Evolution of Child and Youth Mental Health in the Context of the COVID-19 Pandemic: A Longitudinal Analysis.

BACKGROUND: The COVID-19 pandemic generated uncertainty and disruption among the child and adolescent population. Multiple studies have documented a worsening of mental health following the pandemic. The main objective of this longitudinal study is to analyze the short-, medium-, and long-term evolution of the overall functioning of children and adolescents treated by a child and adolescent mental health team in the context of the COVID-19 pandemic. METHODS: 420 patients aged 3 to 18 were assessed using the Global Assessment of Functioning (GAF) scale at three time points: during the lockdown, three months later, and three years later. Differences based on gender, diagnosis, and time were analyzed. RESULTS: A significant improvement was observed in the short-term (three months) and long-term (three years) compared to the lockdown period. This improvement was maintained in all diagnostic subgroups except for mixed cases (severe mental pathology), which showed the least improvement. No significant differences were found between males and females. CONCLUSIONS: The child and adolescent population showed a greater capacity for adaptation to the lockdown than expected. Family support, decreased stress, and therapeutic intervention appear to have played an important role in improving mental health.

Age-Related Differences in Testosterone Concentration and Its Relation to Testicular Biometrics, Hemodynamics, and Fertility in Alpacas (Vicugna pacos).

The goal of this study was to investigate the age-related differences in testosterone concentration and its relation to testicular biometrics, testicular blood flow, and fertility in alpacas (Vicugna pacos). Fifteen alpaca males with different ages (young (YM; ~12-14 mo.), n = 5; intermediate (IM; ~24 mo.), n = 5; and old (OM; ≥36 mo.), n = 5) were enrolled in the study. Blood samples were taken from each alpaca male and the circulating plasmatic testosterone concentration (TC; ng/mL) was determined using ELISA analysis. The testicular traits related to bio-morphometric parameters (the length (L), width (W), area (A), and volume (TV)) were assessed using B-mode ultrasonography. Pulse-wave/power Doppler ultrasonography was used to obtain the circulatory dynamic values (testicular hemodynamics) before the beginning of natural service mating. Significant differences were observed in TC among the age groups, increasing as the age of the males increased (2.47 ± 0.31, 8.45 ± 1.53, and 22.66 ± 2.15 for YM, IM, and OM, respectively; p < 0.05); however, no differences were observed regarding the testicular B-mode ultrasonographic parameters (L, W, and A) (p > 0.05). Positive correlations were observed between TV and testicular L, W, and A (r = 0.96, r = 0.95, and r = 0.96, respectively; p ≤ 0.001). Pulse-wave-Doppler-derived parameters such as the pulsatility index (PI) and the resistive index (RI), as well as the total vascularity area (TVA) assessed by power Doppler, were similar in all of the age groups studied (p > 0.05). General linear model (GLM) analysis showed a relationship between TC and TV (OR = 0.95; p = 0.04), as well as between TC and TVA (OR = 0.99; p= 0.02). Finally, no differences were observed regarding the pregnancy rate among the different age groups (p > 0.05). In conclusion, TC increased as the age of the alpaca males increased. Although TC was related to TV and TVA, the pregnancy rates obtained from individuals belonging to the different age groups were similar, indicating that TC, TV, and TVA were not determining factors in assessing the potential age-related fertility differences in alpaca males.

Enhancing PSMA-PET/CT with intravenous contrast: Improved tracer clearance in the prostate bed.

