Allostatic-interoceptive anticipation of social rejection.

Anticipating social stress evokes strong reactions in the organism, including interoceptive modulations. However, evidence for this claim comes from behavioral studies, often with inconsistent results, and relates almost solely to the reactive and recovery phase of social stress exposure. Here, we adopted an allostatic-interoceptive predictive coding framework to study interoceptive and exteroceptive anticipatory brain responses using a social rejection task. We analyzed the heart-evoked potential (HEP) and task-related oscillatory activity of 58 adolescents via scalp EEG, and 385 human intracranial recordings of three patients with intractable epilepsy. We found that anticipatory interoceptive signals increased in the face of unexpected social outcomes, reflected in larger negative HEP modulations. Such signals emerged from key brain allostatic-interoceptive network hubs, as shown by intracranial recordings. Exteroceptive signals were characterized by early activity between 1-15 Hz across conditions, and modulated by the probabilistic anticipation of reward-related outcomes, observed over distributed brain regions. Our findings suggest that the anticipation of a social outcome is characterized by allostatic-interoceptive modulations that prepare the organism for possible rejection. These results inform our understanding of interoceptive processing and constrain neurobiological models of social stress.

Evaluación del riesgo de alteración de presión diastólica en las variables metabólicas en el embarazo

OBJETIVO: Evaluar la asociación de la presión diastólica (PAD) y variables metabólicas en embarazadas. METODOLOGÍA: Estudio retrospectivo, transversal en embarazadas de término, mayores de 25 años, con embarazo único, agrupadas por Índice de Masa Corporal (IMC). A todas se les midieron lípidos, glucosa y PAD. Se calculó Odds Ratio (IC 95 %), correlación de Spearman entre variables y Kruskal Wallis utilizando SPSS v21.0. RESULTADOS: Se incluyeron 60 embarazadas normoevolutivas, edad promedio 30.9 ± 4.5 años, obteniendo una prevalencia de 41.6 % para sobrepeso y 31.6 % para obesidad. Los valores de glucemia en ayuno fueron de 102.2 ± 49.8 mg/dL en obesidad, 89.8 ± 28.7 mg/dL en sobrepeso y 84.5 ± 12.3 mg/dL en normopeso. Los valores medios de la PAD y PAS mostraron una correlación positiva con el valor medio de IMC pregestacional y gestacional. Mientras que, para las concentraciones de glucosa y lípidos, se obtuvo una correlación positiva con el valor medio de la PAD. CONCLUSIÓN: Se confirma asociación de la PAD con el IMC pregestacional. (provisto por Infomedic Intl)

OBJECTIVE: To evaluate the association of diastolic pressure (DBP) and metabolic variables in pregnant women. METHODOLOGY: Retrospective, cross-sectional study in full-term pregnant women, older than 25 years, with a single pregnancy, grouped by Body Mass Index (BMI). Lipids, glucose and DBP were measured in all of them. Odds Ratio (95% CI), Spearman's correlation between variables and Kruskal Wallis were calculated using SPSS v21.0. RESULTS: 60 normodevelopmental pregnant women were included, mean age 30.9 ± 4.5 years, obtaining a prevalence of 41.6% for overweight and 31.6% for obesity. Fasting blood glucose values ​​were 102.2 ± 49.8 mg / dL in obesity, 89.8 ± 28.7 mg / dL in overweight, and 84.5 ± 12.3 mg / dL in normal weight. The following ORs were obtained for DBP> 80 mmHg with SBP> 130 mmHg (1,571; 95% CI: 0.490-5.037), glucose> 90 mg/dL (1.052; 95% CI: 0.451-2.453), cholesterol > 200 mg / dL (1.667; 95% CI: 0.694-4.004), triglycerides> 150 mg/dL (1.2; 95% CI: 0.243-1.832), platelets <150 thousand / µL (1.072; 95% CI: 0.220-2.974) and lymphocytes <1000 /µL (1.145; 95% CI: 0.168-2.405). CONCLUSION: The association of DBP disorders with pre-pregnancy BMI is confirmed. (provided by Infomedic Intl)

Usefulness of a new semiological classification for characterizing psychogenic nonepileptic seizures.

