Ventriculitis due to multidrug-resistant gram-negative bacilli associated with external ventricular drain: evolution, treatment, and outcomes.

Introduction: Nosocomial infectious ventriculitis caused by multidrug-resistant (MDR) Gram-negative bacilli associated with external ventricular drainage (EVD) placement poses a significant mortality burden and hospital costs. Objectives: This study aims to analyze the characteristics, ventriculitis evolution, treatment, and outcomes of patients with ventriculitis due to MDR Gram-negative bacilli associated with EVD placement. Methods: A retrospective cohort study focusing on patients with nosocomial infection caused by MDR Gram-negative bacilli while on EVD was conducted from 2019 to 2022. Medical, laboratory, and microbiological records were collected. The antibiotic resistance of the Gram-negative bacilli isolated in the cerebrospinal fluid (CSF) of patients was analyzed. The risk factors were identified using univariate risk models and were analyzed using survival curves (Cox regression). An adjusted Cox proportional hazards model was also constructed. Results: Among 530 patients with suspected EVD-associated ventriculitis, 64 patients with isolation of Gram-negative bacilli in CSF were included. The estimated mortality was 78.12%. Hemorrhages (intracranial, subarachnoid, and intraventricular) were observed in 69.8% of patients. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most frequently isolated bacilli. In the univariate analysis, significant risk factors for mortality included arterial hypertension, a Glasgow Coma Scale (GCS) score of ≤ 8, invasive mechanical ventilation (IMV) upon hospital admission and during hospitalization, septic shock, and ineffective treatment. The adjusted Cox proportional hazards model revealed that septic shock (HR = 3.3, 95% CI = 1.5-7.2; p = 0.003) and ineffective treatment (HR = 3.2, 1.6-6.5, 0.001) were significant predictors. A high resistance to carbapenems was found for A. baumannii (91.3%) and P. aeruginosa (80.0%). Low resistance to colistin was found for A. baumannii (4.8%) and P. aeruginosa (12.5%). Conclusion: Ineffective treatment was an independent hazard factor for death in patients with ventriculitis caused by MDR Gram-negative bacilli associated with EVD.

Which health conditions report the most spending on medical imaging? Evidence for Colombia.

Medical imaging is essential for the proper diagnosis and treatment of many diseases. The literature has found that medical imaging generally accounts for a significant percentage of total healthcare spending. We analyzed a national database between 2013 and 2021, with more than 19 million patients on average, to review which health conditions account for the highest spending on medical imaging in the Colombian health system. We segmented the analysis by type of medical imaging, life cycles, health condition and sex. Our findings indicate that cardiac and mental illnesses account for the highest per capita spending on medical imaging, especially for the elderly. As a proportion of total expenditure, hypertension and tuberculosis are added, with special emphasis on the infancy-childhood life cycle.

Loss ratio of the capitation payment unit of the health-promoting entities in Colombia between 2017 and 2021: a financial-actuarial approach.

BACKGROUND: Because of a change of government, the Colombian Ministry of Health and Social Protection is in the process of presenting a structural reform for the General System of Social Security in Health (GSSSH), in order to implement a 'preventive and predictive health model'. However, it will always be relevant to review and analyze the fiscal implications of any proposed public policy program, to protect financial sustainability and to promote the better functioning of the system in question. METHODS: To contribute to this topic, we have calculated, using a financial-actuarial approach, the loss ratio for the years 2017 to 2021 for the Capitation Payment Unit (CPU) for all the Health-Promoting Entities (HPE) for both contributory and subsidized schemes. This information, derived from public reports available on the official website of the National Health Superintendency, allows us to estimate the financial burden of the institutions that guarantee access to and provision of health services and technologies in Colombia. RESULTS: The study shows that close to half of the HPEs in Colombia (which represent 11.6 million affiliates) have CPU loss ratios of more than 100% for the year 2021, evidencing insufficient resources for the operation of health insurance. CONCLUSIONS: Finally, we propose some policy recommendations regarding the strengthening of informed decision-making to allow the healthy financial sustainability of the Colombian GSSSH.

Technology acceptance factors of e-commerce among young people: An integration of the technology acceptance model and theory of planned behavior.