AIMS: We observed hitherto unreported layering of radioactivity in the bladder on PET/CT in prostate cancer (PC) when combined with contrast-enhanced CT (CECT). This effect facilitates assessment of the prostate bed in PC. METHODS: Among 128 patients imaged with [18F]PSMA-1007, we selected all 8 studies without and 28 studies with CECT. 20 patients also underwent PET/MR. As controls, we chose 20 and 16 males studied with [18F]FDG for extrapelvic disease with and without CECT. Posterior anterior (PA) ratio was calculated as SUVpost/SUVant * 100 % based on maximal standard uptake values (SUV) in 20 mm spheres in the anterior and posterior bladder. Four nuclear physicians scored assessibility of the bladder base on a 3-point Likert scale (3 = optimal, 1 = poor). We acquired serial PET/CT over 4 hours of a flask with layering of 100 ml intravenous contrast agent and 100 ml physiological saline with 40 MBq of [18F]PSMA-1007, while a control flask was shaken at the start of the experiment. RESULTS: Layering of tracer was observed in all PET/CT studies with CE-CT, but not in studies without contrast. Median PA ratios were 44 % (interquartile range 33-62) for [18F]PSMA-1007 and 73 % (52-67) for [18F]FDG, respectively. Intravenous contrast improved assessibility scores in PET of the bladder base, but the effect only reached significance in the PET/MR data. In the in vitro data, radioactivity was retained in the aqueous supernatant over the entire experiment whereas there was no separation of phases in the control flask over time. CONCLUSION: When performing PET combined with CECT, sedimentation of contrast agent in the bladder leads to upward displacement of radioactivity, enhancing clarity of PET images in the posterior bladder and the prostate bed on both PET/CT and PET/MR.

Successful pregnancy after mucinous cystic neoplasm with invasive carcinoma of the pancreas in a patient with polycystic ovarian syndrome: a case report.

BACKGROUND: The incidence of invasive cancer within a mucinous cystic neoplasm of the pancreas varies between 6 and 36%. Polycystic ovarian syndrome is a disorder characterized by hyperandrogenism and anovulatory infertility. One surgical treatment that can restore endocrine balance and ovulation in polycystic ovarian syndrome is partial ovarian destruction. Successful pregnancies following preconception pancreaticoduodenectomies (Whipple procedures) and chemoradiation to treat pancreatic neoplasms have been reported rarely but none were diagnosed with pre-cancer polycystic ovarian syndrome-associated infertility. Gemcitabine is an antimetabolite drug used for the treatment of pancreatic cancer that can have profound detrimental effects on oogenesis and ovarian function. Whether the ovarian destructive property of gemcitabine could act as a method to restore ovulation potential in polycystic ovarian syndrome is unknown. CASE PRESENTATION: A 40-year-old white American woman with a history of pancreatic cancer treatment with a Whipple procedure and chemoradiation with gemcitabine had a successful pregnancy after years of pre-cancerous anovulatory infertility and polycystic ovarian syndrome. She received no fertility agents and delivered full term via a spontaneous vaginal delivery with no pregnancy complications. CONCLUSION: Gemcitabine treatment for pancreatic cancer may result in resumption of ovulation in women with polycystic ovarian syndrome and these women should be counseled accordingly.

Nurse practitioner role implementation in Ontario public health units.

OBJECTIVES: To identify the barriers and facilitators associated with the implementation of the nurse practitioner (NP) role in Ontario's public health units (PHUs), the NPs' job satisfaction, and the relationship between NP job satisfaction and practice dimensions. METHODS: This descriptive study involved a postal survey of all NPs (N = 29) working in Ontario PHUs. RESULTS: Twenty-eight (96.5%) NPs completed the survey. The facilitators to role implementation most often identified by the NPs were management support, the NPs' knowledge of the PHU programs, and access to PHU programs for their clients. The barriers most often cited were being the only NP working in the PHU, inadequate salary, and lack of coverage when the NP was away. When working with community physicians, the most common facilitators were the trust shown by physicians when making shared decisions and physician respect for the NP. The most common barriers were the unwillingness of specialist physicians to accept referrals from the NP and physicians' lack of understanding of the role. Overall, the NPs were satisfied with working in the PHU, satisfied with their collaborative relationship with physicians and minimally satisfied with their salaries. CONCLUSION: NPs have recently been introduced in PHUs in Ontario. A number of factors have facilitated role integration. At the same time, a number of barriers to their role implementation have been identified and if addressed, can contribute to the optimal utilization of this role in PHUs.

