Vitalidad Subjetiva, Bienestar Psicológico y Fortaleza Mental en Deportes de Combate / Vitalidade Subjetiva, Bem-Estar Psicológico e Resistência Mental em Esportes de Combate / Subjective Vitality, Psychological Wellbeing and Mental Strength in Combat Sports

La percepción de vitalidad es crítica para el funcionamiento físico, psicológico, y para el bienestar psicológico de los deportistas. Las investigaciones en el ámbito del deporte indican que existe una alta correlación entre vitalidad subjetiva y bienestar psicológico, siendo la fortaleza mental una variable protectora para la salud, ya que aumenta el bienestar psicológico. Por ello, el objetivo del presente estudio es conocer el nivel de bienestar psicológico y las posibles relaciones que existen entre los tres constructos en una muestra de adolescentes y adultos jóvenes de alto rendimiento deportivo en deportes de combate. Los resultados indican que existe una relación positiva entre las tres variables, siendo la vitalidad la que explica parte de la fortaleza mental y el bienestar psicológico con un efecto del tamaño alto. Además, la Fortaleza Mental es mediador de la relación de vitalidad subjetiva con bienestar psicológico (B=.122; SE= .028; LLCI=.073; ULCI=.183). Es decir, la vitalidad subjetiva influye en el bienestar psicológico mediante la fortaleza mental. Por tanto, la fortaleza mental no solo es importante como constructo, sino que en este estudio desempeña un rol de mediador. Parece importante el desarrollo de programas de intervención a jóvenes deportistas para la adquisición de habilidades centradas en las variables estudiadas. (AU)

The perception of vitality is essential for physical, psychological functioning and for the psychological well-being of athletes.Research in sport psychology indicates thatthere is a high correlation between subjective vitality and psychological wellbeing, being mental strength a protective variable for health, since it increases psychological wellbeing. Therefore, the objective of this study is to know the level of psychological well-being and the possible relationships between the three constructs in a sample of adolescents and young adults with high athletic performance in combat sports.The results indicate that there is a positive relationship between the three variables, being vitality that explains part of mental strength and psychological wellbeing with a high effect size. In addition, the Mental Force is a mediator of the relationship of subjective vitality with psychological wellbeing(B=.122; SE= .028; LLCI=.073; ULCI=.183).That is, subjective vitality influences psychological well-being through mental strength. Therefore, mental toughness is not only important as a construct, but plays a mediating role in this study. It seems important to develop intervention programs for young athletes for the acquisition of skills focused on the variables studied. (AU)

A percepção da vitalidade é fundamental para o funcionamentofísico, psicológicoalém de para o bem-estar psicológico dos atletas. Pesquisas na área do esporteindicam que existe uma alta correlação entre vitalidade subjetiva e bem-estar psicológico, sendo a força mental umavariávelprotetora para a saúde, pois aumenta o bem-estar psicológico. Neste sentido, o alvodesteestudo é conhecer o nível de bem-estar psicológico e as possíveisrelações que existem entre os trêsconstrutos em umaamostra de adolescentes e adultos jovenscom alto desempenho atlético em esportes de combate. Os resultados mostram que existe umarelação positiva entre as trêsvariáveis, com a vitalidade explicando parte da força mental e do bem-estar psicológico comumtamanho de efeito alto. Alémdisso, a Resistência Mental medeia a relação entre vitalidade subjetiva e bem-estar psicológico(B=.122; SE= .028; LLCI=.073; ULCI=.183). Ouseja, a vitalidade subjetiva influencia o bem-estar psicológico através da resistência mental. Portanto, a resistência mental não é apenas importante como construto, mas tambémdesempenhaum papel mediador nesteestudo. Parece importante desenvolver programas de intervenção para jovens atletas para aquisição de habilidades focadasnasvariáveis estudadas. (AU)

Síndrome de Edorexia: un posible problema mental de la autorregulación del apetito en obesidad / Edorexia syndrome: a possible mental problem of appetite autoregulation in obesity