This study aims to examine the factors involved in the technological acceptance of e-commerce among young university students. The research is focused on the articulation between the Technology Acceptance Model (TAM) and the Theory of Planned Behavior (TPB) by collecting secondary data and conducting a survey with 376 young university students, validated by using structural equations (SEM). The predominant factors and variables involved in the adoption of e-commerce by young university students in Medellín were identified. The results show that the attitude towards usage has a positive effect on usage intention because people consider a website to be useful and trust builds regarding usage intention, which will enable to make the transaction in an easier and safer way. In conclusion, perceived usefulness comes before attitude towards usage, and thus the main direct antecedent of the intention to use e-commerce is established.

University Dropout Model for Developing Countries: A Colombian Context Approach.

University dropout is a problem that has raised great concern in institutions of higher education. For this reason, academic institutions need to study the phenomenon and come up with alternatives that contribute to the improvement of students' individual commitments. The aim is to examine the dimensions influencing the decision of university students to drop out. A quantitative approach study was carried out, based on a cross-sectional exploratory-descriptive field design, in which 372 students participated. According to the participants, one of the dimensions that influence the decision to leave the university is the support of the institutions to the continuity of the motivation processes to the student body, since the easy access to the credits is greater than the scholarships granted, which coincides with the financing restrictions of university students in developing countries. In conclusion, it is observed that the communication between managers, teachers, and students is a key factor in the processes of academic retention as a strategy to combat the phenomenon of university desertion.

Preliminary phytochemical analysis and in vitro antifungal activity of the ethanolic extract of the leaves of Solanum hispidum pers. collected in the locality in Obraje - Peru. / Análisis fitoquímico preliminar y actividad antifúngica In vitro del extracto etanólico de las hojas de Solanum hispidum pers. Colectadas en la localidad Obraje - Perú.

OBJECTIVE.: To analyze and determine the in vitro antifungical activity of the ethanolic extract of the leaves of Solanum hispidum Pers. MATERIALS AND METHODS.: We carried out a preliminary qualitative phytochemical analysis by color and precipitation reactions. We evaluated the in vitro antifungical activity against Candida albicans, Aspergillus brasilensis and Trichophyton mentagrophytes by using the agar well diffusion method and the minimum inhibitory concentration (MIC) assay. RESULTS.: Preliminary qualitative phytochemical analysis showed the presence of phenolic compounds, tannins, flavonoids, steroids, alkaloids and saponins. In vitro antifungal activity was demonstrated for all fungal cultures with inhibition halos between 23 to 26 mm. The MIC values were 125, 250, and 125 µg/mL for C. albicans, A. brasilensis, and T. mentagrophytes, respectively. CONCLUSIONS.: The ethanolic extract of the leaves of Solanum hispidum Pers. contains important secondary metabolites and has moderate antifungical activity.

OBJETIVO: . Analizar y determinar la actividad antifúngica in vitro del extracto etanólico de las hojas de Solanum hispidum Pers. MATERIALES Y MÉTODOS: . Se realizó el análisis fitoquímico preliminar cualitativo mediante reacciones de color y precipitación. Se investigó la actividad antifúngica in vitro frente a Candida albicans, Aspergillus brasilensis y Trichophyton mentagrophytes usando el método de difusión en pozo de agar y el ensayo de la concentración mínima inhibitoria (CMI). RESULTADOS: . El análisis fitoquímico preliminar cualitativo mostró la presencia de compuestos fenólicos, taninos, flavonoides, esteroides, alcaloides y saponinas. La actividad antifúngica in vitro fue demostrada para todos cultivos fúngicos con halos de inhibición entre 23 a 26 mm. Los valores de la CMI fueron de 125, 250 y 125 µg/mL para C. albicans, A. brasilensis y T. mentagrophytes, respectivamente. CONCLUSIONES.: El extracto etanólico de las hojas de Solanum hispidum Pers contiene importantes metabolitos secundarios y tiene moderada actividad antifúngica.