BACKGROUND: Nonepileptic events misdiagnosed as epilepsy lead to a risk of iatrogenic morbidity, which increases health costs. Among the patients affected by nonepileptic events, 11-46% are psychogenic nonepileptic seizures (PNESs). OBJECTIVE: To investigate the usefulness of the semiological classification of PNESs among patients diagnosed by means of video electroencephalograms (vEEGs). METHODS: This was a retrospective review of the medical records of patients admitted to the adult vEEG unit between April 2007 and December 2016, who were diagnosed with PNES that was confirmed through vEEG. Analysis on demographic and clinical data and classification of PNESs according to the Magaudda classification were performed. RESULTS: We identified 143 patients, among whom 31.5% had also epilepsy. According to the Magaudda classification, the events were: hypermotor (58%); subjective symptoms (21.7%); akinetic (14.7%) and focal motor (5.6%). Hypermotor predominated in both genders, followed by subjective symptoms in women (23.9%) and akinetic in men (19.2%). The mean number of antiepileptic drugs (AEDs) prescribed per patient was 2.3. Thirty-two patients (22.4%) required at least one hospitalization for PNESs. 48.3% of the patients had psychiatric comorbidities. CONCLUSION: The proposed semiological classification of PNESs is a relevant tool that general neurologists can use to characterize these events in their daily practice. Correct use of this classification, together with vEEG and appropriate clinical suspicion, makes it possible to reach an accurate early diagnosis, thus reducing morbidity and, possibly, the high costs associated with PNESs.

Usefulness of a new semiological classification for characterizing psychogenic nonepileptic seizures / Utilidad de una nueva clasificación semiológica para caracterización de eventos paroxísticos no epilépticos de origen psicógeno

ABSTRACT Background: Nonepileptic events misdiagnosed as epilepsy lead to a risk of iatrogenic morbidity, which increases health costs. Among the patients affected by nonepileptic events, 11-46% are psychogenic nonepileptic seizures (PNESs). Objective: To investigate the usefulness of the semiological classification of PNESs among patients diagnosed by means of video electroencephalograms (vEEGs). Methods: This was a retrospective review of the medical records of patients admitted to the adult vEEG unit between April 2007 and December 2016, who were diagnosed with PNES that was confirmed through vEEG. Analysis on demographic and clinical data and classification of PNESs according to the Magaudda classification were performed. Results: We identified 143 patients, among whom 31.5% had also epilepsy. According to the Magaudda classification, the events were: hypermotor (58%); subjective symptoms (21.7%); akinetic (14.7%) and focal motor (5.6%). Hypermotor predominated in both genders, followed by subjective symptoms in women (23.9%) and akinetic in men (19.2%). The mean number of antiepileptic drugs (AEDs) prescribed per patient was 2.3. Thirty-two patients (22.4%) required at least one hospitalization for PNESs. 48.3% of the patients had psychiatric comorbidities. Conclusion: The proposed semiological classification of PNESs is a relevant tool that general neurologists can use to characterize these events in their daily practice. Correct use of this classification, together with vEEG and appropriate clinical suspicion, makes it possible to reach an accurate early diagnosis, thus reducing morbidity and, possibly, the high costs associated with PNESs

RESUMEN Introducción: Los eventos no epilépticos diagnosticados erróneamente como epilepsia conducen a un riesgo de morbilidad iatrogénica que aumenta los costes en salud. Entre los pacientes afectados por eventos no epilépticos, un 11-46% son de origen psicógeno (PNES). Objetivos: Evaluar la utilidad de la clasificación semiológica de PNES en pacientes diagnosticados por video electroencefalograma (vEEG). Métodos: Revisión retrospectiva de los registros médicos de pacientes ingresados en la unidad de adultos de vEEG entre 04-2007 y 12-2016, que fueron diagnosticados con PNES confirmado por vEEG. Se realizó un análisis de los datos demográficos y clínicos, y la clasificación de los PNES según la clasificación de Magaudda. Resultados: Identificamos 143 pacientes, el 31,5% de los cuales también tenía epilepsia. Según la clasificación de Magaudda, los eventos fueron: hipermotor 58%; síntomas subjetivos 21,7%; akinética 14,7% y motor focal 5,6%. El hipermotor predominó en ambos los sexos, seguido de síntomas subjetivos en las mujeres (23,9%) y akinéticos en los hombres (19,2%). La cantidad media de fármacos antiepilépticos (FAE) recetados por paciente fue 2.3. Un total de 32 pacientes (22.4%) requirieron al menos una hospitalización por PNES. El 48,3% de los pacientes tenía comorbilidad psiquiátrica. Conclusión: La clasificación semiológica de los PNES propuesta es una herramienta relevante que los neurólogos generales pueden usar para caracterizar esos eventos en su práctica diaria. El uso correcto de esta clasificación, vEEG y una sospecha clínica adecuada permite llegar a un diagnóstico preciso y temprano, reduciendo así la morbilidad y, posiblemente, los altos costes asociados con las PNES.

[Cerebral structural changes in generalized idiopathic epilepsy identified by automated magnetic resonance imaging analysis]. / Cambios estructurales cerebrales en epilepsia generalizada idiopática identificados por análisis de imágenes de resonancia magnética automatizados.

