary prevention of recurrent stroke. Methods: Search in Medline (PubMed) and in ISI Web of Knowledge. Parameters under analysis and meta-analyses were: stroke, transient ischemic attack (TIA) and atrial fibrillation (AF). Comprehensive Meta-analysis Software V.2.0 (Biostat) was used. Random-effects analyses were carried out. A level of significance of 5% was used. Results: In this study six, randomized trials enrolling 3,750 patients were included. Unlike other published meta-analyses on the same topic, in this case, only clinical trial data, and not follow-up data, were used. PFO closure, as compared with medical therapy alone, demonstrated superiority in reducing the rate of recurrent stroke (risk ratio with PFO closure vs. medical therapy, 0.37; 95% confidence interval [CI], 0.17 to 0.78; p = 0.01). PFO closure did not offer a significant benefit in prevention of TIA (risk ratio with PFO closure vs. medical therapy, 0.96; 95% CI, 0.64 to 1.44; p = 0.85). Among patients assigned to closure group, an increased risk of atrial fibrillation was seen (risk ratio with PFO closure vs. medical therapy, 4.64; 95% CI, 2.38 to 9.01; p < 0.01). Conclusions: In patients with cryptogenic stroke who had a patent foramen ovale, a protective effect of closure was seen concerning the risk of recurrent stroke, but not regarding the prevention of TIA.

Efecto hipoglicemiante de Moringa oleifera (moringa) comparado con smallanthus sonchifolius (yacón) en Rattus norvegicus con diabetes mellitus inducida / Hypoglycemic effect of Moringa oleifera (moringa) compared with Smallanthus sonchifolius (yacon) on Rattus norvegicus with induced diabetes mellitus

RESUMEN Objetivo: Comparar el efecto hipoglicemiante del extracto acuoso de Moringa oleifera (moringa), Smallanthus sonchifolius (yacón) y metformina en Rattus norvegicus, variedad albina, con diabetes mellitus inducida. Materiales y métodos: Estudio preclínico, experimental controlado y aleatorizado. La diabetes se indujo por vía intraperitoneal con una dosis de aloxano a 130mg/kg de peso vivo (PV); se emplearon 24 Rattus norvegicus, variedad albina, machos, cepa Holfzman (seis por grupo). Se dividieron de la siguiente manera: grupo control (sin tratamiento), grupo metformina (14mg/kg PV), grupo M. oleifera (200mg/kg PV), y grupo S. sonchifolius (140 mg/kg PV), los tratamientos fueron administrados mediante sonda orogástrica durante 15 días. Los niveles de glicemia fueron determinados usando un glucómetro electrónico Accu-Chek® Instant (Roche). Resultados: Se observó reducción de la glicemia en los tratamientos: M. oleifera (p=0,009), S. sonchifolius (p=0,002) y metfotmina (p=0,002), en 313 mg/dL, 281,5 mg/dL y 415 mg/dL, respectivamente. En cuanto a la comparación de la glicemia en los grupos tratados y control, se observó que a las 24 horas y cuatro días de tratamiento no hubo diferencia (p>0,05); mientras que al octavo (p<0,05) y décimo quinto día (p<0,01) los grupos tratados tuvieron menor glicemia respecto al control, pero similares entre ellos. Conclusión: El extracto acuoso de S. sonchifolius y de M. oleifera, y la metformina presentaron similar efecto hipoglicemiante en ratas de experimentación con diabetes inducida.

