Symptoms of depression and anxiety in young people in El Salvador: Associations with peer and family relationships, artistic activities and health behaviours during the COVID-19 pandemic.

BACKGROUND: Little is known regarding the correlates of mental health, during the COVID-19 pandemic, in lower income countries. Using data from almost the entire population of graduating high school students in El Salvador, we examine the associations between depression and anxiety symptoms and potentially protective factors including peer and family relationships, health behaviours and artistic leisure activities. METHODS: Data comes from the AVANZO survey conducted in El Salvador with 42,314 graduating high school students aged 15-21 in November 2020. Participants completed the Revised Child Anxiety and Depression Scale and Socioemotional Skills Scale. Using a structural equation modelling framework, we tested the associations between these variables and whether these associations varied by sex. RESULTS: Participants who experienced more positive family relationships reported fewer symptoms of depression (ß = -0.304, p < .001) and anxiety (ß = -0.103, p < .001). Similar results were found between health behaviours and symptoms of depression (ß = -0.398, p < .001), and anxiety (ß = -0.312, p < .001). Peer relationships were non-significantly associated with depression and anxiety symptoms. Associations were similar for boys and girls. LIMITATIONS: Students undertook the mental health survey as part of an academic test, which might have increased mental stress. The Socioemotional Skills Scales is newly developed, and results are cross-sectional. CONCLUSIONS: Our findings provide insight into the experiences of an understudied population during the pandemic and identify positive family relationships and health behaviours as important correlates of mental health during this time.

Usefulness of magnetic resonance spectroscopy in mesial temporal sclerosis: a systematic review.

BACKGROUND: Magnetic resonance spectroscopy (MRS) provides non-invasive information about metabolic features in different regions of the brain affected by mesial temporal sclerosis (MTS). PURPOSE: To review articles analyzing the most common alterations in biochemical parameters in MTS and the applications of MRS in presurgical assessment. METHODS: We undertook a systematic literature search for MRS in MTS in PubMed, SCOPUS, and Cochrane based on the MESH terms ""Magnetic Resonance Spectroscopy", "Proton Magnetic Resonance Spectroscopy", "Carbon-13 Magnetic Resonance Spectroscopy", "1H-MRS", "31P-MRS", "mesial temporal sclerosis", "hippocampal sclerosis", "mesial temporal seizure", and "mesial temporal epilepsy". RESULTS: Of the initial 134 articles found, 30 were selected after the exclusion process. Of these, 13 detected a decrease in N-acetylaspartate (NAA), 9 showed a decreased in the ratio NAA/Cho+Cr, and 8 demonstrated a decreased in the ratio NAA/Cr, all of them in the ipsilateral hippocampus. Nine studies also found reduced NAA levels in extrahippocampal regions. CONCLUSIONS: The main findings were a decrease in NAA in the ipsilateral hippocampus. In addition, NAA levels were low outside the hippocampus so MTS could be a more extensive disease. Patients without MTS also presented a decrease in NAA in the ipsilateral hippocampus although NAA was even lower in the MTS patients. Thus, MRS could be useful in the presurgical evaluation to locate the epileptogenic focus, but not specific for the diagnosis of MTS.

Tratamiento endovascular de la estenosis de los senos venosos intracraneales en la hipertensión intracraneal: descripción de tres casos y discusión de la bibliografía / Endovascular treatment of intracranial venous sinus stenosis in intracranial hypertension: three case reports and a discussion of the literature

INTRODUCCIÓN: La hipertensión intracraneal idiopática es una entidad con una incidencia anual aproximada de 1,2 por cada 100.000 habitantes. Afecta en mayor proporción a mujeres obesas y en edad fértil. La cefalea es el síntoma más característico, seguido de las alteraciones visuales. En los últimos años, se ha incrementado el diagnóstico de la estenosis de los senos durales en los casos de hipertensión intracraneal resistentes al tratamiento convencional. Por ello, se encuentra en auge el desarrollo de la terapia endovascular como opción terapéutica en pacientes seleccionados. Casos clínicos. Se presentan tres casos de hipertensión intracraneal secundaria a estenosis de los senos durales, diagnosticados y tratados en nuestro hospital. A pesar de la instauración del adecuado tratamiento diurético y de la realización de procedimientos invasivos de derivación del líquido cefalorraquídeo, persistían la clínica neurológica y el déficit visual. Tras comprobar que cumplían los requisitos descritos en la bibliografía, se sometieron a la implantación de stent intracraneal (stenting), con resultado satisfactorio en todos ellos, logrando la desaparición de la cefalea y la recuperación de la agudeza visual. CONCLUSIÓN: El stenting de la estenosis de los senos durales como causa de hipertensión intracraneal es una técnica cada vez más utilizada que ha presentado resultados favorables. Es necesaria la realización de estudios para conocer su impacto a largo plazo