[Five year experience with thin layer agar medium for rapid diagnosis of tuberculosis]. / Cinco años de experiencia con el agar de capa delgada para el diagnóstico rápido de tuberculosis.

Tuberculosis represents a public health problem worldwide, mainly in developing countries where 95% of the cases occur. New technologies that support rapid diagnosis are not available in these settings because of high cost. New, rapid, and less expensive techniques are necessary before diagnosis can be improved in these areas. The present work compared the performance of a rapid and costly culture media, thin layer agar (CD7H11), with the traditional Lowenstein-Jensen (LJ) culture method. For this comparison, 1,809 clinical specimens were processed for diagnosis of mycobacterial infections. Clinical samples were processed according to standard procedures and cultured concomitantly in LJ and CD7H11. The times required to obtain an isolate were compared for culture media. Sensitivity (S), specificity (Sp), predictive values (PPV, NPV) and agreement (kappa coefficient) were calculated for CD7H11, with LJ serving as the gold standard. CD7H11 showed S to be 73.5% (C.I.95%: 69.6-80.4), Sp to be 99.2% (C.I.95%: 98.8-99.6), PPV 90.4% (C.I.95%: 85.3-95.6) and NPV 97.6% (C.I.95%: 96.8-98.3). Agreement had a kappa coefficient of 0.52. The mean time for CD7H11 was 11 days (SD+/-4.9) compared with 26.5 (SD+/-8.6) days for LJ. Similar results were obtained in a comparison of respiratory and multibacillary clinical samples. In extrapulmonary samples and those with lowered bacillus count, CD7H11 demonstrated a lower sensitivity. The concomitant use of both culture media enhanced sensitivity of detection. CD7H11 proved a simple and rapid technique for culturing mycobacteria and can be combined with traditional methods for improving laboratory capability for diagnosis of tuberculosis.

Cinco años de experiencia con el agar de capa delgada para el diagnóstico rápido de tuberculosis

La tuberculosis continúa siendo un problema de salud pública en el mundo, principalmente en los países en vía de desarrollo, donde ocurre el 95% de los casos. Estos países no tienen fácil acceso a los métodos de diagnóstico rápido actualmente disponibles, debido al alto costo que tienen. Por tanto, se hace necesario el desarrollo de técnicas rápidas de más bajo costo que sean accesibles a estas regiones. Este trabajo tuvo como objetivo comparar un medio de cultivo rápido y de bajo costo, el agar de capa delgada (CD7H11), con el medio de Lowenstein-Jensen. Para esto se procesaron 1.809 muestras clínicas de pacientes con diagnóstico presuntivo de tuberculosis y que requirieron cultivo. Las muestras se procesaron según los métodos estándar recomendados y se sembraron en ambos medios de cultivo. Se comparó la rapidez para la detección de cultivos positivos y la sensibilidad, la especificidad, los valores predictivos (VPP y VPN) y la concordancia de CD7H11 con respecto al método de referencia. CD7H11 mostró una sensibilidad del 73,5% (IC95%:69,6-80,4) y una especificidad del 99,2% (IC95%: 98,8-99,6), valor predictivo positivo de 90,4% (IC95%: 85,3-95,6) y valor predictivo negativo de 97,6% (IC95%: 96,8-98,3). La concordancia entre los dos métodos fue de 0,52 (coeficiente kappa). CD7H11 tuvo un tiempo promedio para la detección de las micobacterias de 11 días (DE±4,9), frente a 26,5 (DE±8.6) días del LJ. Se obtuvieron resultados similares al comparar las muestras pulmonares y multibacilares. CD7H11 mostró una sensibilidad menor en muestras extrapulmonares, comparada con las pulmonares (65,8; IC95%: 55,1-76,5 vs. 81,0; IC95%: 72,4-89,7). El uso concomitante de los medios de cultivo aumentó la sensibilidad pues 24,1% de las muestras se detectaron sólo por LJ y 7,1% por CD7H11. El medio de capa delgada demostró ser un método rápido de cultivo para micobacterias que es fácilmente accesible a los sistemas de salud de los países en desarrollo, en ...