Fundamentos: En este trabajo, se aborda el problema de la obesidad desde una perspectiva biopsicosocial. Definiendo la obesidad como una consecuencia de la autorregulación del apetito y cuyas conductas tienen una finalidad psicológica relacionada con el alivio de emociones y situaciones aversivas. Basándose en la autorregulación del apetito, se observa el Síndrome de Edorexia y se analiza su relación con la obesidad, personalidad y estilos de afrontamiento. Métodos: La muestra se constituyó por 111 individuos universitarios (29 individuos con edoréxicos y 82 sinedoréxicos) que no realizaban actividad física intensa en gimnasios y no presentaban un trastorno mental severo. Se administraron a todos los participantes el Cuestionario del Síndrome de Edorexia (CSE), el Cuestionario de Personalidad (BFQ) y el Cuestionario de Respuesta de afrontamiento (CRI-A).Resultados: Se observa que el Síndrome de Edorexia guarda relación con el abuso y evitación de los alimentos. Además, predice mejor la obesidad en comparación con otras conductas. Conclusiones: Los estudios recientes vinculan la obesidad con un problema relacionado con la autorregulación del apetito y desde este enfoque, el Síndrome de Edorexia parece ser un buen predictor de la obesidad. Según estos trabajos, la inhibición y la desinhibición del consumo de alimentos pueden ser la estrategia empleada por el organismo para solventar una situación aversiva. Por este motivo, la obesidad puede entenderse como una consecuencia del conjunto de síntomas y conductas al que se denomina Síndrome de Edorexia y resultado de una situación en la cual el individuo no dispone de otras conductas, habilidades y recursos para afrontarlo de una manera más saludable. (AU)

Background: In this article, we approach the problem of obesity from a biopsychosocial perspective. Obesity is defined as a consequence of self-regulation of appetite and such that its’ behaviors have a psychological purpose related to the relief of emotions and aversive situations. Based on self-regulation of appetite, we describe Edorexia Syndrome and we analyze its relationship with obesity, personality and coping. Methods: The sample was constituted by 111 university students (29 edorexic and 82 non-edorexic) who didn’t practice intense physical activity in gyms and didn’t present a severe mental disorder. A battery of psychological tests was applied to the whole sample. This battery consisted of Edorexia Syndrome Questionnaire (CSE), Big Five Personality Questionnaire (BFQ) and the Coping Response Inventory (CRI-A). Results: The results showed that the Edorexia Syndrome is related to the abuse and avoidance of food. It also showed that Edorexia predicts obesity better than other behaviors. Conclusions: Recent studies related obesity with a problem of self-regulation of appetite and from this perspective, Edorexia Syndrome seems to be a good predictor of obesity. According to these articles, the inhibition and disinhibition of food consumption may be the strategy used by the organism to resolve an aversive situation. For this reason, obesity can be comprehended as a consequence of the set of symptoms and behaviors called Edorexia Syndrome and the result of a situation in which the individual does not have other behaviors, skills and resources to confront it in a healthier way. (AU)

Evolution of lbx spinal cord expression and function.

Ladybird homeobox (Lbx) transcription factors have crucial functions in muscle and nervous system development in many animals. Amniotes have two Lbx genes, but only Lbx1 is expressed in spinal cord. In contrast, teleosts have three lbx genes and we show here that zebrafish lbx1a, lbx1b, and lbx2 are expressed by distinct spinal cell types, and that lbx1a is expressed in dI4, dI5, and dI6 interneurons, as in amniotes. Our data examining lbx expression in Scyliorhinus canicula and Xenopus tropicalis suggest that the spinal interneuron expression of zebrafish lbx1a is ancestral, whereas lbx1b has acquired a new expression pattern in spinal cord progenitor cells. lbx2 spinal expression was probably acquired in the ray-finned lineage, as this gene is not expressed in the spinal cords of either amniotes or S. canicula. We also show that the spinal function of zebrafish lbx1a is conserved with mouse Lbx1. In zebrafish lbx1a mutants, there is a reduction in the number of inhibitory spinal interneurons and an increase in the number of excitatory spinal interneurons, similar to mouse Lbx1 mutants. Interestingly, the number of inhibitory spinal interneurons is also reduced in lbx1b mutants, although in this case the number of excitatory interneurons is not increased. lbx1a;lbx1b double mutants have a similar spinal interneuron phenotype to lbx1a single mutants. Taken together these data suggest that lbx1b and lbx1a may be required in succession for correct specification of dI4 and dI6 spinal interneurons, although only lbx1a is required for suppression of excitatory fates in these cells.