The purpose of this study was to combine two automated methods of magnetic resonance imaging (MRI) structural analysis in order to identify structural changes in patients born in Argentina with idiopathic generalized epilepsy (IGE) compared to a healthy adult control group. Twenty-eight patients with IGE and 26 controls with no significant demographic differences were included. The analysis of the brain structures was conducted with two automated methods of magnetic resonance image analysis: voxelbased morphometry and FSL-integrated registration and segmentation toolbox (FSL-FIRST). FSL showed volume decrease in both thalamus in patients with IGE compared to the control group (left: 8092 mm3 control group vs. 7424 mm3 IGE, p = 0.0015; right: 7951 mm3 control group vs. 7247 mm3 IGE, p = 0.0016). A reduction in the volume of both caudate nuclei was also seen (left: 3612 mm3 control group vs. 3376 mm3 IGE, p = 0.01; right: 3683 mm3 control group vs. 3459 mm3 IGE, p = 0.04). Voxel-based-morphometry showed a volume decrease in both caudate nuclei in patients with IGE compared to the control group. The other cerebral structures analyzed did not show significant differences between the groups. In conclusion, this study shows the reduction in volume in the subcortical, thalamic, and caudate nuclei structures in patients with IGE in comparison to control group. This study conducted in our country delves into the analysis of brain structural changes in patients with EGI compared to healthy subjects.

El objetivo de este estudio fue combinar dos métodos automatizados de análisis estructural de imágenes de resonancia magnética para identificar cambios estructurales en pacientes nacidos en Argentina con epilepsia generalizada idiopática (EGI) en comparación con un grupo control de adultos sanos. Fueron incluidos 28 pacientes con EGI y 26 controles sin diferencias demográficas significativas. El análisis de las estructuras cerebrales se realizó con dos métodos automatizados de análisis de imágenes de resonancia magnética: la morfometría basada en vóxel y con la herramienta de segmentación y registro integrada FSL (FSL-FIRST). FSL mostró una disminución del volumen en ambos tálamos en EGI en comparación con el grupo control (tálamo izquierdo: 8092 mm3 grupo control vs. 7424 mm3 EGI, p = 0.0015; tálamo derecho: 7951 mm3 grupo control vs. 7247 mm3 EGI, p = 0.0016). Se observó una reducción en el volumen de ambos núcleos caudados (izquierdo: 3612 mm3 grupo control vs. 3376 mm3 EGI, p = 0.01; derecho 3683 mm3 grupo control vs. 3459 mm3 EGI, p = 0.04). La morfometría basada en vóxel mostró una disminución del volumen en ambos núcleos caudados en EGI en comparación con el grupo control. Las otras estructuras cerebrales analizadas no mostraron diferencias significativas entre los grupos. Este estudio muestra la reducción en el volumen en las estructuras subcortical, tálamos y núcleos caudados en pacientes con EGI comparado con un grupo control.

Cambios estructurales cerebrales en epilepsia generalizada idiopática identificados por análisis de imágenes de resonancia magnética automatizados / Cerebral structural changes in generalized idiopathic epilepsy identified by automated magnetic resonance imaging analysis

El objetivo de este estudio fue combinar dos métodos automatizados de análisis estructural de imágenes de resonancia magnética para identificar cambios estructurales en pacientes nacidos en Argentina con epilepsia generalizada idiopática (EGI) en comparación con un grupo control de adultos sanos. Fueron incluidos 28 pacientes con EGI y 26 controles sin diferencias demográficas significativas. El análisis de las estructuras cerebrales se realizó con dos métodos automatizados de análisis de imágenes de resonancia magnética: la morfometría basada en vóxel y con la herramienta de segmentación y registro integrada FSL (FSL-FIRST). FSL mostró una disminución del volumen en ambos tálamos en EGI en comparación con el grupo control (tálamo izquierdo: 8092 mm³ grupo control vs. 7424 mm³ EGI, p = 0.0015; tálamo derecho: 7951 mm³ grupo control vs. 7247 mm³ EGI, p = 0.0016). Se observó una reducción en el volumen de ambos núcleos caudados (izquierdo: 3612 mm³ grupo control vs. 3376 mm³ EGI, p = 0.01; derecho 3683 mm³ grupo control vs. 3459 mm³ EGI, p = 0.04). La morfometría basada en vóxel mostró una disminución del volumen en ambos núcleos caudados en EGI en comparación con el grupo control. Las otras estructuras cerebrales analizadas no mostraron diferencias significativas entre los grupos. Este estudio muestra la reducción en el volumen en las estructuras subcortical, tálamos y núcleos caudados en pacientes con EGI comparado con un grupo control.