INTRODUCTION: Idiopathic intracranial hypertension is an entity with an incidence of approximately 1.2: 100,000 inhabitants/year. It affects in a greater proportion obese women and women of childbearing age. Headache is the most characteristic symptom, followed by visual disturbances. In recent years, the diagnosis of dural sinus stenosis has increased in cases of intracranial hypertension resistant to conventional treatment. For this reason, the development of endovascular therapy as a therapeutic option in selected patients is booming. Case reports. We present three cases of intracranial hypertension secondary to dural sinus stenosis, diagnosed and treated in our hospital. Despite the establishment of adequate diuretic treatment and the performance of invasive procedures to bypass the cerebrospinal fluid, they persisted with neurological symptoms and visual deficits. After verifying that they fulfilled the requirements described in the literature, they underwent intracranial stenting, with satisfactory results in all of them, achieving the disappearance of the headache and recovery of visual acuity. CONCLUSION: Stenting of dural sinus stenosis as a cause of intracranial hypertension is an increasingly used technique, which has presented favorable results. Studies are necessary to know its long-term impact

On relativistic multipole moments of stationary space-times.

Among the known exact solutions of Einstein's vacuum field equations the Manko-Novikov and the Quevedo-Mashhoon metrics might be suitable ones for the description of the exterior gravitational field of some real non-collapsed body. A new proposal to represent such exterior field is the stationary q-metric. In this contribution, we computed by means of the Fodor-Hoenselaers-Perjés formalism the lowest 10 relativistic multipole moments of these metrics. Corresponding moments were derived for the static vacuum solutions of Gutsunayev-Manko and Hernández-Martín. A direct comparison between the multipole moments of these non-isometric space-times is given.

Comparison of vacuum static quadrupolar metrics.

We investigate the properties of static and axisymmetric vacuum solutions of Einstein equations which generalize the Schwarzschild spherically symmetric solution to include a quadrupole parameter. We test all the solutions with respect to elementary and asymptotic flatness and curvature regularity. Analysing their multipole structure, according to the relativistic invariant Geroch definition, we show that all of them are equivalent up to the level of the quadrupole. We conclude that the q-metric, a variant of the Zipoy-Voorhees metric, is the simplest generalization of the Schwarzschild metric, containing a quadrupole parameter.

Brain Functional Connectivity Is Modified by a Hypocaloric Mediterranean Diet and Physical Activity in Obese Women.

Functional magnetic resonance imaging (fMRI) in the resting state has shown altered brain connectivity networks in obese individuals. However, the impact of a Mediterranean diet on cerebral connectivity in obese patients when losing weight has not been previously explored. The aim of this study was to examine the connectivity between brain structures before and six months after following a hypocaloric Mediterranean diet and physical activity program in a group of sixteen obese women aged 46.31 ± 4.07 years. Before and after the intervention program, the body mass index (BMI) (kg/m²) was 38.15 ± 4.7 vs. 34.18 ± 4.5 (p < 0.02), and body weight (kg) was 98.5 ± 13.1 vs. 88.28 ± 12.2 (p < 0.03). All subjects underwent a pre- and post-intervention fMRI under fasting conditions. Functional connectivity was assessed using seed-based correlations. After the intervention, we found decreased connectivity between the left inferior parietal cortex and the right temporal cortex (p < 0.001), left posterior cingulate (p < 0.001), and right posterior cingulate (p < 0.03); decreased connectivity between the left superior frontal gyrus and the right temporal cortex (p < 0.01); decreased connectivity between the prefrontal cortex and the somatosensory cortex (p < 0.025); and decreased connectivity between the left and right posterior cingulate (p < 0.04). Results were considered significant at a voxel-wise threshold of p ≤ 0.05, and a cluster-level family-wise error correction for multiple comparisons of p ≤ 0.05. In conclusion, functional connectivity between brain structures involved in the pathophysiology of obesity (the inferior parietal lobe, posterior cingulate, temporo-insular cortex, prefrontal cortex) may be modified by a weight loss program including a Mediterranean diet and physical exercise.