Variational fitting of the Fock exchange potential with modified Cholesky decomposition.

The variational fitting of the Fock potential employing localized molecular orbitals requires either the inversion of the local two-center Coulomb matrices or alternatively the solution of corresponding linear equation systems with these matrices. In both cases, the method of choice is the Cholesky decomposition of the formally positive definite local two-center Coulomb matrices. However, due to finite-precision round-off errors, the local Coulomb matrices may be indefinite, and thus, the Cholesky decomposition is not applicable. To overcome this problem, we propose to make use of a modified Cholesky decomposition based on the indefinite factorization of local two-center Coulomb matrices. To this end, the working equations for the use of the modified Cholesky decomposition within the variational fitting of the Fock potential are presented. Benchmark calculations with global and range-separated hybrid functionals show that the proposed method can improve considerably the workload balance in parallel calculations.

Variational Density Fitting with a Krylov Subspace Method.

In this work, we present the implementation of a variational density fitting methodology that uses iterative linear algebra for solving the associated system of linear equations. It is well known that most difficulties with this system arise from the fact that the coefficient matrix is in general ill-conditioned and, due to finite precision round-off errors, it may not be positive definite. The dimensionality, given by the number of auxiliary functions, also poses a challenge in terms of memory and time demand since the coefficient matrix is dense. The methodology presented is based on a preconditioned Krylov subspace method able to deal with indefinite ill-conditioned equation systems. To assess its potential, it has been combined with double asymptotic electron repulsion integral expansions as implemented in the deMon2k package. A numerical study on a set of problems with up to 130,000 auxiliary functions shows its effectiveness to alleviate the abovementioned problematic. A comparison with the default methodology used in deMon2k based on a truncated eigenvalue decomposition of the coefficient matrix indicates that the proposed method exhibits excellent robustness and scalability when implemented in a parallel setting.

Asymmetric Density Fitting with Modified Cholesky Decomposition Applied to Second-Order Electron Propagator.

Computation of molecular orbital electron repulsion integrals (MO-ERIs) as a transformation from atomic orbital ERIs (AO-ERIs) is the bottleneck of second-order electron propagator calculations when a single orbital is studied. In this contribution, asymmetric density fitting is combined with modified Cholesky decomposition to generate efficiently the required MO-ERIs. The key point of the presented algorithms is to keep track of integrals through partial contractions performed on three-center AO-ERIs; these contractions are stored in RAM instead of the AO-ERIs. Two implementations are provided, an in-core, which reduces the arithmetic and memory scaling factors as compared to the four-center AO-ERIs contraction method, and a semidirect, which overcomes memory limitations by evaluating antisymmetrized MO-ERIs in batches. On the numerical side, the proposed approach is fast and stable. The bad effects due to ill conditioning, namely, several negative and close to zero eigenvalues due to machine round off errors of the matrix associated with the density fitting process, are effectively controlled by means of a modified Cholesky factorization that avoids the matrix inversion needed to perform the asymmetrical density fitting implementation. The numerical experience presented shows that the in-core implementation is highly competitive to perform calculations on medium and large basis sets, while the semidirect implementation has small variations in time by changes in the available memory. The general applicability is illustrated on a set of selected relatively large-size molecules.

Transcriptomic analysis of Pacific white shrimp (Litopenaeus vannamei, Boone 1931) in response to acute hepatopancreatic necrosis disease caused by Vibrio parahaemolyticus.