The purpose of this study was to combine two automated methods of magnetic resonance imaging (MRI) structural analysis in order to identify structural changes in patients born in Argentina with idiopathic generalized epilepsy (IGE) compared to a healthy adult control group. Twenty-eight patients with IGE and 26 controls with no significant demographic differences were included. The analysis of the brain structures was conducted with two automated methods of magnetic resonance image analysis: voxel-based morphometry and FSL-integrated registration and segmentation toolbox (FSL-FIRST). FSL showed volume decrease in both thalamus in patients with IGE compared to the control group (left: 8092 mm³ control group vs. 7424 mm³ IGE, p = 0.0015; right: 7951 mm³ control group vs. 7247 mm³ IGE, p = 0.0016). A reduction in the volume of both caudate nuclei was also seen (left: 3612 mm³ control group vs. 3376 mm³ IGE, p = 0.01; right: 3683 mm³ control group vs. 3459 mm³ IGE, p = 0.04). Voxel-based-morphometry showed a volume decrease in both caudate nuclei in patients with IGE compared to the control group. The other cerebral structures analyzed did not show significant differences between the groups. In conclusion, this study shows the reduction in volume in the subcortical, thalamic, and caudate nuclei structures in patients with IGE in comparison to control group. This study conducted in our country delves into the analysis of brain structural changes in patients with EGI compared to healthy subjects.

[Progressive myoclonic epilepsy secondary to Lafora's body disease]. / Epilepsia mioclónica progresiva secundaria a enfermedad por cuerpos de Lafora.

Lafora's disease is infrequent. However, it is one of the most common causes of progressive myoclonus epilepsy. We present the case of a 19-year-old woman, without comorbidities and normal development that started at 8 years with seizures and that from 15 years, had progressive cognitive deterioration. She was admitted to our institution with a diagnosis of super refractory status epilepticus. The diagnosis of Lafora's disease was made through pathological anatomy, later a genetic test was performed that reported a pathogenic variant of the EPM2A gene, confirming the diagnosis. We present a cause of progressive myoclonic epilepsy, with an ominous prognosis and a treatment oriented to palliative measures, so it is important to analyze the differential diagnoses with other entities, in order to establish a prognosis, offer better quality of life, adequate medical care and provide genetic counseling to family members.

Epilepsia mioclónica progresiva secundaria a enfermedad por cuerpos de Lafora / Progressive myoclonic epilepsy secondary to Lafora's body disease

La enfermedad de Lafora es infrecuente; sin embargo, es una de las causas más comunes de epilepsia mioclónica progresiva. Presentamos el caso de una mujer de 19 años sin comorbilidades y pautas madurativas normales, que inició a los 8 años con convulsiones y que a partir de los 15 años agregó deterioro cognitivo progresivo. Fue internada en nuestra institución con diagnóstico de estatus epiléptico super refractario. Se diagnosticó enfermedad de Lafora, confirmada por la anatomía patológica, y posteriormente se realizó un test genético que informó una variante patogénica del gen EPM2A, que confirmó el diagnóstico. Presentamos una causa de epilepsia mioclónica progresiva, con un pronóstico ominoso y un tratamiento orientado a medidas paliativas, por lo que es importante analizar los diagnósticos diferenciales con otras entidades, a fin de establecer un pronóstico, ofrecer mejor calidad de vida, asistencia médica adecuada y brindar asesoría genética a los familiares.

Lafora's disease is infrequent. However, it is one of the most common causes of progressive myoclonus epilepsy. We present the case of a 19-year-old woman, without comorbidities and normal development that started at 8 years with seizures and that from 15 years, had progressive cognitive deterioration. She was admitted to our institution with a diagnosis of super refractory status epilepticus. The diagnosis of Lafora's disease was made through pathological anatomy, later a genetic test was performed that reported a pathogenic variant of the EPM2A gene, confirming the diagnosis. We present a cause of progressive myoclonic epilepsy, with an ominous prognosis and a treatment oriented to palliative measures, so it is important to analyze the differential diagnoses with other entities, in order to establish a prognosis, offer better quality of life, adequate medical care and provide genetic counseling to family members.