Cholinergic Potentiation and Audiovisual Repetition-Imitation Therapy Improve Speech Production and Communication Deficits in a Person with Crossed Aphasia by Inducing Structural Plasticity in White Matter Tracts.

Donepezil (DP), a cognitive-enhancing drug targeting the cholinergic system, combined with massed sentence repetition training augmented and speeded up recovery of speech production deficits in patients with chronic conduction aphasia and extensive left hemisphere infarctions (Berthier et al., 2014). Nevertheless, a still unsettled question is whether such improvements correlate with restorative structural changes in gray matter and white matter pathways mediating speech production. In the present study, we used pharmacological magnetic resonance imaging to study treatment-induced brain changes in gray matter and white matter tracts in a right-handed male with chronic conduction aphasia and a right subcortical lesion (crossed aphasia). A single-patient, open-label multiple-baseline design incorporating two different treatments and two post-treatment evaluations was used. The patient received an initial dose of DP (5 mg/day) which was maintained during 4 weeks and then titrated up to 10 mg/day and administered alone (without aphasia therapy) during 8 weeks (Endpoint 1). Thereafter, the drug was combined with an audiovisual repetition-imitation therapy (Look-Listen-Repeat, LLR) during 3 months (Endpoint 2). Language evaluations, diffusion weighted imaging (DWI), and voxel-based morphometry (VBM) were performed at baseline and at both endpoints in JAM and once in 21 healthy control males. Treatment with DP alone and combined with LLR therapy induced marked improvement in aphasia and communication deficits as well as in selected measures of connected speech production, and phrase repetition. The obtained gains in speech production remained well-above baseline scores even 4 months after ending combined therapy. Longitudinal DWI showed structural plasticity in the right frontal aslant tract and direct segment of the arcuate fasciculus with both interventions. VBM revealed no structural changes in other white matter tracts nor in cortical areas linked by these tracts. In conclusion, cholinergic potentiation alone and combined with a model-based aphasia therapy improved language deficits by promoting structural plastic changes in right white matter tracts.

Mild Developmental Foreign Accent Syndrome and Psychiatric Comorbidity: Altered White Matter Integrity in Speech and Emotion Regulation Networks.

Foreign accent syndrome (FAS) is a speech disorder that is defined by the emergence of a peculiar manner of articulation and intonation which is perceived as foreign. In most cases of acquired FAS (AFAS) the new accent is secondary to small focal lesions involving components of the bilaterally distributed neural network for speech production. In the past few years FAS has also been described in different psychiatric conditions (conversion disorder, bipolar disorder, and schizophrenia) as well as in developmental disorders (specific language impairment, apraxia of speech). In the present study, two adult males, one with atypical phonetic production and the other one with cluttering, reported having developmental FAS (DFAS) since their adolescence. Perceptual analysis by naïve judges could not confirm the presence of foreign accent, possibly due to the mildness of the speech disorder. However, detailed linguistic analysis provided evidence of prosodic and segmental errors previously reported in AFAS cases. Cognitive testing showed reduced communication in activities of daily living and mild deficits related to psychiatric disorders. Psychiatric evaluation revealed long-lasting internalizing disorders (neuroticism, anxiety, obsessive-compulsive disorder, social phobia, depression, alexithymia, hopelessness, and apathy) in both subjects. Diffusion tensor imaging (DTI) data from each subject with DFAS were compared with data from a group of 21 age- and gender-matched healthy control subjects. Diffusion parameters (MD, AD, and RD) in predefined regions of interest showed changes of white matter microstructure in regions previously related with AFAS and psychiatric disorders. In conclusion, the present findings militate against the possibility that these two subjects have FAS of psychogenic origin. Rather, our findings provide evidence that mild DFAS occurring in the context of subtle, yet persistent, developmental speech disorders may be associated with structural brain anomalies. We suggest that the simultaneous involvement of speech and emotion regulation networks might result from disrupted neural organization during development, or compensatory or maladaptive plasticity. Future studies are required to examine whether the interplay between biological trait-like diathesis (shyness, neuroticism) and the stressful experience of living with mild DFAS lead to the development of internalizing psychiatric disorders.