Acute hepatopancreatic necrosis disease (AHPND), caused by marine bacteria Vibrio Parahaemolyticus, is a huge problem in shrimp farms. The V. parahaemolyticus infecting material is contained in a plasmid which encodes for the lethal toxins PirABVp, whose primary target tissue is the hepatopancreas, causing sloughing of epithelial cells, necrosis, and massive hemocyte infiltration. To get a better understanding of the hepatopancreas response during AHPND, juvenile shrimp Litopenaeus vannamei were infected by immersion with V. parahaemolyticus. We performed transcriptomic mRNA sequencing of infected shrimp hepatopancreas, at 24 hours post-infection, to identify novel differentially expressed genes a total of 174,098 transcripts were examined of which 915 transcripts were found differentially expressed after comparative transcriptomic analysis: 442 up-regulated and 473 down-regulated transcripts. Gene Ontology term enrichment analysis for up-regulated transcripts includes metabolic process, regulation of programmed cell death, carbohydrate metabolic process, and biological adhesion, whereas for down-regulated transcripts include, microtubule-based process, cell activation, and chitin metabolic process. The analysis of protein- protein network between up and down-regulated genes indicates that the first gene interactions are connected to oxidation-processes and sarcomere organization. Additionally, protein-protein networks analysis identified 20-top highly connected hub nodes. Based on their immunological or metabolic function, ten candidate transcripts were selected to measure their mRNA relative expression levels in AHPND infected shrimp hepatopancreas by RT-qPCR. Our results indicate a close connection between the immune and metabolism systems during AHPND infection. Our RNA-Seq and RT-qPCR data provide the possible immunological and physiological scenario as well as the molecular pathways that take place in the shrimp hepatopancreas in response to an infectious disease.

Comparison of the amount and patterns of late enhancement in Chagas disease according to the presence and type of ventricular tachycardia.

BACKGROUND: Ventricular tachycardia (VT) is one of the main predictors of mortality in Chagas cardiomyopathy (CC). Although the substrate of sustained and nonsustained-VT (NS-VT) seems to be the same, little is known about the distribution of late enhancement (LE). Our aim was to compare the clinical findings and the amount and patterns of LE in Chagas disease according to the presence and type of VT. METHODS AND RESULTS: Magnetic resonance imaging was performed in 54 Chagas seropositive patients: 8 indeterminate and 46 with CC of whom 15 were without VT, 13 with NS-VT, and 18 with sustained-VT (S-VT). There were 31 males (57%), mean age was 55.9 ± 12.2 years. LE was found in 87% of all patients and in 50%, 80%, and 100% of the indeterminate, without VT and VT groups, respectively. The percentage of LE increased progressively in the indeterminate, CC without VT, and CC with VT groups; without a significant difference between NS-VT and S-VT (0.93%, 15.2%, 23.2%, and 21.4%, respectively). The amount of LE increased with the functional class. LE in the basal and mid lateral wall was more frequent in VT, without difference between S-VT and NS-VT. The only predictor of VT was the percentage of LE, odds ratio (OR), 6.2; (95% confidence interval [CI], 3.7-28.4; P = .01) with a cutoff of Odds Ratio 17.1%. CONCLUSIONS: The amount of LE increases in relation to the clinical stage of the disease and its functional class in Chagas seropositive patients. The amount of LE was the main predictor of VT, without difference between S-VT and NS-VT.

Neutrophil-to-lymphocyte ratio as a serum biomarker associated with community acquired pneumonia / Índice neutrófilo/linfocito como biomarcador sérico asociado con neumonía adquirida en comunidad

Background: Community acquired pneumonia (CAP) is the main infectious cause of mortality in the world. Several scales evaluates outcomes, however the current tendency favors using biomarkers as surrogates of clinical prognosis. Objective: To evaluate utility of neutrophil-to-lymphocyte ratio to identify severe patients according to Pneumonia Severity Index scale. Methods: Observational and retrospective study in adults ≥18 years old with CAP, evaluated in an emergency ward of a secondary level hospital. Demography, laboratory results, treatment and Pneumonia Severity Index scale (PSI) data were collected. The neutrophil-to-lymphocyte ratio (NLR) between two groups was compared, high risk vs. low risk of complications according to PSI. Results: 94 patients were studied. There were not differences in tobacco smoking, comorbidities and outcomes between groups. Neutrophil total count, lymphopenia, and NLR were more elevated in the high risk group (p < 0.05). Uni and multivariate analysis showed that neutrophils and NLR could be surrogate of PSI III or higher (OR: 1.05 and 1.14 respectively). A NLR value ≥ 7.2 provided that probability (AUC 0.65; IC 95% 0.53-0.78). Conclusion: NLR is useful to identify patients with grave pneumonia and risk of complications according to PSI.