Social and personal control, legitimacy of authorities, and social cohesion as protective factors of anti-sociality in adolescents / Control social y personal, legitimidad de las autoridades y cohesión social como factores protectores de la conducta antisocial en adolescentes

Abstract Law can shape individual and social behavior in different ways including through perceived control and legitimacy of authorities. The primary aim of this study was to investigate whether legitimacy of authorities, social and personal control, and social cohesion influence antisocial behaviors in juvenile offenders. The study, included a sample of two hundred juvenile offenders in Mexico, used structural equation modeling to test the relationship between the perception of just treatment by police and judges (i.e., legitimacy) and social and personal control and outcomes of antisocial behaviors and tendencies (self-report and probability of antisocial behavior as well as reports of peer antisocial behavior). Results indicate legitimacy of authorities and personal control had a negative effect while social control showed a positive effect on these behaviors. Social cohesion had a positive effect on social control. Our results suggest that legitimacy of authorities and personal control act as protective factors against antisocial behaviors whereas, contrary to the expected results, social control may be a risk factor. This research highlights the importance of preventative protective efforts in juvenile offenders such as just treatment and development of personal control rather than the use of punitive processes. In this sense, it is important to consider alternatives for judicial involvement and punishment such as community programs as well as cognitive and emotional prevention and intervention efforts to reduce antisocial behaviors. Programs such as the Reasoning and Rehabilitation Program, other cognitive skill interventions as well as developmental prevention programs have shown efficacy.

Resumen La ley puede modelar la conducta de diferentes maneras, consecuentemente, el objetivo de este estudio fue analizar los efectos de la legitimidad, el control social y personal, y la cohesión social en la conducta antisocial de jóvenes infractores. Doscientos menores infractores en México contestaron un cuestionario realizado para este estudio. Los datos fueron analizados a través de ecuaciones estructurales. Cuatro factores fueron especificados: Legitimidad de las autoridades, relacionada con la percepción de tratamiento justo por parte de policías y jueces. Disuasión y norma social conformaron la variable de control social. Orientación al futuro, normas personales y autodeterminación integraron la variable de control personal. La variable conducta antisocial resultó del autoreporte respecto a la conducta antisocial y la probabilidad de conducta antisocial, y del reporte de la conducta antisocial de los amigos. Los resultados indicaron un efecto negativo de la legitimidad y el control personal y uno positivo del control social en la conducta antisocial. La cohesión social tuvo un efecto positivo en el control social. Contrario a lo esperado el control social tuvo un efecto positivo en la conducta antisocial. Por lo tanto, se deben considerar alternativas al "tratamiento" en internamiento (cárcel), ya que la disuasión y el castigo no producen los efectos esperados de retraer a los adolescentes de que cometan delitos. La alternativa pudiera ser los programas de tratamiento comunitarios, así como programas de prevención e intervención que contemplen aspectos emocionales y cognitivos.

Análisis fitoquímico preliminar y actividad antifúngica In vitro del extracto etanólico de las hojas de Solanum hispidum pers. Colectadas en la localidad Obraje - Perú / Preliminary phytochemical analysis and in vitro antifungal activity of the ethanolic extract of the leaves of Solanum hispidum pers. collected in the locality in Obraje - Peru

RESUMEN Objetivo . Analizar y determinar la actividad antifúngica in vitro del extracto etanólico de las hojas de Solanum hispidum Pers. Materiales y métodos . Se realizó el análisis fitoquímico preliminar cualitativo mediante reacciones de color y precipitación. Se investigó la actividad antifúngica in vitro frente a Candida albicans, Aspergillus brasilensis y Trichophyton mentagrophytes usando el método de difusión en pozo de agar y el ensayo de la concentración mínima inhibitoria (CMI). Resultados . El análisis fitoquímico preliminar cualitativo mostró la presencia de compuestos fenólicos, taninos, flavonoides, esteroides, alcaloides y saponinas. La actividad antifúngica in vitro fue demostrada para todos cultivos fúngicos con halos de inhibición entre 23 a 26 mm. Los valores de la CMI fueron de 125, 250 y 125 µg/mL para C. albicans, A. brasilensis y T. mentagrophytes, respectivamente. Conclusiones. El extracto etanólico de las hojas de Solanum hispidum Pers contiene importantes metabolitos secundarios y tiene moderada actividad antifúngica.