Intervención educativa sobre gingivoestomatitis herpética aguda, dirigida a médicos de la atención primaria / Educational Intervention on Herpetic Gingivostomatitis for Family Physicians in Primary Health Care

Introducción: es insuficiente el conocimiento de los médicos de familia sobre la gingivoestomatitis herpética aguda, una urgencia dentro de las normas estomatológicas. Objetivo: evaluar la efectividad de una intervención educativa sobre gingivoestomatitis herpética aguda, dirigida a médicos de familia que laboran en consultorios pertenecientes al área de salud. Métodos: estudio cuasi experimental comparativo en el período comprendido de enero a junio de 2013 en 25 médicos de familia y 13 internos de los consultorios pertenecientes al área de salud de la clínica Manuel Angulo Farrán, de las policlínicas Julio Grave de Peralta, Pedro del Toro y Alex Urquiola. En la etapa de diagnóstico se determinaron las necesidades de aprendizaje por medio de encuestas. Luego se distribuyeron folletos educativos sobre el tema y finalmente se realizó la evaluación bajo los mismos criterios que en la etapa diagnóstica. Resultados: se obtuvieron diferencias significativas entre el estado inicial y final de los conocimientos ya que al comienzo de la investigación el 64% de los médicos y el 70,6% de los internos poseían insuficientes conocimientos sobre esta enfermedad y el 100% no había recibido información sobre la misma, mientras que al finalizar el estudio el 100% de los médicos y el 92,3% de los internos mostraron buenos conocimientos sobre el tema. Conclusiones: la aplicación de la intervención educativa permitió motivar a los médicos y elevar sus conocimientos acerca de esta enfermedad, de manera que puede efectuarse en otras instituciones en el territorio.

Introduction: the family doctors´ knowledge on acute herpetic gingivostomatitis is insufficient, an urgency within the stomatologic standars. Objective: to assess the effectiveness of an educational intervention on acute herpetic gingivostomatitis, for family physicians working in health areas. Method: a comparative quasi-experimental study from January to June 2013 in 25 family physicians and 13 internal doctors from Manuel Angulo Farrán health area, Julio Grave de Peralta, Pedro del Toro and Alex Urquiola polyclinics. At the stage of diagnosis, learning needs were determined by surveys. Then they were distributed in educational brochures on the subject and finally, the evaluation was performed under the same criteria of diagnostic stage. Results: significant differences between the initial and final state of knowledge obtained since the beginning of the investigation, 64% of physicians and 70.6% of the patients had insufficient knowledge about the disease and had not received 100% about this, while at the end of the study 100% of physicians and 92.3% of the patients showed good knowledge on the subject. Conclusions: the application of educational intervention allowed doctors to motivate and increase their knowledge about this disease, so that could take place in other institutions in the territory.

Efectividad del oleozón en el tratamiento de la estomatitis subprótesis en pacientes mayores de 60 años / Oleozon Effectiveness in Denture Subprostheses Stomatitis Treatment in Patients Older than 60 Years Old

Introducción: la estomatitis protésica es una enfermedad de etiología multifactorial que se manifiesta a la exploración clínica por cambios inflamatorios de la mucosa en la bóveda palatina cubierta por la prótesis. Objetivo: evaluar la efectividad del oleozón en el tratamiento de la estomatitis subprótesis grado I y II en pacientes mayores de 60 años. Métodos: se realizó un estudio cuasi experimental con grupo control entre mayo a septiembre del 2015 en el área de salud del Policlínico Cristino Naranjo. El universo estuvo constituido por 46 pacientes mayores de 60 años portadores de prótesis estomatológicas que cumplieron con los criterios de inclusión. Se analizaron las variables: tipo de tratamiento, grado inicial de la estomatitis, tiempo de mejoría y tiempo de curación. Resultados: se observó que 20 pacientes (86,9%) fueron curados entre los cuatro y siete días con aplicación diaria del ozono y descanso de la prótesis. En el grupo control, 16 pacientes (69,5%) fueron curados a los siete días o más con aplicación del nistatín y descanso nocturno de la prótesis. Conclusiones: el oleozón resultó ser eficaz en el tratamiento de la estomatitis subprótesis en los pacientes mayores de 60 años; se logró la curación de las lesiones en menor tiempo que en el tratamiento convencional, lo cual mejoró la calidad de vida de estos pacientes.

Introduction: denture stomatitis is disease of multifactorial etiology. Through clinical diagnosis, an erythema takes on the form of the limits of the prosthesis. Objective: to evaluate the effectiveness of the oleozon in denture stomatitis treatment in patients older than 60 years old. Methods: a quasi-experimental study between May 2015 and September 2015 in Cristino Naranjo health area was carried out. The universe consisted of 46 patients older than 60 years old who were using stomatology prosthesis who fulfilled the inclusion criteria. The variables analyzed were: type of treatment, initial degree of stomatitis, improvement and healing time. Results: the results showed that 20 patients (86.9%) were cured between four and seven days with daily application of ozone and taking out the prosthesis. In the control group, 16 patients (69.5%) were cured in seven days treated with nystatin, without using the prosthesis during the nights rest. Conclusions: the oeozon proved that was effective in denture stomatitis treatment in patients older than 60 years old, achieving the healing of lesions in less time, comparing with the use of conventional treatment, which improves the quality of life of these patients.