ABSTRACT Objective: To compare the hypoglycemic effect of the aqueous extract of Moringa oleifera (moringa), Smallanthus sonchifolius (yacon) and metformin on Rattus norvegicus, albino variety, with induced diabetes mellitus. Materials and methods: Preclinical, experimental, controlled and randomized study. Diabetes was induced intraperitoneally with a dose of alloxan at 130 mg/kg. A total of 24 male Rattus norvegicus, albino variety, Holfzman strain (6 per group) were used. They were divided as follows: control group (no treatment), metformin group (14 mg/kg), M. oleifera group (200 mg/kg), and S. sonchifolius group (140 mg/kg), treatments were administered via orogastric tube for 15 days. Glycemia levels were determined using an Accu-Chek® Instant electronic glycometer (Roche). Results: Decreased glycemia was observed in the treatment groups: M. oleifera (p = 0.009), S. sonchifolius (p = 0.002) and metformin (p = 0.002), by 313 mg/dL, 281.5 mg/dL and 415 mg/dL, respectively. When comparing glycemia in the treated and control groups, no difference was observed (P > 0.05) at 24 hours and four days of treatment; while at the eighth (P < 0.05) and fifteenth day (P < 0.01) the treated groups had lower glycemia than the control group, but it was similar among them. Conclusion: The aqueous extract of S. sonchifolius, M. oleifera, and metformin presented similar hypoglycemic effect in experimental rats with induced diabetes.

Impact of Transcatheter Aortic Valve Implantation on Kidney Function / Impacto do Implante Percutâneo de Válvula Aórtica na Função Renal

Abstract Background: Chronic kidney disease (CKD) is frequently present in patients with aortic valve disease. Decreased kidney perfusion as a consequence of reduced cardiac output may contribute to renal dysfunction in this setting. Objective: Given the potential reversibility of kidney hypoperfusion after valve repair, this study aimed to analyze the impact of percutaneous transcatheter aortic valve implantation (TAVI) on kidney function. Methods: We performed a retrospective analysis of 233 consecutive patients who underwent TAVI in a single center between November 2008 and May 2016. We assessed three groups according to their baseline estimated glomerular filtration rate (eGFR) (mL/min/1.73 m2): Group 1 with eGFR ≥ 60; Group 2 with 30 ≤ eGFR < 60; and Group 3 with eGFR < 30. We analyzed the eGFR one month and one year after TAVI in these three groups, using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula to calculate it. Results: Patients from Group 1 had a progressive decline in eGFR one year after the TAVI procedure (p < 0.001 vs. pre-TAVI). In Group 2 patients, the mean eGFR increased one month after TAVI and continued to grow after one year (p = 0.001 vs. pre-TAVI). The same occurred in Group 3, with the mean eGFR increasing from 24.4 ± 5.1 mL/min/1.73 m2 before TAVI to 38.4 ± 18.8 mL/min/1.73 m2 one year after TAVI (p = 0.012). Conclusions: For patients with moderate-to-severe CKD, kidney function improved one year after the TAVI procedure. This outcome is probably due to better kidney perfusion post-procedure. We believe that when evaluating patients that might need TAVI, this 'reversibility of CKD effect' should be considered.

Resumo Fundamento: Pacientes com doença valvar aórtica frequentemente apresentam doença renal crônica (DRC). Diminuição da perfusão renal como consequência da redução do débito cardíaco pode contribuir para a disfunção renal neste cenário. Objetivo: Dado o potencial de reversibilidade da hipoperfusão renal após o reparo valvar, este estudo teve o objetivo de analisar o impacto do implante percutâneo de válvula aórtica (TAVI - transcatheter aortic valve implantation) na função renal. Métodos: Foi realizada uma análise retrospectiva de 233 pacientes consecutivos submetidos ao TAVI em um único centro, entre novembro de 2008 e maio de 2016. Três grupos foram avaliados de acordo com a taxa de filtração glomerular estimada (TFGe) basal (mL/min/1,73 m2): Grupo 1 com TFGe ≥ 60; Grupo 2 com 30 ≤ TFGe < 60; e Grupo 3 com TFGe < 30. O TFGe foi analisado nestes três grupos um mês e um ano após o TAVI e calculado usando a fórmula do Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI). Resultados: Os pacientes do Grupo 1 tiveram um declínio progressivo da TFGe um ano após o procedimento TAVI (p < 0,001 vs. pré-TAVI). Nos pacientes do Grupo 2, a média da TFGe aumentou um mês depois do TAVI e continuou crescendo depois de um ano (p = 0,001 vs. pré-TAVI). O mesmo ocorreu no Grupo 3, com a média da TFGe subindo de 24,4 ± 5,1 mL/min/1,73 m2 antes do TAVI para 38,4 ± 18,8 mL/min/1,73 m2 um ano após o TAVI (p = 0,012). Conclusões: Em pacientes com DRC moderada a grave, a função renal melhorou um ano após o procedimento TAVI. Este resultado é provavelmente devido à melhora da perfusão renal pós-procedimento. Acredita-se que, ao avaliar pacientes que possam precisar de TAVI, este 'efeito de reversibilidade da DRC' deva ser considerado.