Five year experience with thin layer agar medium for rapid diagnosis of tuberculosis Tuberculosis represents a public health problem worldwide, mainly in developing countries where 95% of the cases occur. New technologies that support rapid diagnosis are not available in these settings because of high cost. New, rapid, and less expensive techniques are necessary before diagnosis can be improved in these areas. The present work compared the performance of a rapid and costly culture media, thin layer agar (CD7H11), with the traditional Lowenstein-Jensen (LJ) culture method. For this comparison, 1,809 clinical specimens were processed for diagnosis of mycobacterial infections. Clinical samples were processed according to standard procedures and cultured concomitantly in LJ and CD7H11. The times required to obtain an isolate were compared for culture media. Sensitivity (S), specificity (Sp), predictive values (PPV, NPV) and agreement (kappa coefficient) were calculated for CD7H11, with LJ serving as the gold standard. CD7H11 showed S to be 73.5% (C.I.95%: 69.6-80.4), Sp to be 99.2% (C.I.95%: 98.8-99.6), PPV 90.4% (C.I.95%: 85.3-95.6) and NPV 97.6% (C.I.95%: 96.8-98.3). Agreement had a kappa coefficient of 0.52. The mean time for CD7H11 was 11 days (SD±4.9) compared with 26.5 (SD±8.6) days for LJ. Similar results were obtained in a comparison of respiratory and multibacillary clinical samples. In extrapulmonary samples and those with lowered bacillus count, CD7H11 demonstrated a lower sensitivity. The concomitant use of both culture media enhanced sensitivity of detection. CD7H11 proved a simple and rapid technique for culturing mycobacteria and can be combined with traditional methods for improving laboratory capability for diagnosis of tuberculosis.

Evaluación de medios de cultivo alternativos para el diagnóstico de la tuberculosis pulmonar / Alternative culture media evaluation for the diagnosis of pulmonary Tuberculosis

Objetivos: el uso de nuevos métodos que proporcionen rapidez al diagnóstico es necesario en laboratorios que hacen diagnóstico de tuberculosis y no poseen recursos para el uso de tecnología costosa. Nuestro objetivo fue evaluar MGIT (mycobacterial growth indicator tube) comparativamente con el cultivo en Ogawa- Kudoh (OK) y el cultivo en agar de capa delgada (CD) para el diagnóstico de tuberculosis. Materiales y métodos: se procesaron 218 muestras de esputo en 1 año, en pacientes con diagnóstico clínico de tuberculosis. Todas las muestras se decontaminaron por un método estándar y se les realizó coloración directa de Kinyoun. Resultados: De las 218 muestras 15.1 por ciento fueron positivas por CD, 24.3 por ciento lo fueron por MGIT y 24.7 por ciento lo fueron por OK. La sensibilidad, especificidad, valores predictivos positivos y negativos y la eficiencia se calcularon para MGIT y capa delgada con respecto al OK y fueron respectivamente 84.0 por ciento, 94.1 por ciento, 87.5 por ciento, 92.3 por ciento, 90.8 por ciento en MGIT y para CD 71.1 por ciento, 99.1 por ciento, 96.9 por ciento, 90.0 por ciento, 91.4 por ciento. La frecuencia de contaminación fué 11.4 por ciento, 20.6 por ciento y 22.9 por ciento para OK, CD y MGIT respectivamente. En los primeros 15 días fueron positivas el 56.2 por ciento de las muestras en CD, el 38.8 por ciento en MGIT y el 7.2 por ciento en OK. MGIT fue más sensible en muestras paucibacilares 15.5 por ciento, con respecto a OK 4.6 por ciento y CD 5.6 por ciento. Conclusión: El MGIT y la CD son alternativas para incrementar la rapidez en el diagnóstico de tuberculosis, el MGIT provee mayor sensibilidad en muestras paucibacilares