Attention, in and Out: Scalp-Level and Intracranial EEG Correlates of Interoception and Exteroception.

Interoception, the monitoring of visceral signals, is often presumed to engage attentional mechanisms specifically devoted to inner bodily sensing. In fact, most standardized interoceptive tasks require directing attention to internal signals. However, most studies in the field have failed to compare attentional modulations between internally- and externally-driven processes, thus probing blind to the specificity of the former. Here we address this issue through a multidimensional approach combining behavioral measures, analyses of event-related potentials and functional connectivity via high-density electroencephalography, and intracranial recordings. In Study 1, 50 healthy volunteers performed a heartbeat detection task as we recorded modulations of the heartbeat-evoked potential (HEP) in three conditions: exteroception, basal interoception (also termed interoceptive accuracy), and post-feedback interoception (sometimes called interoceptive learning). In Study 2, to evaluate whether key interoceptive areas (posterior insula, inferior frontal gyrus, amygdala, and somatosensory cortex) were differentially modulated by externally- and internally-driven processes, we analyzed human intracranial recordings with depth electrodes in these regions. This unique technique provides a very fine grained spatio-temporal resolution compared to other techniques, such as EEG or fMRI. We found that both interoceptive conditions in Study 1 yielded greater HEP amplitudes than the exteroceptive one. In addition, connectivity analysis showed that post-feedback interoception, relative to basal interoception, involved enhanced long-distance connections linking frontal and posterior regions. Moreover, results from Study 2 showed a differentiation between oscillations during basal interoception (broadband: 35-110 Hz) and exteroception (1-35 Hz) in the insula, the amygdala, the somatosensory cortex, and the inferior frontal gyrus. In sum, this work provides convergent evidence for the specificity and dynamics of attentional mechanisms involved in interoception.

Association of CYP1A1 and CYP1B1 polymorphisms with bone mineral density variations in postmenopausal Mexican-Mestizo women.

Herein, we investigated potential associations between polymorphisms of genes related to estrogen metabolism and bone mineral density (BMD) in postmenopausal women. This was a cross-sectional study, in which two hundred and ninety postmenopausal Mexican-Mestizo women were studied. The BMD of the lumbar spine (LS), total hip (TH), and femoral neck (FN) was measured. The distribution of the genetic polymorphisms, including rs1799814 and rs1048943 at CYP1A1 as well as rs1056836 at CYP1B1, were analyzed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP), single-stranded conformational polymorphism (SSCP), and DNA sequencing. Deviations from Hardy-Weinberg equilibrium (HWE) were tested, and linkage disequilibrium (LD) was calculated by direct correlation (r2). Moreover, haplotype analysis was performed. All polymorphisms were in HWE. The genotype and allele distributions of the three single nucleotide polymorphisms (SNPs) studied showed no significant differences. However, statistical significance was reached when constructing haplotypes. The CG haplotype in CYP1A1 was associated with variations in LS and FN BMD after adjustment for covariates (p = 0.021 and 0.045, respectively), but the association with TH BMD was not significant. These results suggested that the CG haplotype in CYP1A1 may play an important role in the mechanism of osteoporosis and may be useful as a genetic marker.

Usefulness of measuring renal papillae in Hounsfield units in stone - forming patients

ABSTRACT Introduction: The aim of this work is to study the density of the renal papillae in stone-forming patients and to determine its usefulness. Materials and Methods: This study included a total of 79 patients diagnosed with renal stones and on whom a computed tomography without contrast was performed from June 2014 to May 2015. The patients were divided into two groups: Group 1 (single episode) included 43 patients, and Group 2 (recurrent episodes) included 36 patients. The density of six renal papillae (3 per kidney) was measured, and the means obtained were compared between Groups 1 and 2. Statistical analysis was performed using SPSS 20.0. Results: The mean papillary density in Group 1 was 32.26 (SD 4.07) HU compared to 42.36 (SD 8.03) HU in Group 2 (P=00001). A ROC curve was constructed, obtaining an optimal cut-off point of 36.8HU [area under the curve, 0.881 (95% CI; 0.804-0.958); P=0001], with a sensitivity of 80% and a specificity of 90%. The relative risk was estimated at 40.3 (95% CI; 10.8-151.1), meaning that a patient with a mean papillary density greater than 36.8HU would have a 40 times greater risk of having recurrent renal stones. The positive predictive value (PPV) was 81% and the negative predictive value (NPV) was 90%. Conclusion: The measurement of renal papillary density could be useful in predicting recurrent stone-formers. These results need to be confirmed in future studies with a greater number of patients and a longer follow-up.