Growth and weight status of Brazilian children with autism spectrum disorders: A mixed longitudinal study / Crescimento e massa corporal em crianças brasileiras com transtornos do espectro autista: um estudo longitudinal misto

ABSTRACT Objective: This study examined the growth status and physical development of Brazilian children with autism spectrum disorders from 4 to 15 years of age. Furthermore, it was examined whether variation in growth patterns and weight status was influenced by the use of psychotropic medications. Methods: One-hundred and twenty children aged 3.6-12.1 years at baseline (average = 7.2 years, SD = 2.3 years) diagnosed with autism spectrum disorders were measured on three repeated occasions across a 4-year period. Stature, body mass, and body mass index were considered. Bayesian multilevel modeling was used to describe the individual growth patterns. Results: Growth in stature was comparable to the age-specific 50th percentile for Centers for Disease Control and Prevention reference data until approximately 8 years, but a substantial decrease in growth rate was observed thereafter, reaching the age-specific 5th percentile at 15 years of age. Both body mass and body mass index values were, on average, higher than both the Brazilian and Centers for Disease Control and Prevention age-specific 95th percentile reference until 8 years, but below the 50th specific-age percentile at the age of 15 years. Conclusions: Brazilian boys with autism spectrum disorders between 4 and 15 years appear to have impaired growth in stature after 8-9 years of age, likely impacting pubertal growth. A high prevalence of overweight and obesity was observed in early childhood, although a trend of substantial decrease in body mass and body mass index was apparent when children with autism spectrum disorders entered the years of pubertal development.

RESUMO Objetivo: Este estudo examinou o estado de crescimento e o desenvolvimento físico de crianças brasileiras com transtornos do espectro autista entre 4 e 15 anos. Adicionalmente, examinamos se a variação nos padrões de crescimento e na massa corporal foi influenciada pelo uso de medicamentos psicotrópicos. Métodos: 120 crianças com idades entre 3,6 e 12,1 anos no início do estudo (média = 7,2 anos, DP = 2,3 anos) diagnosticadas com transtornos do espectro autista foram avaliadas em três ocasiões repetidas em um período de 4 anos. Foram considerados estatura, massa corporal e índice de massa corporal. O modelo multinível bayesiano foi utilizado para descrever os padrões de crescimento individual. Resultados: O crescimento em estatura foi comparável ao percentil 50 específico para a idade para os dados de referência do Centro de Controle e Prevenção de Doenças dos Estados Unidos até cerca de 8 anos. Porém, foi observada uma redução substancial na taxa de crescimento depois dos 8 anos, atingindo o percentil 5 específico para a idade aos 15 anos de idade. Tanto os valores de massa corporal quanto de índice de massa corporal foram, em média, maiores comparativamente ao percentil 95 específico para a idade até aos 8 anos da referência brasileira e do Centro de Controle e Prevenção de Doenças dos Estados Unidos, porém abaixo do percentil 50 específico para a idade aos 15 anos de idade. Conclusões: Os meninos brasileiros com transtornos do espectro autista entre 4 e 15 anos parecem ter retardo do crescimento na estatura após os 8-9 anos, provavelmente afeta o crescimento púbere. Foi observada uma alta prevalência de sobrepeso e obesidade na primeira infância, apesar de uma tendência de redução substancial na massa corporal e no índice de massa corporal ter sido aparente quando as crianças com transtornos do espectro autista entraram nos anos de desenvolvimento púbere.

