INTESTINAL ULTRASOUND AND ITS ROLE IN THE ACUTE SETTING: STENOSING CROHN'S DISEASE AND ACUTE BOWEL OBSTRUCTION DUE TO FOREIGN BODY INGESTION (DENTAL POST AND CROWN).

A 39-year-old woman with a history of Crohn's disease presents at the Emergency Room for a 2-hour long colicky abdominal pain with bloating, vomiting and no gas passing. She refers an accidental ingestion of a foreign body three weeks ago, a dental post and crown (she is currently using an invisible orthodontic technique). Her Crohn's disease affects the terminal ileum, and was diagnosed 8 years before, she has been suffering mild to no symptoms for the last years, but due to evidence of biochemical, endoscopic and ultrasonographic activity she is on Ustekinumab 90mg subcutaneously every 4 weeks, after Infliximab and Adalimumab loss of response. An abdominal x-ray reveals bowel dilation and hydro-aerial levels, as well as a radiopaque element in the pelvis consistent with the dental post and crown. CT-scan confirms the bowel obstruction, ileal stenosis is found. Intestinal ultrasound is performed at our centre finding a long ileal stenosis, 33 cm, thickened wall 5.6mm, destructuring of the layer pattern, hyperemia (modified Limberg score 3), ileoileal fistula with no collection associated, and a prestenotic dilation of 40mm. The dental foreign body is found, non-impacted, in the prestenotic dilated loop. Even though an initial course of intraneous steroids is ordered, due to previous medical history of a persistent active Crohn's disease with loss of response to three advanced therapies, as well as the very low probability of progression of the foreign body along with the risk of permanent impaction or perforation, surgery is indicated. Ileocecal resection with extraction of the foreign body is performed uneventfully.

Analyzing Dropout in Alcohol Recovery Programs: A Machine Learning Approach.

Background: Retention in treatment is crucial for the success of interventions targeting alcohol use disorder (AUD), which affects over 100 million people globally. Most previous studies have used classical statistical techniques to predict treatment dropout, and their results remain inconclusive. This study aimed to use novel machine learning tools to identify models that predict dropout with greater precision, enabling the development of better retention strategies for those at higher risk. Methods: A retrospective observational study of 39,030 (17.3% female) participants enrolled in outpatient-based treatment for alcohol use disorder in a state-wide public treatment network has been used. Participants were recruited between 1 January 2015 and 31 December 2019. We applied different machine learning algorithms to create models that allow one to predict the premature cessation of treatment (dropout). With the objective of increasing the explainability of those models with the best precision, considered as black-box models, explainability technique analyses were also applied. Results: Considering as the best models those obtained with one of the so-called black-box models (support vector classifier (SVC)), the results from the best model, from the explainability perspective, showed that the variables that showed greater explanatory capacity for treatment dropout are previous drug use as well as psychiatric comorbidity. Among these variables, those of having undergone previous opioid substitution treatment and receiving coordinated psychiatric care in mental health services showed the greatest capacity for predicting dropout. Conclusions: By using novel machine learning techniques on a large representative sample of patients enrolled in alcohol use disorder treatment, we have identified several machine learning models that help in predicting a higher risk of treatment dropout. Previous treatment for other substance use disorders (SUDs) and concurrent psychiatric comorbidity were the best predictors of dropout, and patients showing these characteristics may need more intensive or complementary interventions to benefit from treatment.

The moderating role of sex in the relationship between cannabis use treatment admission profile and treatment processes and outcomes: A gender perspective.

BACKGROUND: Gender-specific interventions are crucial in addressing substance use disorders -particularly cannabis use disorder - as they allow for tailored therapeutic approaches and increase the likelihood of successful outcomes. However, differences in therapeutic processes and outcomes between males and females are often not observed, making the prognosis and development of such interventions more difficult. OBJECTIVE: This study aimed to examine the moderating role of sex in the relationship between treatment admission profile characterized by indicators of cannabis use and sociodemographic sources of gender inequality (e.g., employment status) and adherence and outcome at discharge. METHOD: A multicentric retrospective observational study was conducted with a sample of 3,814 outpatients diagnosed with cannabis use disorder. Electronic health records were used for data analysis. RESULTS: The interaction between sex and the number of children, as well as pre-treatment cannabis use, predicted lower treatment adherence, particularly among females. Additionally, the interaction between sex and the number of children predicted outcomes at discharge, with females showing a higher likelihood of dropout compared to males. DISCUSSION AND CONCLUSION: Enhanced comprehensive treatment with intensified contingency management programs should be prioritized for females (especially those with children) who have consumed cannabis in the month before treatment. Adopting a treatment policy framework incorporating sex/gender-sensitive therapist training and evaluative measures is essential for optimizing treatment outcomes for all patients.