Alzheimer's like brain changes correlate with low adiponectin plasma levels in type 2 diabetic patients.

AIM: To study the association between adiponectin plasma levels, and gray matter brain volume and cerebral glucose metabolism in a group of type 2 diabetes patients. METHODS: We studied 25 type 2 diabetes patients and 25 age- and gender-matched healthy control participants. Biochemical analysis and structural cerebral magnetic resonance imaging, including voxel-based morphometry and (18)-fluorodeoxyglucose positron emission tomography, were performed. The gray matter volumes and metabolism changes were analyzed using statistical parametric mapping (SPM8). RESULTS: Lower levels of adiponectin correlated with a lower gray matter volume in temporal regions and with reduced cerebral glucose metabolism in temporal regions (p<0.001), adjusted for age, gender, education, and the presence of at least one epsilon 4 allele for the apolipoprotein E (APOEε4 genotype). CONCLUSIONS: Positive correlations between adiponectin plasma levels and both gray matter volume and cerebral glucose metabolism were found, predominantly in temporal regions, as in Alzheimer's disease. Adiponectin might be a biomarker for the cognitive decline associated with type 2 diabetic patients.

Association of early kidney allograft failure with preformed IgA antibodies to ß2-glycoprotein I.

In the current immunosuppressive therapy era, vessel thrombosis is the most common cause of early graft loss after renal transplantation. The prevalence of IgA anti-ß2-glycoprotein I antibodies (IgA-aB2GPI-ab) in patients on dialysis is elevated (>30%), and these antibodies correlate with mortality and cardiovascular morbidity. To evaluate the effect of IgA-aB2GPI-ab in patients with transplants, we followed all patients transplanted from 2000 to 2002 in the Hospital 12 de Octubre prospectively for 10 years. Presence of IgA-aB2GPI-ab in pretransplant serum was examined retrospectively. Of 269 patients, 89 patients were positive for IgA-aB2GPI-ab (33%; group 1), and the remaining patients were negative (67%; group 2). Graft loss at 6 months post-transplant was significantly higher in group 1 (10 of 89 versus 3 of 180 patients in group 2; P=0.002). The most frequent cause of graft loss was thrombosis of the vessels, which was observed only in group 1 (8 of 10 versus 0 of 3 patients in group 2; P=0.04). Multivariate analysis showed that the presence of IgA-aB2GPI-ab was an independent risk factor for early graft loss (P=0.04) and delayed graft function (P=0.04). There were no significant differences regarding patient survival between the two groups. Graft survival was similar in both groups after 6 months. In conclusion, patients with pretransplant IgA-aB2GPI-ab have a high risk of early graft loss caused by thrombosis and a high risk of delayed graft function. Therefore, pretransplant IgA-aB2GPI-ab may have a detrimental effect on early clinical outcomes after renal transplantation.

Dissociated repetition deficits in aphasia can reflect flexible interactions between left dorsal and ventral streams and gender-dimorphic architecture of the right dorsal stream.

Assessment of brain-damaged subjects presenting with dissociated repetition deficits after selective injury to either the left dorsal or ventral auditory pathways can provide further insight on their respective roles in verbal repetition. We evaluated repetition performance and its neural correlates using multimodal imaging (anatomical MRI, DTI, fMRI, and(18)FDG-PET) in a female patient with transcortical motor aphasia (TCMA) and in a male patient with conduction aphasia (CA) who had small contiguous but non-overlapping left perisylvian infarctions. Repetition in the TCMA patient was fully preserved except for a mild impairment in nonwords and digits, whereas the CA patient had impaired repetition of nonwords, digits and word triplet lists. Sentence repetition was impaired, but he repeated novel sentences significantly better than clichés. The TCMA patient had tissue damage and reduced metabolism in the left sensorimotor cortex and insula. DTI showed damage to the left temporo-frontal and parieto-frontal segments of the arcuate fasciculus (AF) and part of the left ventral stream together with well-developed right dorsal and ventral streams, as has been reported in more than one-third of females. The CA patient had tissue damage and reduced metabolic activity in the left temporoparietal cortex with additional metabolic decrements in the left frontal lobe. DTI showed damage to the left temporo-parietal and temporo-frontal segments of the AF, but the ventral stream was spared. The direct segment of the AF in the right hemisphere was also absent with only vestigial remains of the other dorsal subcomponents present, as is often found in males. fMRI during word and nonword repetition revealed bilateral perisylvian activation in the TCMA patient suggesting recruitment of spared segments of the left dorsal stream and right dorsal stream with propagation of signals to temporal lobe structures suggesting a compensatory reallocation of resources via the ventral streams. The CA patient showed a greater activation of these cortical areas than the TCMA patient, but these changes did not result in normal performance. Repetition of word triplet lists activated bilateral perisylvian cortices in both patients, but activation in the CA patient with very poor performance was restricted to small frontal and posterior temporal foci bilaterally. These findings suggest that dissociated repetition deficits in our cases are probably reliant on flexible interactions between left dorsal stream (spared segments, short tracts remains) and left ventral stream and on gender-dimorphic architecture of the right dorsal stream.