Canine POMC deletion (P187fs) allele frequency in Labrador Retrievers in Brazil / Frequência de alelos mutados (P187fs) no POMC de cães Labrador Retriever no Brasil

The Labrador Retriever is among the main breeds with the greatest predisposition to obesity. Several factors, especially the interrelationships between food management, exercise and social factors; influence the likelihood of a dog becoming obese. Furthermore, genetic factors are also responsible for obesity in dogs, and in Labrador Retriever, a frameshift mutation (P187fs) in pro-opiomelanocortin (POMC) gene is strongly associated with obesity. There is no knowledge of studies that have previously evaluated the prevalence of the canine POMC deletion (P187fs) in Brazilian Labrador Retriever. Therefore, the objective of this study was to investigate this mutation in Labrador Retriever dogs in Brazil. Of the 108 Labrador Retrievers that were assessed in this study, 59 were from a previous study, composed by animals assisted in a veterinary hospital with unknown lineage, and 49 were from a prospective study, composed of 19 pet and 30 assistance/rescue Labrador Retriever dogs. The obesity risk and appetite questionnaire were applied, with some modifications, to tutors of the animals used in the prospective study. Fragments of the DNA, containing the mutation, were amplified by PCR and submitted to direct gene sequencing. The allele frequency of the mutation was 21.3% and was out of Hardy-Weinberg equilibrium (P<0.05). Using only the data of animals with known lineage, the presence of the mutated allele was higher in the Assistance/rescue Group than Pet Group (P<0.01), furthermore, the allele frequencies observed in Assistance Group (31.7%) was out of Hardy-Weinberg equilibrium (P<0.05), while that in the Pet Group (18.4%) was in equilibrium (P>0.05). Although the mutation has increased the food-motivation in the assistance/rescue dogs, other variables, especially frequent exercising, favored that these animals maintained the ideal body weight (body condition score = 5). In summary, the Hardy-Weinberg disequilibrium observed in the allele distribution of the deletion POMC_P187fs in this study, independently of the Labrador Retriever group assessed, suggesting the possibility of positive selection of the mutated allele, which may lead to the maintenance of this deleterious allele in the studied population.(AU)

O Labrador Retriever é uma das principais raças caninas com maior predisposição à obesidade. Vários fatores, especialmente as interrelações entre a alimentação, exercício e fatores sociais, influenciam a probabilidade de um cão se tornar obeso. Além disso, fatores genéticos são também responsáveis pela obesidade em cães, e no Labrador Retriever a mutação "frameshift" P187fs no gene pró-opiomelanocortina (POMC) está fortemente associada à obesidade. Não existem estudos prévios de prevalência da deleção P187fs no gene POMC em cães Labrador Retriever no Brasil. Portanto, o objetivo deste estudo foi investigar esta mutação em cães da raça Labrador Retriever no Brasil. Dos 108 Labradores Retrievers avaliados neste estudo, 59 eram de um estudo retrospectivo (composto por animais atendido no hospital veterinário e sem linhagem conhecida) e 49 eram de um estudo prospectivo (composto por 19 cães pet e 30 cães de assistência/resgate). Um questionário de risco de obesidade modificado foi aplicado nos tutores dos animais usados no estudo prospectivo. Fragmentos de DNA, contendo a mutação, foram amplificados por PCR e submetidos ao sequenciamento gênico direto. A frequência alélica da mutação foi de 21,3% e estava fora do equilíbrio de Hardy-Weinberg (P<0,05). Usando somente os dados dos animais de linhagem conhecida, a presença do alelo mutado foi maior no Grupo de cães de Assistência/resgate que no Grupo de Pets (P<0,01), além disso, as frequências alélicas nos Grupos de Assistência/resgate (31,7%) e no de pets (18,4%) estavam fora e em equilíbrio de Hardy-Weinberg (P<0,05), respectivamente. Embora a mutação tenha aumentado a motivação pelo alimento em cães Labrador Retriever do Grupo de Assistência/resgate, outras variáveis, especialmente o frequente exercício, favoreceu a manutenção o peso corporal ideal (peso corporal = 5). Em resumo, o desequilíbrio de Hardy-Weinberg observado na distribuição do alelo POMC_P187fs observado neste estudo, independentemente do grupo de Labrador Retriever avaliado, sugere a possibilidade de uma seleção positiva para o alelo mutado, o qual poderá levar a manutenção desse alelo deletério nesta população.(AU)