Introducción: la neumonía adquirida en comunidad (NAC) es la principal causa de muerte por infección en el mundo. Diversas escalas de riesgo valoran desenlaces, sin embargo, la tendencia actual es utilizar biomarcadores predictores de la evolución clínica. Objetivo: evaluar la utilidad del índice neutrófilo/linfocito para discriminar pacientes graves con base en el índice de severidad de la neumonía. Métodos: estudio observacional, retrospectivo, de adultos ≥ 18 años de edad con NAC, atendidos en el servicio de urgencias de un hospital de segundo nivel de atención. Se recolectaron datos demográficos, paraclínicos, sobre el tratamiento y el índice de severidad de la neumonía (PSI). Con base en el PSI se contrastó el índice neutrófilo/linfocito (INL) en dos grupos, uno de bajo riesgo de complicaciones y otro de alto riesgo. Resultados: se analizaron 94 casos. No se observaron diferencias entre los grupos en el historial de tabaco, comorbilidades y desenlaces. Entre las variables paraclínicas, la neutrofilia, linfopenia y el INL fueron una constante en el grupo de alto riesgo (p < 0.05). El análisis univariado y multivariado demostraron que el porcentaje de neutrófilos y el INL pueden ser indicadores de una clase III del PSI o mayor (razón de momios 1.05 y 1.14 respectivamente). El valor de INL que precisa dicha probabilidad fue ≥ 7.2 (AUC 0.65; IC 95% 0.53-0.78). Conclusión: el INL es útil para identificar pacientes con neumonía grave y riesgo de complicaciones con base en el PSI.

[Asthma-chronic obstructive pulmonary disease overlap syndrome: clinical-functional profile]. / Síndrome de sobreposición asma-enfermedad pulmonar obstructiva crónica: perfil clínico-funcional.

BACKGROUND: Asthma and Chronic Obstructive Pulmonary Disease (COPD) affects 1 in 10 individuals worldwide. Asthma and COPD overlap syndrome (ACOS) have more symptoms, exacerbations and worse pulmonary function. OBJECTIVE: To evaluate the clinical-functional profile with ACOS who are detected in a second level clinic. METHODS: Retrospective study; 466 patients 18 years and older with COPD and asthma with acceptable spirometries were analyzed. ACOS definition proposed by Montes de Oca and colleagues was used. Patients were divided in three groups: Asthma, COPD and ACOS. Differences were estimated with Chi square and ANOVA with Bonferroni´s adjustment. RESULTS: 79.1% were diagnosed with asthma, 8.1% COPD and 12.6% ACOS. ACOS patients were more symptomatic; the exacerbation frequency during the last year was greater (Asthma: 24.9% vs. COPD: 15.8% vs. ACOS: 39%; p=0.036); in patients with ACOS the magnitude of change in pulmonary function was greater than those with asthma (p=0.000). The severity of obstruction was worse among those patients with COPD and ACOS. Having medical diagnosis of ACOS, dyspnea mMRC >2 and ACT <15 increased the probability of exacerbation during last the year. CONCLUSION: The prevalence of ACOS was 12.6% in our group. The patients with ACOS had the worst disease control, more frequency of previous exacerbations and more severity in lung function.