ABSTRACT Objective. To analyze and determine the in vitro antifungical activity of the ethanolic extract of the leaves of Solanum hispidum Pers. Materials and methods. We carried out a preliminary qualitative phytochemical analysis by color and precipitation reactions. We evaluated the in vitro antifungical activity against Candida albicans, Aspergillus brasilensis and Trichophyton mentagrophytes by using the agar well diffusion method and the minimum inhibitory concentration (MIC) assay. Results. Preliminary qualitative phytochemical analysis showed the presence of phenolic compounds, tannins, flavonoids, steroids, alkaloids and saponins. In vitro antifungal activity was demonstrated for all fungal cultures with inhibition halos between 23 to 26 mm. The MIC values were 125, 250, and 125 μg/mL for C. albicans, A. brasilensis, and T. mentagrophytes, respectively. Conclusions. The ethanolic extract of the leaves of Solanum hispidum Pers. contains important secondary metabolites and has moderate antifungical activity.

Characteristics, treatment, and nursing care of patients infected by Sars-CoV-2 hospitalized in intensive care units: multicenter study of colombian hospitals.

OBJECTIVES: To describe the clinical characteristics, treatment, evolution, and nursing care of adult patients with severe acute respiratory distress syndrome who were positive for SARS-CoV-2 and hospitalized in intensive care units (ICUs) during the first peak of the pandemic in Colombia, 2020. METHODS: Multicenter descriptive study of four high-complexity hospitals in Colombia, which included 473 consecutive adult patients admitted to intensive care units with a confirmed diagnosis of SARS CoV-2. Sociodemographic and clinical information - comorbidities, treatment and evolution - and nursing care provided were included. RESULTS: Of the patients included, 43.7% died, 88.8% had pneumonia, and 60.2% developed respiratory distress syndrome. Most of those who died were men. Those who died had a median age of 68.4 years and a higher frequency of comorbidities (hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and higher body mass index). They were admitted to the ICU with higher rate of dyspnea, lower oxygen saturation, and higher score of multiorgan failure. They also more often required mechanical ventilation and pronation therapy and were given more vasopressors and renal replacement therapy. CONCLUSIONS: People with severe acute respiratory distress syndrome due to COVID-19 who were hospitalized in the ICU had a high risk of death, especially older patients; males; those with cardiovascular, respiratory, and hypertension comorbidities; those who needed mechanical ventilation; and those with an elevated SOFA score. The nursing care of these critically ill patients focused on respiratory care and the prevention of associated complications.

Characteristics, treatment, and nursing care of patients infected by Sars-CoV-2 hospitalized in intensive care units: multicenter study of colombian hospitals / Características, tratamiento y cuidados de enfermería de pacientes infectados por SARS-CoV-2 hospitalizados en unidades de cuidados intensivos: estudio multicéntrico de hospitales colombianos / Características, tratamento e cuidados de enfermagem de pacientes infectados por SARS-CoV-2 hospitalizados em unidades de tratamento intensivos: estudo multicêntrico de hospitais colombianos

Objective. To describe the clinical characteristics, treatment, evolution, and nursing care of adult patients with severe acute respiratory distress syndrome who were positive for SARS-CoV-2 and hospitalized in intensive care units (ICUs) during the first peak of the pandemic in Colombia, 2020. Methods. Multicenter descriptive study of four high-complexity hospitals in Colombia, which included 473 consecutive adult patients admitted to intensive care units with a confirmed diagnosis of SARS CoV-2. Sociodemographic and clinical information - comorbidities, treatment and evolution - and nursing care provided were included. Results. Of the patients included, 43.7% died, 88.8% had pneumonia, and 60.2% developed respiratory distress syndrome. Most of those who died were men. Those who died had a median age of 68.4 years and a higher frequency of comorbidities (hypertension, cardiovascular disease, chronic obstructive pulmonary disease, and higher body mass index). They were admitted to the ICU with higher rate of dyspnea, lower oxygen saturation, and higher score of multiorgan failure. They also more often required mechanical ventilation and pronation therapy and were given more vasopressors and renal replacement therapy. Conclusion. People with severe acute respiratory distress syndrome due to COVID-19 who were hospitalized in the ICU had a high risk of death, especially older patients; males; those with cardiovascular, respiratory, and hypertension comorbidities; those who needed mechanical ventilation; and those with an elevated SOFA score. The nursing care of these critically ill patients focused on respiratory care and the prevention of associated complications.