Modeling the Therapeutic Process of Patients with Cocaine Use Disorders: A Guide for Predicting Readmission.

INTRODUCTION: Patients with cocaine use disorders have very high readmission rates. Our aim was to model the relationships between attributes of patients with cocaine use disorder at the beginning of treatment, therapeutic process indicators of time in treatment or proportion of appointments attended, and treatment outcomes, including outcomes at discharge and non-readmissions posttreatment as indicators of therapeutic success. METHOD: A retrospective observational design was used with 10,298 cocaine use disorder patients. Electronic health records were used for statistical analysis of the data. Randomized subsample 1 (n = 5,150) was used for exploratory analysis and subsample 2 (n = 5,148) for modeling relationships between the variables. RESULTS: Patients attributes at intake (e.g., legal services as the source of referral) were of limited significance in explaining time in treatment, proportion of appointments attended, and treatment outcomes. Time in treatment and proportion of appointments attended emerged as significant factors in explaining outcomes at discharge. However, readmissions were primarily explained by time in treatment and outcomes at discharge, although referrals to addiction centers by health services also appeared to be relevant for explaining readmission. DISCUSSION/CONCLUSION: Our study has shown that maintaining a sufficient appointment attendance rate and remaining in treatment for a longer duration are critical therapeutic process indicators for explaining outcomes at the point of discharge and therapeutic success, as indicated by a reduced likelihood of readmissions. Patients who remained in treatment for an extended period were found to have a reduced risk of future readmissions. In addition, our study highlights the importance of maintaining a satisfactory appointment attendance rate to attain successful short- and medium-term therapeutic discharge outcomes. These guidelines could help to increase the efficiency of patient treatment and alleviate the suffering of both patients and their families.

Examining Profiles and Treatment Outcomes in Dual Diagnosis: Comparison of Coordinated Treatment With Mental Health Services Versus Addiction Center Alone. A Real-World Data Analysis.

OBJECTIVE: The aim of this work was to examine the profile and treatment outcomes of patients with dual pathology depending on whether the patients were attending addiction centers or are being treated in a coordinated model by mental health services. METHODS: Data from 7225 dual diagnosis patients were used, of whom 2417 (33.5%) received treatment in the mental health coordinated modality. Clinical information was taken from the patients' electronic health record. RESULTS: Differences were found in patients' sociodemographic and comorbidity profiles according to treatment modality. In general, coordinated care yielded favorable outcomes (higher attendance and lower dropout rates but no differences in retention). The logistic regression analysis identified predictors of patient profiles in coordinated care, emphasizing having a severe mental health disorder (OR = 3.878, 95% CI [3.443, 4.368]; p = .000), being referred by social/health services, or having retired status. Main differences were observed according to the comorbid diagnosis presented, particularly in cases in which the patient had impulse control, hyperkinetic, or cluster C personality disorder. CONCLUSIONS: While therapeutic outcomes are influenced by associated comorbidities, the disorders prognosis can be favorable with appropriate treatment. Furthermore, analysis of differences according to treatment modality allows for predicting the type of patient who will receive a particular service, which enables the development of tailored treatments.

Iatrogenic rectal perforation due to application of topical treatment in a patient with ulcerative colitis: a rare complication.

Rectal perforations due to topical treatments (enemas or foams) are unusual complications and they have been mostly reported in the use of barium enemas or in elderly patients with constipation. Very little has been reported about perforations secondary to topical treatment in patients with ulcerative colitis. We present the case of a patient with ulcerative colitis who suffered a rectal perforation complicated with a superinfected collection after the application of topical mesalazine foam.

Operational definitions and measurement of externalizing behavior problems: An integrative review including research models and clinical diagnostic systems.