Histerectomía: 24 horas de estancia hospitalaria electiva / Hysterectomies: 24 hours of elective hospital stay

La incidencia de complicaciones en las pacientes sometidas a histerectomía abdominal y egresadas en las primeras 24 horas, es similar a las del grupo control y menor a la reportada a nivel mundial, de manera que esta investigación no encuentra riesgo alguno en tal proceder.

Enfermedades de transmisión sexual asociadas al VPH / Sexually transmitted diseases asociated of HPV

Las enfermedades de transmisión sexual se han vuelto incontrolables, tanto desde el punto de vista epidemiológico como desde una perspectiva terapéutica, de manera que cada día aumenta la incidencia de estas enfermedades y son pocas los tratamientos para enfrentarlas. Objetivo: Determinar en pacientes portadoras del virus del Papiloma Humano, a nivel cérvico vaginal, la incidencia de pruebas sanguíneas positivas para Clamydia, Herpes simple tipo II, Hepatitis B, Síndrome de Inmuno Deficiencia Adquirida y Sífilis. Para ello, se estudiaron sesenta y nueve pacientes de la consulta de los autores, en las que se había diagnosticado el VPH a través de una biopsia colposcópicamente dirigida, y tipeado a través de la PCR. Se procedió a realizar cinco pruebas sanguíneas, a saber: VDRL, HIV, HBsAg, Ig G, Ig M, anti Clamydia y Ig G, Ig M anti HSV II. La edad promedio fue de 25.7, con un 42 por ciento de mujeres casadas y una paridad promedio de 1,5 por ciento. El inicio de la vida sexual ocurrió en promedio a los 16 años, ninguna de ellas ha utilizado de manera estricta el preservativo y el número promedio de compañeros sexuales fue de 3.2. La incidencia de anticuerpos positivos para el HSV II fue de 79 por ciento. La incidencia de anticuerpos positivos para Clamydia fue de 58 por ciento. El SIDA tuvo una correlación del 0 por ciento. El antígeno Australia fue positivo en el 4.3 por ciento de la serie. El VDRL fue positivo en el 2.8 por ciento. El virus del Papiloma Humano se asocia a una alta incidencia de pruebas sanguíneas positivas para Clamydia, Herpes simple tipo II y Hepatitis B.

Hemodilución isovolémica preoperatoria en pacientes con histerectomía radical por cáncer de cérvix: Experiencia de 12 casos en el Hospital Dr. Rafael Angel Calderón Guardia / Isovolemic hemodilution preoperating in patients with radical hysterectomy for cervical cancer: Experience of 12 cases in the Hospital Dr. Rafael Angel Calderón Guardia

