Latinx Sexual Minority Adolescent Substance Use: State of the Science and Call for Intersectional Minority Stressors and Protective Factors.

Purpose of review: Latinx sexual minority adolescents (LSMA) are at an intersection of ethnic and sexual minority (SM) status and may experience heighten risk of substance use and related problems. These youth may also hold unique protective factors that help mitigate the effects of minority stress and curb substance use. Little is known, however, about the intersectional minority stressors (i.e., due to ethnicity and SM status) and protective factors related to substance use among this population. Recent Findings: According to the minority stress model, there are unique minority stressors and resiliency factors that can help explain differences in behavioral health rates between white SM and SM of color. Research supports the notion that minority stressors (e.g., stigma/risk, homophobic bullying, and family rejection of SM status) confer risk for substance use among LSMA. In terms of resilience, less is known, but there may be some protective factors that have not been measured that could explain lower rates in some substances (i.e., club drugs and methamphetamine). Summary: Little is known about how the intersections of ethnicity and SM status are associated with substance use in adolescence. Future research should assess the temporal relationship of multilevel (i.e., intrapersonal, relational, and system), intersectional (i.e., ethnicity and SM status) minority stressors and protective factors unique to LSMA on substance use. We propose that the findings from these future studies will help to create socioculturally appropriate behavioral health treatments that consider the intersectional risks and strengths within the LSMA population.

Valoración mediante resonancia magnética cerebral de embolias clínicamente silentes en pacientes con fibrilación auricular sometidos a cardioversión eléctrica / Assessment of silent microembolism by magnetic resonance imaging after cardioversion in atrial fibrillation

Introducción y objetivos. Estudiar si la cardioversión eléctrica en pacientes con fibrilación auricular puede causar lesiones cerebrales isquémicas agudas clínicamente silentes. Métodos. Se realizó un análisis prospectivo de 62 pacientes consecutivos (media de edad, 62±10 años; 16 mujeres). Todos ellos fueron anticoagulados durante al menos 3 semanas con acenocumarol, manteniendo una media de razón internacional normalizada=2,69±0,66. En todos los casos se realizó una resonancia magnética cerebral antes y 24 h después de la cardioversión, incluidas las secuencias potenciadas en difusión. Se realizó también una exploración neurológica antes y después del procedimiento, utilizando las escalas de ictus National Institute of Health Stroke Scale y de Rankin modificada. Se obtuvo el consentimiento informado por escrito en todos los casos. Resultados. De los 62 pacientes, en 51 (85%) se revirtió a ritmo sinusal. La exploración neurológica no mostró cambios después de la cardioversión. La resonancia magnética realizada antes del procedimiento mostró enfermedad de pequeño vaso en 35 pacientes (56%); de ellos, 2 presentaban enfermedad cerebrovascular previa conocida. La resonancia magnética tras la cardioversión no mostró nuevas áreas de isquemia en ningún caso. Conclusiones. Después de la cardioversión, no encontramos cambios en la exploración neurológica ni áreas de isquemia aguda en la resonancia magnética de ningún paciente de nuestra serie. Sin embargo, en nuestro estudio, la resonancia magnética basal mostró lesiones isquémicas clínicamente silentes en 35 pacientes (56%) con fibrilación auricular persistente (AU)

Introduction and objectives. To study electrical cardioversion in patients with atrial fibrillation as a potential cause of acute ischemic brain lesions. Methods. We performed prospective analysis of 62 consecutive patients (62 [10] years, 16 female). All of them were anticoagulated for at least 3 weeks with an international normalized tatio of 2.69 (0.66). In all cases a magnetic resonance imaging of the brain was performed before and 24h after the cardioversion, including diffusion-weighted sequences. A neurological exploration was also performed before and after the procedure, using the modified Ictus on the National Institute of Health Stroke Scale and the modified Rankin scale. Written informed consent was obtained in all cases. Results. Of the 62 patients, 51 (85%) reverted to sinus rhythm. The neurological examination showed no changes after cardioversion. The pre-procedure magnetic resonance imaging showed microvascular disease in 35 (56%), including 2 patients with known cerebrovascular disease, and did not depict new clinically silent ischemic areas after cardioversion. Conclusions. After electrical cardioversion no acute ischemic lesions in the brain nor alteration in the neurological scales were found. Nevertheless, in 35 patients (56%) with persistent atrial fibrillation, the magnetic resonance imaging showed clinically silent ischemic lesions (AU)

Assessment of silent microembolism by magnetic resonance imaging after cardioversion in atrial fibrillation.

INTRODUCTION AND OBJECTIVES: To study electrical cardioversion in patients with atrial fibrillation as a potential cause of acute ischemic brain lesions. METHODS: We performed prospective analysis of 62 consecutive patients (62 [10] years, 16 female). All of them were anticoagulated for at least 3 weeks with an international normalized ratio of 2.69 (0.66). In all cases a magnetic resonance imaging of the brain was performed before and 24h after the cardioversion, including diffusion-weighted sequences. A neurological exploration was also performed before and after the procedure, using the modified Ictus on the National Institute of Health Stroke Scale and the modified Rankin scale. Written informed consent was obtained in all cases. RESULTS: Of the 62 patients, 51 (85%) reverted to sinus rhythm. The neurological examination showed no changes after cardioversion. The pre-procedure magnetic resonance imaging showed microvascular disease in 35 (56%), including 2 patients with known cerebrovascular disease, and did not depict new clinically silent ischemic areas after cardioversion. CONCLUSIONS: After electrical cardioversion no acute ischemic lesions in the brain nor alteration in the neurological scales were found. Nevertheless, in 35 patients (56%) with persistent atrial fibrillation, the magnetic resonance imaging showed clinically silent ischemic lesions.