INTRODUCCIÓN: el asma y la enfermedad pulmonar obstructiva crónica (EPOC) afectan a uno de cada 10 individuos a nivel mundial. Su coexistencia (ACOS) se traduce en mayor frecuencia de síntomas, agudizaciones y en peor función pulmonar. OBJETIVO: evaluar el perfil clínico-funcional de los pacientes con sobreposición asma-EPOC. MÉTODOS: estudio transversal y retrospectivo; se analizaron a 466 pacientes mayores de 18 años con asma y EPOC con espirometrías aceptables. Se usó la definición de ACOS propuesta por Montes de Oca et al. Los pacientes se dividieron en tres grupos: asma, EPOC y ACOS. Se estimaron las diferencias con Chi cuadrada y ANOVA con ajuste de Bonferroni. RESULTADOS: el 79.3% de los pacientes tuvo diagnóstico de asma, el 8.1% de EPOC y el 12.6% de ACOS. Los pacientes con ACOS fueron más sintomáticos; la frecuencia de una exacerbación en el año previo fue significativamente mayor en ellos (asma: 24.9% vs. EPOC: 15.8% vs. ACOS: 39%; p = 0.036); En los pacientes con ACOS, la magnitud del cambio en función pulmonar fue mayor al compararse con los pacientes con asma (p = 0.000). La gravedad de la obstrucción fue mayor entre los grupos de EPOC y ACOS (p = 0.000). Tener el diagnóstico de ACOS, disnea mMRC > 2 y ACT < 15 otorgaron una probabilidad mayor de exacerbaciones el año previo. CONCLUSIÓN: la prevalencia de ACOS fue de 12.6%. Los pacientes con ACOS tenían peor control de la enfermedad, más frecuencia de exacerbaciones previas y mayor gravedad de la función pulmonar.

Síndrome de Sjögren primario y bronquiolitis. Una asociación no usual / Primary Sjögren's syndrome and bronchiolitis. An unusual association

El síndrome de Sjögren (SS) es una enfermedad sistémica autoinmune que afecta principalmente a las glándulas exocrinas. Se ha reportado que la asociación entre SS y compromiso respiratorio ocurre entre el 11 y el 45% de los casos. El diagnóstico se basa en la integración de criterios clínicos, inmunológicos e histopatológicos. Se presenta el caso de un masculino de 58 años, con SS, disnea grave y exacerbaciones recurrentes de la vía respiratoria, asociado a bronquiolitis-bronquiectasias. La ausencia de anticuerpos anti-Ro y anti-La, relacionados con la gravedad de la bronquiolitis, es una forma de presentación poco caracterizada en este grupo de pacientes, más aún, su tratamiento óptimo no está establecido

Sjögren's syndrome (SS) is a systemic autoimmune disease that mainly affects the exocrine glands. It has been reported that the association between SS and respiratory involvement occurs in 11% and 45% of cases, and can be the initial manifestation of the disease. The diagnosis is based on the integration of clinical, immunological and histopathological criteria. This paper examines a 58-year-old man with SS, severe dyspnea and recurrent exacerbations associated with bronchiolitis-bronchiectasis. The absence of anti-Ro and anti-La antibodies associated with severe bronchiolitis is a clinical presentation that is poorly characterized in this group of patients; moreover, how to treat them remains unclear

Pérdida recurrente del embarazo e hipertensión pulmonar idiopática / Recurrent pregnancy loss and idiopatic pulmonary hypertension

Resumen La pérdida recurrente del embarazo ocurre cuando una mujer tiene 2 ó más pérdidas de embarazos clínicos antes de las 20 semanas de gestación. Existen múltiples factores de riesgo relacionados con este padecimiento, entre ellos, la presencia de Hipertensión Pulmonar (HP) se vincula con elevada mortalidad (30-56% de los casos) y riesgo de abortos entre las semanas 9 y 12 de gestación. No se conoce con precisión la frecuencia de asociación entre las condiciones clínicas referidas. Presentamos el caso de una mujer de 31 años de edad que ingresó al hospital con un aborto en evolución, en el periodo posterior al legrado evidencian Hipoxemia Grave e Insuficiencia Cardiaca Derecha; durante el abordaje diagnóstico se confirma que la causa primaria de la recurrencia de abortos se encuentra asociada con la presencia de Hipertensión Pulmonar Idiopática.

Abstract Recurrent pregnancy loss occurs whenever a woman has 2 or more miscarriages of their clinical pregnancy before 20 weeks of gestation. There are multiple risk factors relates to this condition, among, them, the presence of pulmonary hypertension (PH) is linked with high mortality (30-56% of cases) and risk of miscarriages between 9 weeks and 12 of gestation. The prevalence of both conditions are not well known. Here, we present the case of a 31 year-old women who was admitted to the hospital with an abortion in evolution, immediately after the curettage, the patient exhibit severe hypoxemia in association with Right Heart Failure; the medical approach established that the primary cause of recurrent abortions was an uncontrolled idiopathic pulmonary hypertension.