Measurement of externalizing disorders such as antisocial disorders, attention-deficit/hyperactivity disorder or borderline disorder have relevant implications for the daily lives of people with these disorders. While the Diagnostic and Statistical Manual of Mental Disorders (DSM) and the International Classification of Diseases (ICD) have provided the diagnostic framework for decades, recent dimensional frameworks question the categorical approach of psychopathology, inherent in traditional nosotaxies. Tests and instruments develop under the DSM or ICD framework preferentially adopt this categorical approach, providing diagnostic labels. In contrast, dimensional measurement instruments provide an individualized profile for the domains that comprise the externalizing spectrum, but are less widely used in practice. Current paper aims to review the operational definitions of externalizing disorders defined under these different frameworks, revise the different measurement alternatives existing, and provide an integrative operational definition. First, an analysis of the operational definition of externalizing disorders among the DSM/ICD diagnostic systems and the recent Hierarchical Taxonomy of Psychopathology (HiTOP) model is carried out. Then, in order to analyze the coverage of operational definitions found, a description of measurement instruments among each conceptualization is provided. Three phases in the development of the ICD and DSM diagnosis systems can be observed with direct implications for measurement. ICD and DSM versions have progressively introduced systematicity, providing more detailed descriptions of diagnostic criteria and categories that ease the measurement instrument development. However, it is questioned whether the DSM/ICD systems adequately modelize externalizing disorders, and therefore their measurement. More recent theoretical approaches, such as the HiTOP model seek to overcome some of the criticism raised towards the classification systems. Nevertheless, several issues concerning this model raise mesasurement challenges. A revision of the instruments underneath each approach shows incomplete coverage of externalizing disorders among the existing instruments. Efforts to bring nosotaxies together with other theoretical models of psychopathology and personality are still needed. The integrative operational definition of externalizing disorders provided may help to gather clinical practice and research.

Monitoring adherence and abstinence of cannabis use disorder patients: Profile identification and relationship with long-term treatment outcomes.

BACKGROUND: Patients with cannabis use disorder (CUD) show heterogeneous sociodemographic and consumption patterns. Although previous studies, focused on identifying subgroups of CUD patients using input variables, have yielded useful results for planning individualized treatments, no published research has analyzed the profiles of CUD patients according to their therapeutic progress. This study therefore aims to identify subgroups of patients using adherence and abstinence indicators and to explore whether these profiles are associated with sociodemographic characteristics, consumption variables, and long-term therapeutic outcomes. METHODS: This was a retrospective observational study with a multisite sample of 2055 CUD outpatients who were beginning treatment. The study monitored patient data at two-year follow-up. We conducted latent profiles analysis on the appointment attendance ratio and percentage of negative cannabis tests. RESULTS: A three profile solution emerged: i) moderate abstinence/moderate adherence (n = 997); ii) high abstinence/moderate adherence (n = 613); and iii) high abstinence/high adherence (n = 445). The study found the most marked differences at the beginning of treatment for education level (chi2 (8) = 121.70, p < .001), source of referral (chi2 (12) = 203.55, p < .001), and frequency of cannabis use (chi2 (10) = 232.39, p < .001). Eighty percent of patients from the "high abstinence/high adherence" group were relapse-free at two year follow-up. This percentage decreased to 24.3 % in the "moderate abstinence/moderate adherence" group. CONCLUSIONS: Research has shown adherence and abstinence indicators to be useful for identifying subgroups of patients with different prognoses regarding long-term success. Recognizing the sociodemographic and consumption variables associated with these profiles at the beginning of treatment could help to inform the design of more individualized interventions.

Determinación de la concentración mínima inhibitoria de lotes de OLEOZON® tópico frente a Trichophyton rubrum, Trichophyton mentagrophytes y Epidermophyton floccosum / Determination of the minimum inhibitory concentration of batches of topical OLEOZON® against trichophyton rubrum, trichophyton mentagrophytes and epidermophyton floccosum

Introducción: En la actualidad las infecciones por hongos afectan entre el 20 y el 25 por ciento de la población. Objetivo: Determinar la concentración mínima inhibitoria de dos lotes de OLEOZON® almacenados a temperaturas de 5 y 30°C en envases de vidrio y polietileno de alta densidad, durante 24 meses como parte del estudio de estabilidad del OLEOZON® tópico. Métodos: Mediante el método dilución en agar fueron evaluadas cinco concentraciones del producto frente a los dermatofitos trichophyton rubrum, trichophyton mentagrophytes y epidermophyton floccosum. Resultados: Se obtuvo que el 8,9 mg/mL fue el valor de la CMI para las cepas evaluadas en el estudio vida de estante; se observó en el estudio acelerado el mismo valor frente a las cepas de trichophyton mientras que para epidermophyton floccosum fue de 17,8 mg/mL a excepción del envase frasco de vidrio del lote 803295 donde se obtuvo 8,9 mg/mL. El análisis estadístico, tanto del estudio acelerado como en vida de estante, mostró que existe diferencia estadísticamente significativa entre el primer y el último mes de ensayo, estas son las diferencias más apreciables en los lotes almacenados en frasco de vidrio. El OLEOZON® tópico almacenado en frasco de polietileno de alta densidad presentó mejores valores de actividad frente a los dermatofitos. Conclusiones: Todos los valores de la concentración mínima inhibitoria encontrados, independiente del tipo de envase, el tiempo o la temperatura de almacenamiento, muestran que el producto mantiene su actividad antifúngica. Se evidenció una similitud entre las cepas del género trichophyton en comparación con el género epidermophyton(AU)