Justificación: El cáncer de cérvix es la patología neoplástica más frecuente entre la población femenina. En casos de invasión localizada, la histerectomía radical puede considerarse un tratamiento curativo, sin embargo, el sangrado transoperatorio significativo hace necesaria la transfusión en muchos casos, con todas las complicaciones que esta conlleva. Hasta donde sabemos, no hay ningún estudio publicado en la bibliografía nacional, acerca de la técnica de hemodilución isovolémica para reducir los requerimientos transfusionales en estas pacientes. Objetivos: a) Hacer experiencia clínica con la Hemodilución isovolémica en pacientes sometidas a histerectomía radical por cáncer de cérvix. b) Evaluar la utilidad de la Hemodilución isovolémica como un método para reducir la necesidad de transfusión de sangre alogénica. Materiales y métodos: El estudio fue prospectivo. Se seleccionó en forma consecutiva a todas las pacientes sometidas a histerectomía radical por cáncer de cérvix, del Servicio de Ginecología Oncológica del Hospital Dr. Rafael Angel Calderón Guardia, entre los meses de enero de 2000 a enero 2001. Se realizó sangría, a través de una línea arterial, un volumen hemático calculado con base en el peso y el hematocrito de la paciente. La sangre autóloga fue retransfundida al término de la cirugía...

L.A.S.E.R: una opción terapéutica para el Papiloma virus humano / L.A.S.E.R: a therapeutic option for the human Papilloma virus

Se analiza el efecto del láser de bióxido de carbono como tratamiento de las lesiones del papiloma virus humano a nivel cervical, vaginal y vulvar. Se estudiaron 20 pacientes con cuadros floridos a quienes se les diagnosticó el PVH a través de una biopsia dirigida por colposcopía. La tasa del éxito fue de 95 por ciento sin que se presentara ninguna complicación. El tiempo de reepitelización fue menor a 90 días en el 85 por ciento de la serie. Las reacciones adversas fueron leves. Se tomó como criterio de éxito una colposcopía post tratamiento negativa

Tratamiento de las lesiones por virus del Papiloma humano (PVH) a nivel cérvico-vaginal (criocirugía asociado a 5ïfluoracilo y aciclovir) / Treatment to lesions for human Papilloma virus (PVH) in cervico-vaginal level

72 pacientes fueron estudiados, todos con lesiones diagnosticadas a través de colposcopía y biopsia para P.H.V. Un esquema basado en dos categorías tal como la aplicación de crema 5-fluoracilo y aciclovir por vía oral. El estudio muestra efectividad en 80 por ciento y falla fue comunicada por pacientes que mostraron lesiones en la parte externa de la vagina. Complicaciones aparecieron en 42 por ciento de los pacientes, especialmemte en aquellos que mostraron alteraciones de la pelvis estática.

El varón portador del virus del Papiloma: un enfoque terapéutico / The men carrier of the Papillomarovirus: a terapeutic focussing

Se analizaron 30 pacientes en cuyas parejas se habían diagnosticado lesiones de PVH por colposcopía y biopsia. A todos se les sometió a una exploración y a una colposcopía con ácido acético. Se encontró que el 96 por ciento tenían lesiones condilomatosas. Al aplicar el tratamiento en base a 5 fluoracilo y aciclovir, 92 por ciento mostraron curación, hubo una tasa de 8 por ciento de complicaciones todas derivadas de una mala aplicación del producto. Se concluye que el 5 fluoracilo y el Aciclovir, administrado acorde al protocolo utilizado resultó útil en el 92 por ciento de la serie

El derecho a la muerte digna: 2 parte / The right to die with dignity: part 2

El derecho a la muerte digna -en nuestro país- ha sido producto de una creación jurisprudencial constitucional. Es decir, se creó un derecho fundamental, vía jurisprudencia, al desarrollar conceptos plasmados en la Constitución Política. Es importante resaltar el criterio de don Rubén Hernández Valle en cuanto al aspecto teleológico que el derecho a la vida encierra. Dice que lógicamente este derecho se refiere, en primer término, a la vida física, biológica del ser humano. No obstante, es conveniente recordar que la vida humana no se agota, como en el caso de los animales, en su manifestación netamente biológica. En él, por el contrario, lo más importante de su existencia es el aspecto espiritual, dado que es el único ser de la naturaleza cuya conducta es teleológica, es decir, el único ser que introduce fines en ella, para tratar de conformarla de acuerdo con sus ideas

Patrones morfológicos del virus Papiloma Humano (HPV) en vulvo-vaginitis / Morphological patterns of the Human Papillomavirus (PHV) in vulvo-vaginitis

Se estudiaron 42 pacientes con lesiones vulvo-vaginales sugestivas de PVH se les realiza una colposcopía y biopsia cérvico vaginal y se describen las características de las lesiones; encontrando patrones morfológicos que correlacionan en más de un 75 por ciento con el resultado de PVH por biopsia