Objetivo. Describir las características clínicas, tratamiento, evolución y cuidados de enfermería de los pacientes adultos con síndrome de dificultad respiratoria aguda grave, positivos para SARS-CoV-2, hospitalizados en Unidades de Cuidados Intensivos (UCI) durante el primer pico de pandemia en Colombia en 2020. Métodos. Estudio descriptivo multicéntrico con la participación de cuatro hospitales de alto nivel de complejidad en Colombia, que incluyó 473 pacientes adultos, admitidos de forma consecutiva en unidades de cuidados intensivos -UCI-, con diagnóstico confirmado para SARS CoV-2. Se incluyó información sociodemográfica, clínica, comorbilidades, tratamiento y evolución, además de los cuidados de enfermería brindados. Resultados. Del total de pacientes incluidos fallecieron el 43.7%, presentaron neumonía el 88.8% y un 60.2% desarrollaron síndrome de dificultad respiratoria. Las personas que fallecieron en su mayoría fueron hombres, con una mediana de edad de 68.4 años, con mayor frecuencia de comorbilidades (hipertensión, enfermedad cardiovascular, enfermedad pulmonar obstructiva crónica y mayor índice de masa corporal); además ingresaron a UCI con mayor presencia de disnea, menor saturación de oxígeno, y con puntaje mayor de falla multiorgánica. Así mismo, requirieron con más frecuencia de ventilación mecánica, terapia de pronación, uso de vasopresores y terapia de reemplazo renal. Los cuidados de enfermería de estos pacientes en estado crítico se enfocaron al cuidado respiratorio y la prevención de complicaciones asociadas. Conclusión. Las personas con síndrome de dificultad respiratoria aguda grave por COVID-19 que se hospitalizaron en UCI tuvieron un riesgo elevado de fallecer, especialmente los pacientes de mayor edad, sexo masculino y con comorbilidades cardiovasculares, respiratorias e hipertensión arterial, uso de ventilación mecánica y un puntaje puntaje de SOFA elevado. Los cuidados de enfermería de estos pacientes en estado crítico se enfocaron al cuidado respiratorio y la prevención de complicaciones asociadas.

Objetivo. Descrever as características clínicas, tratamento, evolução e cuidados de enfermagem dos pacientes adultos com síndrome de dificuldade respiratória aguda grave, positivos para SARS-CoV-2, hospitalizados nas Unidades de tratamentos Intensivos (UTI) durante o primeiro pico de pandemia na Colômbia em 2020. Métodos. Estudo descritivo multicêntrico com a participação de quatro hospitais de alto nível de complexidade na Colômbia, que incluiu 473 pacientes adultos, admitidos de forma consecutiva nas unidades de tratamentos intensivos -UTI-, com diagnóstico confirmado para SARS CoV-2. Se incluiu informação sociodemográfica, clínica, comorbilidades, tratamento e evolução, além dos cuidados de enfermagens brindados. Resultados. Do total de pacientes incluídos faleceram 43.7%, apresentaram pneumonia 88.8% e um 60.2% desenvolveram síndrome de dificuldade respiratória. As pessoas que faleceram em sua maioria foram homens, com uma média de idade de 68.4 anos, com maior frequência de comorbilidades (hipertensão, doença cardiovascular, doença pulmonar obstrutiva crónica e maior índice de massa corporal); ademais ingressaram a UTI com maior presença de dispneia, menor saturação de oxigeno, e com pontuação maior de falha multiorgânica. Assim mesmo, requereram com mais frequência de ventilação mecânica, terapia de pronação, uso de vasopressores e terapia de substituição renal. Os cuidados de enfermagem destes pacientes em estado crítico se enfocaram ao cuidado respiratório e a prevenção de complicações associadas. Conclusão. As pessoas com síndrome de dificuldade respiratória aguda grave por COVID-19 que se hospitalizaram em UTI tinham um elevado risco de morte, especialmente os pacientes mais velhos; os homens; aqueles com comorbilidades cardiovasculares, respiratórias e hipertensão; aqueles que precisavam de ventilação mecânica; e aqueles com um escore SOFA elevado. Os cuidados de enfermagem destes pacientes criticamente doentes concentraram-se nos cuidados respiratórios e na prevenção de complicações associadas.