Introduction: Currently fungal infections affect between 20 and 25percent of the population. Objective: To determine the minimum inhibitory concentration of two batches of OLEOZON® stored at temperatures of 5 and 30 0C in glass and high-density polyethylene containers, for 24 months as part of the stability study of topical OLEOZON®. Methods: Using the agar dilution method, five concentrations of the product were evaluated against the dermatophytes Trichophyton rubrum, Trichophyton mentagrophytes and Epidermophyton floccosum. Results: It was found that 8.9 mg/mL was the MIC value for the strains evaluated in this shelf life study; and the same value was observed in the accelerated study against the trichophyton strains, while for epidermophyton floccosum it was 17.8 mg/mL with the exception of the glass bottle container of batch 803295 where 8.9 mg/mL was obtained. The statistical analysis, both in the accelerated study and in shelf life, showed that there is a statistically significant difference between the first and the last month of the trial, these are the most appreciable differences in the batches stored in glass jars. Topical OLEOZON® stored in a high-density polyethylene bottle presented better activity values against dermatophytes. Conclusions: All the values of the minimum inhibitory concentration found, regardless of the type of container, the time or the storage temperature, show that the product maintains its antifungal activity during the months of study. A similarity was apparent between the strains of the genus trichophyton compared to the genus epidermophyton(AU)

Psychometric properties of the Spanish adaptation of the Externalizing Spectrum Inventory-Brief Form (ESI-BF).

The Externalizing Spectrum Inventory-Brief Form (ESI-BF) measures tendencies toward disinhibition, lack of control, aggression, and substance use. This study adapts the ESI-BF to the Spanish population and assesses its psychometric properties. The study included 742 community adults obtained by stratified random sampling with proportional allocation according to gender, age, and geographical area of the Spanish territory and a clinical sample consisting of 333 patients. All participants completed the Personality Inventory for Diagnostic and Statistical Manual of Mental Disorders, fifth edition (PID-5) and the Alcohol Substance Dependence Severity Scale, in addition to the Spanish version of the ESI-BF. Reliability was quantified using McDonald's omega and Cronbach's α reliability coefficients. Validity evidences were studied applying confirmatory factor analysis (CFA) and correlations. Results indicated adequate reliability of scores on the ESI-BF's general factors and most of its facets. Regarding internal structure, and in line with previous studies, both symmetric and S-1 hierarchical two-subfactor (bifactor) emerged as the best-fitting models. Considering both criticisms of symmetric models and parsimony, the S-1 bifactor model, which showed configural invariance across gender and samples, was retained. Validity evidence based on the relationship with other measures of personality and alcohol consumption show correlations values theoretically expected in both clinical and community samples. Findings suggest that the Spanish adaptation of the ESI-BF shows functional near-equivalence to the original version. Its effective psychometric properties make it useful instrument for further research related to the externalizing spectrum. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Retention in treatment and therapeutic adherence: How are these associated with therapeutic success? An analysis using real-world data.

INTRODUCTION: Treatment retention and adherence are used as outcomes in numerous randomized clinical trials and observational studies conducted in the addiction field. Although usual criteria are 3/6 months of treatment retention or number of sessions attended, there is not a methodological support for conclusions using these criteria. This study analyzed the usefulness of retention and adherence to predict therapeutic success. METHODS: Retrospective observational study using real-world data from electronic health records of 11,907 patients in treatment diagnosed with cocaine, alcohol, cannabis and opiate use disorders or harmful use. RESULTS: Moderate effect size relations were found between the different type of clinical discharge and months in retention (η2  = 0.12) and proportion of attendance (η2  = 0.10). No relationship was found with the number of sessions attended. Using cut-off points (i.e., 3 or 6 months in treatment or attending 6 therapy sessions) worsens the ability to predict the type of discharge. DISCUSSIONS/CONCLUSION: Treatment retention and adherence are indicators moderately related to therapeutic success. Research using these indicators to assess the effectiveness of therapies should complement their results with other clinical indicators and quality of life measures.

The role of lumen-apposing metal stents (LAMS) in iatrogenic esophageal perforations secondary to endoscopic dilation of benign short esophageal strictures.