Usefulness of measuring renal papillae in Hounsfield units in stone - forming patients.

INTRODUCTION: The aim of this work is to study the density of the renal papillae in stone-forming patients and to determine its usefulness. MATERIALS AND METHODS: This study included a total of 79 patients diagnosed with renal stones and on whom a computed tomography without contrast was performed from June 2014 to May 2015. The patients were divided into two groups: Group 1 (single ep¬isode) included 43 patients, and Group 2 (recurrent episodes) included 36 patients. The density of six renal papillae (3 per kidney) was measured, and the means obtained were compared between Groups 1 and 2. Statistical analysis was performed using SPSS 20.0. RESULTS: The mean papillary density in Group 1 was 32.26 (SD 4.07) HU compared to 42.36 (SD 8.03) HU in Group 2 (P=00001). A ROC curve was constructed, obtaining an optimal cut-off point of 36.8HU [area under the curve, 0.881 (95% CI; 0.804-0.958); P=0001], with a sensitivity of 80% and a specificity of 90%. The relative risk was estimated at 40.3 (95% CI; 10.8-151.1), meaning that a patient with a mean papillary density greater than 36.8HU would have a 40 times greater risk of having recurrent renal stones. The positive predictive value (PPV) was 81% and the negative predictive value (NPV) was 90%. CONCLUSION: The measurement of renal papillary density could be useful in predicting recurrent stone-formers. These results need to be confirmed in future studies with a greater number of patients and a longer follow-up.

Parálisis diafragmática bilateral idiopática tratada con ventilación mecánica no invasiva / Idiopathic bilateral diaphragmatic paralysis with noninvasive mechanical ventilation

Resumen La parálisis diafragmática bilateral es infrecuente y puede ser idiopática o más comúnmente asociada a varias entidades. Describimos el caso de un varón de 61 años con antecedentes de asma bronquial quien desarrolló parálisis difragmática bilateral sin causa evidente, la cual es excepcional. El paciente presentó disnea progresiva y ortopnea, que no mejoraban con antibioterapia ni esteroides sistémicos, por lo que se descartaron diversas etiologías como neuralgia lateral amiotrófica y finalmente se le diagnosticó parálisis diafragmática lateral en base a la exploración física y las pruebas de imagen. Se inició ventilación mecánica no invasiva con gran mejoría clínica.

Bilateral paralysis of the diaphragm is uncommon and can be either idiopathic or more frequently associated with several medical conditions. We describe the case of a 61-year-old man with a history of asthma who developed severe bilateral diaphragmatic paralysis without any obvius cause, which is exceptional. The patient manifested progressive dyspnea and debilitating orthopnea with no improvement with antibiotics or systemic steroids. Different etiologies were discarded as amyotrophic lateral neuralgia, and he was diagnosed of bilateral diaphragmatic paralysis based on physical examination and imaging tests. Noninvasive mechanical ventilation was started with great clinical improvement.

El papel de la adaptación como generadora de satisfacción laboral en médicos de salud ocupacional / The role of adaptation as generator of job satisfaction in occupational health doctors

OBJETIVO: analizar la construcción teórica del concepto de satisfacción laboral a través de la percepción de la adaptación al puesto de trabajo en médicos de salud ocupacional. MÉTODO: se aplicó la teoría fundamentada, utilizando el muestreo teórico propositivo hasta la saturación teórica. La muestra se integró con diez médicos dedicados a la salud ocupacional en la ciudad de México, durante el 2014. Se aplicaron entrevistas a profundidad y los datos obtenidos fueron analizados con el software Atlas-ti, dando como resultado códigos que se integraron en categorías, con las cuales se generó la teoría. RESULTADOS: Mis motivos de elección, Cambié de vida, y Oportunidades y proyectos fueron las categorías emergentes con las cuales se integró la dimensión de Adaptación al puesto de trabajo como elemento básico de la construcción teórica de la satisfacción laboral de los médicos de salud ocupacional. CONCLUSIONES: La satisfacción laboral en los médicos de salud ocupacional se presenta conforme se da su adaptación al puesto de trabajo, pues no existe desde el inicio de su vida laboral en el área, sino que se va generando conforme van aprendiendo y cambiando de actitud con respecto al trabajo.

OBJECTIVE: to analyze the theoretical construction of job satisfaction's concept through the adaptation to the job's perception in occupational health physicians. METHOD: it was applied the grounded theory, using proactive until theoretical saturation theoretical sampling. The sample was composed of ten physicians dedicated to occupational health in Mexico city, during the 2014. In-depth interviews were applied and the data obtained were analyzed with the software Atlas-ti, giving as a result: codes, which were integrated into categories, with which the theory was generated. RESULTS: My reasons for choice, I changed my life, and Opportunities and projects were the emerging categories with which joined the dimension of Adaptation to the post, as a basic element of the theoretical construction of the job satisfaction of occupational health physicians. CONCLUSIONS: Job satisfaction in occupational health physicians is presented as its adaptation to the job. It did not exist since the beginning of their working lives in the area, but it was generated as they learned and changed the attitude towards the work.