Musculoskeletal disorders and related factors in the Colombian orthodontists' practice.

Objective. This study aimed to characterize the symptoms of musculoskeletal disorders (MSDs) and their related factors in a group of orthodontists in the city of Medellín (Colombia). Methods. A cross-sectional study was conducted in a sample of 100 orthodontists. A survey provided sociodemographic and work-related information. MSDs were recorded through the Nordic questionnaire. Descriptive and bivariate analyses were carried out by determining the prevalence of MSD symptoms by anatomical zone and selected variables. Results. Prevalence of MSDs was 81% for males and 88% for females. Anatomical regions were the neck (males 44%, females 59%), shoulders (males 44%, females 48%), lower back-lumbar zone (males 63%, females 51%), elbow-forearm (males 15%, females 15%) and wrist-hand (males 32%, females 51%). The frequency of symptoms was higher in males >41 years old, with more than a work contract or females who worked >40 h per week, and in orthodontists (males-females) who reported higher work-related dissatisfaction levels. Conclusions. A high prevalence of MSDs was found among orthodontists, with differences in the frequency of symptoms related to sociodemographic and work-related factors. Preventive strategies related to health and work safety would be advisable considering the particular needs of this dentist group.

Presurgical epilepsy evaluation and epilepsy surgery.

With a prevalence of 0.8 to 1.2%, epilepsy represents one of the most frequent chronic neurological disorders; 30 to 40% of patients suffer from drug-resistant epilepsy (that is, seizures cannot be controlled adequately with antiepileptic drugs). Epilepsy surgery represents a valuable treatment option for 10 to 50% of these patients. Epilepsy surgery aims to control seizures by resection of the epileptogenic tissue while avoiding neuropsychological and other neurological deficits by sparing essential brain areas. The most common histopathological findings in epilepsy surgery specimens are hippocampal sclerosis in adults and focal cortical dysplasia in children. Whereas presurgical evaluations and surgeries in patients with mesial temporal sclerosis and benign tumors recently decreased in most centers, non-lesional patients, patients requiring intracranial recordings, and neocortical resections increased. Recent developments in neurophysiological techniques (high-density electroencephalography [EEG], magnetoencephalography, electrical and magnetic source imaging, EEG-functional magnetic resonance imaging [EEG-fMRI], and recording of pathological high-frequency oscillations), structural magnetic resonance imaging (MRI) (ultra-high-field imaging at 7 Tesla, novel imaging acquisition protocols, and advanced image analysis [post-processing] techniques), functional imaging (positron emission tomography and single-photon emission computed tomography co-registered to MRI), and fMRI significantly improved non-invasive presurgical evaluation and have opened the option of epilepsy surgery to patients previously not considered surgical candidates. Technical improvements of resective surgery techniques facilitate successful and safe operations in highly delicate brain areas like the perisylvian area in operculoinsular epilepsy. Novel less-invasive surgical techniques include stereotactic radiosurgery, MR-guided laser interstitial thermal therapy, and stereotactic intracerebral EEG-guided radiofrequency thermocoagulation.

Epidemiology and pathophysiology of autonomic seizures: a systematic review.

PURPOSE: To review the epidemiology and pathophysiology of autonomic symptoms and signs during epileptic seizures. METHODS: We performed a systematic literature search on the following autonomic symptoms and signs during epileptic seizures: cardiovascular changes, respiratory manifestations, gastrointestinal symptoms, cutaneous manifestations, sexual and genital manifestations, and urinary symptoms. RESULTS: Autonomic symptoms and signs can represent the predominant symptom at the onset of a focal seizure, which would then lead to the seizure being classified as a focal onset autonomic seizure. Conversely, clinically relevant autonomic symptoms and signs frequently accompany seizures of focal, generalized, and/or unknown onset, but the seizure is regardless classified according to other, more relevant features. Autonomic symptoms and signs do not represent mere reactions to motor activity or other behavioral seizure manifestations, but rather they are generated by epileptic discharges affecting the central autonomic network. We have reviewed the localizing and lateralizing information currently available on the seizure onset zone and on seizure propagation pathways as provided by systematic analysis of specific autonomic seizure symptoms and signs. We present data on how autonomic seizure symptoms and signs are useful for gaining a better understanding of the anatomical and functional organization of the central autonomic network. Finally, we discuss the differential diagnosis of focal autonomic seizures with autonomic symptoms and signs representing the sole seizure manifestation versus various non-epileptic conditions. CONCLUSIONS: Autonomic seizure symptoms and signs are relevant in clinical epileptology and open a unique window on the functional organization and pathophysiology of the central autonomic network.