81 year-old male had an asymptomatic iatrogenic perforation after balloon dilation of esophageal strictures. After the migration of the full covered self expandable metal stent (FCSEMS), a lumen-apposing metal stent (LAMS) was placed and no esophageal leak was seen after. LAMS could be an appropiate first-line approach to benign short esophageal strictures complicated with iatrogenic small perforation but further prospective studies are needed.

Norms According to Age and Gender for the Spanish Version of the Inventory of Depression and Anxiety Symptoms (IDAS-II).

Inventory of Depression and Anxiety Symptoms-II (IDAS-II) constitutes a useful measurement tool with demonstrated psychometric properties that is contributing to the advancement of knowledge of emotional disorders within transdiagnostic models. To implement its use in clinical settings it is important that the scores can be interpreted in order to guide clinical decisions. This study aims to develops normative data for the Spanish version of the IDAS-II. An anonymous online survey was applied to 1,072 subjects, recruited through a stratified random sampling procedure taking into account population gender, age, and geographical region of Spain. Results show that women tend to score higher than men, particularly on the Dysphoria, General Depression, Appetite Gain, and Lassitude scales. Largest effect sizes for differences in the scores according to age were found for Lassitude, Dysphoria, and General Depression. Therefore, normative data according to gender and age group for each IDAS-II scale is provided. The norms provided in this work complement those already available, facilitating the decision-making of clinical professionals. Evidence of unidimensionality is provided for the 19 IDAS-II scales that allows researchers and clinicians to use specific IDAS-II scales independently.

Abdominal ultrasound and its significant role in colon cancer. The advantage of its dynamic nature: using respiratory movements to assess neoplasia relations to adjacent organs.

A 58-year-old, otherwise healthy male presented to the Emergency Room due to a 24-hour-long bloody diarrhea and constitutional syndrome. Colonoscopy confirmed the presence of a colonic neoplasia. A CT scan revealed an irregular surface and poorly delimited hypodensity of liver segment 5, next to the neoplasia, with malignant infiltration being impossible to rule out.

Impact of Cluster B Personality Disorders in Drugs Therapeutic Community Treatment Outcomes: A Study Based on Real World Data.

BACKGROUND: The impact of dual pathology on treatment outcomes is unclear, with the literature reporting both favorable and unfavorable evidence. The main aim of this study was to determine how dual pathology affects treatment outcomes using real world data obtained from inpatients that began treatment in therapeutic communities. METHOD: The data of 2458 inpatients were used. Clinical information was obtained from electronic medical records. Reliability of diagnosis was checked and revealed a mean kappa value of 0.88. RESULTS: Of the sample, 41.8% were discharged after achieving the therapeutic objectives. Patients diagnosed with Cluster B personality disorders were found to have a higher risk of dropping out of treatment (HR = 1.320; z = 2.61; p = 0.009). CONCLUSIONS: Personality traits exhibited by Cluster B patients can interfere with treatment in therapeutic communities. There is a need to develop specific interventions for these inpatient groups, which could be implemented in therapeutic communities.

Intestinal burying of the jejunal-tube of a PEG-J levodopa-carbidopa release system for Parkinson's disease. Successful endoscopic management.

Levodopa-carbidopa intestinal gel (LCIG) continuous infusion into the jejunum through a percutaneous endoscopic gastrostomy with a jejunal extension (PEG-J) is an alternative therapy for Parkinson's disease (PD) patients, with a very poor control of their symptoms on regular oral medications (Hoehn-Yahr stage IV). Around 62.2 % of patients present procedure and device-related adverse effects (AE), with an 8.2 % rate of mayor complications.

Impairments in Executive Functioning in Patients with Comorbid Substance Use and Personality Disorders: A Systematic Review.

OBJECTIVE: The purpose of this systematic review was to examine the evidence for impaired executive functioning in patients diagnosed with a dual pathology of personality disorder (PD) and substance use disorder, and to identify whether differences exist in comparison to those with a single diagnosis. Methods: A systematic search was conducted to identify studies using measures of executive functioning in patients with PD-substance use disorder dual pathology. Sixteen studies were selected. Results: The results indicate that dual pathology patients with Cluster C personality disorder do not differ from controls, and that the presence of dual pathology does not influence the updating domain of executive functioning. The findings were inconclusive with regard to dual pathology patients with Cluster B personality disorders. Whilst the various studies consistently show that these patients show worse performance than the control groups, here are contradictory results with regard to whether Cluster B personality disorders add more alterations in executive functioning to those that already appear in substance use disorder. Conclusions: The results suggest the need for further research that more adequately controls variables such as time in treatment, medication, and sample size, whilst there is also a need to employ longitudinal designs that include more patients from Clusters A and C.