Surgical treatment of focal symptomatic refractory status epilepticus with and without invasive EEG.

PURPOSE: Neurosurgery appears to be a reasonable alternative in carefully selected patients with refractory status epilepticus (RSE) and super-refractory status epilepticus (SRSE). We discuss the optimal timing of the surgery and the use of previous stereoelectroencephalography (SEEG) invasive evaluation. METHODS: We identified 3 patients (two pediatric and one adult) who underwent epilepsy surgery because of RSE or SRSE from our epilepsy surgery database, one of them with previous SEEG. RESULTS: Status epilepticus resolved acutely in all of them with no mortality and no substantial morbidity. At follow-up (median: 2 years), 1 patient was seizure-free, and 2 had significant improvement. CONCLUSION: Surgery should be considered in all cases of RSE and SRSE early in the course of the evolution of the disease.

[Usefulness of antimicrobial prophylaxis with ciprofloxacin prior to flexible cystoscopy]. / ¿Está indicada la profilaxis antibiótica con ciprofloxacino en la realización de cistoscopia flexible?

BACKGROUND: Flexible cystoscopy is a common test in clinical practice done with or without antibiotic prophylaxis. AIM: To evaluate the efficacy of antibiotic prophylaxis with ciprofloxacin to reduce the incidence of urinary infection. MATERIAL AND METHODS: Prospective, non-randomized observational study that included 60 patients divided into two groups. Group 1 received prophylactic ciprofloxacin 500 mg, one hour prior to the procedure and group 2 did not receive prophylaxis. The presence of bacteriuria, symptoms or signs of urinary infection or attending Emergency rooms or primary care for these symptoms were recorded during the seven days after the cystoscopy. RESULTS: In groups 1 and 2, four and one patients had a positive urine culture, respectively. Only one patient in group 1 consulted in primary care for symptoms. No significant differences in symptoms or signs of urinary infection between groups were observed. CONCLUSIONS: In this group of patients, antibiotic prophylaxis with ciprofloxacin 500 mg prior to cystoscopy had no benefit.

¿Está indicada la profilaxis antibiótica con ciprofloxacino en la realización de cistoscopia flexible? / Usefulness of antimicrobial prophylaxis with ciprofloxacin prior to flexible cystoscopy

Background: Flexible cystoscopy is a common test in clinical practice done with or without antibiotic prophylaxis. Aim: To evaluate the efficacy of antibiotic prophylaxis with ciprofloxacin to reduce the incidence of urinary infection. Material and Methods: Prospective, non-randomized observational study that included 60 patients divided into two groups. Group 1 received prophylactic ciprofloxacin 500 mg, one hour prior to the procedure and group 2 did not receive prophylaxis. The presence of bacteriuria, symptoms or signs of urinary infection or attending Emergency rooms or primary care for these symptoms were recorded during the seven days after the cystoscopy. Results: In groups 1 and 2, four and one patients had a positive urine culture, respectively. Only one patient in group 1 consulted in primary care for symptoms. No significant differences in symptoms or signs of urinary infection between groups were observed. Conclusions: In this group of patients, antibiotic prophylaxis with ciprofloxacin 500 mg prior to cystoscopy had no benefit.

Auditory Feedback Differentially Modulates Behavioral and Neural Markers of Objective and Subjective Performance When Tapping to Your Heartbeat.

Interoception, the perception of our body internal signals, plays a key role in maintaining homeostasis and guiding our behavior. Sometimes, we become aware of our body signals and use them in planning and strategic thinking. Here, we show behavioral and neural dissociations between learning to follow one's own heartbeat and metacognitive awareness of one's performance, in a heartbeat-tapping task performed before and after auditory feedback. The electroencephalography amplitude of the heartbeat-evoked potential in interoceptive learners, that is, participants whose accuracy of tapping to their heartbeat improved after auditory feedback, was higher compared with non-learners. However, an increase in gamma phase synchrony (30-45 Hz) after the heartbeat auditory feedback was present only in those participants showing agreement between objective interoceptive performance and metacognitive awareness. Source localization in a group of participants and direct cortical recordings in a single patient identified a network hub for interoceptive learning in the insular cortex. In summary, interoceptive learning may be mediated by the right insular response to the heartbeat, whereas metacognitive awareness of learning may be mediated by widespread cortical synchronization patterns.