Surveillance colonoscopy in Austria: Are we following the guidelines?

BACKGROUND AND STUDY AIM: The European guidelines for quality assurance in colorectal cancer screening and diagnosis contain postpolypectomy surveillance recommendations. They recommend follow-up intervals depending on the findings at index colonoscopy, and divide patients into a low-, intermediate- or high-risk group. The aim of this study was to assess the adherence of Austrian endoscopists to the European guidelines and to determine whether sending a reminder letter resulted in better adherence. METHODS: A single reminder letter containing the guidelines was sent to all endoscopists who participated in the Certificate of Quality for Screening Colonoscopy program in Austria. Adherence was assessed before and after the letter had been sent. Factors associated with adherence were investigated. RESULTS: We found poor baseline adherence to the guidelines. After the reminder letter, the adherence slightly improved in the low-risk group, but did not change in the intermediate-risk or high-risk groups. An adenoma detection rate of at least 20 % was associated with higher adherence rates. Generally, internists and hospitals showed better adherence compared with surgeons and private practices, respectively, both before and after the reminder letter. CONCLUSION: A single reminder letter was not enough to improve the poor adherence to the European postpolypectomy surveillance guidelines. Thus, future studies are required to identify and eliminate all factors responsible for nonadherence to postpolypectomy guidelines in order to reach the goal of a safe, effective, and cost-effective colorectal cancer prevention tool in the near future.

Early detection of gastric cancer using global, genome-wide and IRF4, ELMO1, CLIP4 and MSC DNA methylation in endoscopic biopsies.

Clinically useful molecular tools to triage gastric cancer patients are not currently available. We aimed to develop a molecular tool to predict gastric cancer risk in endoscopy-driven biopsies obtained from high-risk gastric cancer clinics in low resource settings.We discovered and validated a DNA methylation biomarker panel in endoscopic samples obtained from 362 patients seen between 2004 and 2009 in three high-risk gastric cancer clinics in Lima, Perú, and validated it in 306 samples from the Cancer Genome Atlas project ("TCGA"). Global, epigenome wide and gene-specific DNA methylation analyses were used in a Phase I Biomarker Development Trial to identify a continuous biomarker panel that combines a Global DNA Methylation Index (GDMI) and promoter DNA methylation levels of IRF4, ELMO1, CLIP4 and MSC.We observed an inverse association between the GDMI and histological progression to gastric cancer, when comparing gastritis patients without metaplasia (mean = 5.74, 95% CI, 4.97-6.50), gastritis patients with metaplasia (mean = 4.81, 95% CI, 3.77-5.84), and gastric cancer cases (mean = 3.38, 95% CI, 2.82-3.94), respectively (p < 0.0001). Promoter methylation of IRF4 (p < 0.0001), ELMO1 (p < 0.0001), CLIP4 (p < 0.0001), and MSC (p < 0.0001), is also associated with increasing severity from gastritis with no metaplasia to gastritis with metaplasia and gastric cancer.Our findings suggest that IRF4, ELMO1, CLIP4 and MSC promoter methylation coupled with a GDMI>4 are useful molecular tools for gastric cancer risk stratification in endoscopic biopsies.

Onychomycosis in children. A review.

Onychomycosis is considered an age-related infection with increasing prevalence in the older age groups. It is rare in the pediatric population, except in children with Down syndrome and with immunodeficiencies, who are more likely to have fungal nail infections. The number of reports about onychomycosis in children is relatively small, and the epidemiologic data vary, but a rise in prevalence has been demonstrated. In this article, we review the most up-to-date literature and summarize the epidemiology, etiology, clinical presentation, diagnosis, and treatment of onychomycosis in children, as well as the differences with the disease presenting in adults. Dermatologists must consider onychomycosis in the differential diagnosis of nail alterations in children and always perform a mycological study to confirm the diagnosis.

Risk factors cannot explain the higher prevalence rates of precancerous colorectal lesions in men.

BACKGROUND: Prevalence of (pre)cancerous colorectal lesions are higher in men than in women, although transition rates from advanced lesions to cancer is similar in both sexes. Our aim was to investigate whether the sex-specific difference in incidence of premalignant colorectal lesions might be explained by the impact of risk factors. METHODS: A cross-sectional study analysing health check-up examinations and screening colonoscopies performed within a national quality assurance program. RESULTS: A total of 25 409 patients were included in this study, 50.8% were women. Median age for both sexes was 60 years (interquartile range (IQR) 54-67). A multivariable model showed that risk factors mediated only 0.6 of the 10.4% gender gap in adenoma and 0.47 of the 3.2% gender gap in advanced adenoma detection rate. Smoking was the only independent risk factor with a varying sex-specific effect (men OR 1.46, CI 1.29, 1.64, women OR 1.76, CI 1.53, 2.06) and advanced adenomas (men OR 1.06, CI 0.80-1.42; women OR 2.08, CI 1.52-2.83). Independent risk factors for adenomas were BMI (OR 1.35 per IQR, CI 1.25-1.47) and triglyceride level (OR 1.03 per IQR, CI 1.00-1.06); for advanced adenomas physical activity (none vs regular: OR 1.54, CI 1.18-2.00, occasional vs regular: OR 1.17, CI 1.00-1.38), cholesterol level (OR 1.13 per IQR, CI 1.02-1.25), blood glucose level (OR 1.05 per IQR, CI 1.01-1.09) and alcohol score (OR 1.09 per IQR, CI 1.01-1.18). CONCLUSIONS: Risk factors cannot explain higher prevalence rates in men. Results of this study strongly underline the need for sex-specific screening recommendations.

Trends in quality of screening colonoscopy in Austria.

Background and study aim: Screening colonoscopy only effectively prevents colorectal cancer if performed with high quality. The aim of this study was to analyze the detection rates of premalignant colorectal lesions in screening colonoscopies performed within a nationwide quality control program for screening colonoscopy in Austria. Methods: Data from electronic records of the screening program from its implementation in 2007 until December 2014 were analyzed in order to calculate detection rates for adenomas, advanced adenomas, polyps, and proximal lesions, and rates of cecal intubation, sedation, complications, and adequate bowel preparation. Results were evaluated to identify trends and changes in quality parameters over the 8-year study period. Results: During the study period, 301 endoscopists provided data from 159 246 screening colonoscopies. Mean age of screened individuals was 61.1 years, and 49.1 % were women. Significant increases over time were found for age- and sex-adjusted adenoma detection rates (ADRs), which increased from a mean of 22.2 % (SD 10.7 %) in 2007/2008 to 24.2 % (SD 11.6 %) in 2013/2014. On average, each endoscopist increased their individual ADR by + 1.5 percentage points per 2-year period (95 % confidence interval [CI] 0.9 - 2.2 percentage points; P < 0.01). Similarly, detection rates for proximal lesions rose from 15.8 % (SD 9.8 %) to 21.7 % (SD 13.3 %  + 2.5 percentage points per 2-year period, 95 %CI 1.9 - 3.1 percentage points; P < 0.01). ADR in men increased from 27.6 % in 2007/2008 (SD 11.1 %) to 29.2 % in 2013/2014 (SD 12.7 %; P < 0.01); ADR in women increased from 14.2 % (SD 7.1 %) in 2007/2008 to 19.0 % (SD 10.5 %) in 2013/2014 (P < 0.01). Advanced adenoma detection rates decreased during the study period, from 11.4 % (SD 9.0 %) in 2007/2008 to 7.6 % (SD 5.4 %) in 2013/2014 (P = 0.06) in men, and from 5.5 % (SD 5.3 %) in 2007/2008 to 4.0 % (SD 4.1 %) in 2013/2014 in women (P = 0.21). Conclusions: This study showed an improvement in the quality of screening colonoscopies performed within a quality assurance program in Austria between 2007 and 2014. Although, overall ADR increased significantly during the study period, there was a decrease in the rate of advanced adenoma detection.