[Laryngeal disease. Endoscopic characterization of 1493 procedures based on age]. / Patología laríngea. Caracterización endoscópica de 1493 procedimientos con base en la edad.

BACKGROUND: Based on international epidemiology, some laryngeal diseases could be more frequent at certain ages. The objective was to describe endoscopic findings in patients through distinct decades of age in a laryngoscopy facility. METHODS: retrospective and descriptive study; clinical and endoscopic records were collected from 1493 procedures performed between 2009 and 2015, and organized in five groups of age for analysis. Differences among them were analyzed by chi squared and ANOVA. RESULTS: 70% of patients reported dysphonia as a main symptom; 24% of subjects were referred with cancer diagnosis and just 7% of them, showed findings related to malignancy; on the other hand, cancer suspicion increased in direct proportion with age (p < 0.0001); inespecific inflammation and other benign endoscopic manifestations (e.g. vocal fold paralysis, subglotic stenosis and nodules) represented 80% of the whole findings; 14% of the procedures were reported as normal. Glottic and supraglottic structures were the two regions affected by malignancy; this finding was directly related to advanced age, particularly in patients of 70 years of age or older. Finally, subglottic stenosis was observed in patients younger than 50 years of age (p < 0.0001). CONCLUSIONS: Causes of laryngeal diseases are different in individuals according to their age. Carcinoma was more prevalent in adults of 70 years of age or older. Benign causes were secondary to inflammatory and functional conditions.

INTRODUCCIÓN: con base en datos epidemiológicos internacionales, algunas enfermedades de la laringe se presentan con mayor frecuencia en ciertos grupos etarios. El objetivo fue describir los hallazgos endoscópicos por edad de un grupo de pacientes enviados a una unidad de referencia de laringoscopía. MÉTODOS: se realizó una recolección de los datos clínicos y hallazgos endoscópicos de 1493 casos entre 2009 y 2015, organizados para su estudio en cinco grupos de edad. Se estimaron las diferencias con chi cuadrada y ANOVA. RESULTADOS: 70% de los pacientes manifestaron disfonía; 24% de los sujetos fueron enviados con diagnóstico de cáncer y solo el 7% de los casos tuvo datos compatibles; la sospecha de carcinoma se incrementó de manera directa con la edad (p < 0.0001); la inflamación y otros hallazgos (por ejemplo, parálisis cordal, nódulos, etcétera) representaron el 80% de los hallazgos endoscópicos; 14% de los procedimientos fueron normales. La región anatómica con mayor frecuencia de cáncer fue la supraglotis-glotis; este hallazgo también fue directamente proporcional con la edad, con mayor prevalencia en los mayores de 70 años. Finalmente, la estenosis traqueal se observó en pacientes jóvenes menores de 50 años (p < 0.0001). CONCLUSIONES: las causas de enfermedad laríngea difieren entre los individuos según la edad; la frecuencia mayor de carcinoma fue en pacientes > 70 años. Las causas benignas fueron principalmente por enfermedades inflamatorias y funcionales.

Análisis del comportamiento alimentario y sus factores psicológicos en población universitaria no obesa / Eating behaviour analysis and its psychological factors in non-obese university population

En el comportamiento alimentario de la población obesa pueden influir diversos factores psicológicos como, por ejemplo, la restricción alimentaria, la falta de control o el comer emocional. Aunque en la mayoría de las ocasiones estas variables se han estudiado en la población obesa, este estudio pretende evaluar la relación de estos factores con el comportamiento alimentario de la población no obesa y relacionar este comportamiento con el Síndrome de Edorexia. Se aplica una batería de tests compuesta por el Cuestionario del Síndrome de Edorexia, el Cuestionario de Personalidad BFQ y el Cuestionario de Respuesta de afrontamiento CRI-A a una muestra de 75 alumnos de la Universidad de Murcia. Nuestros resultados muestran cómo el Síndrome de Edorexia se relaciona con una disminución de estabilidad emocional, control emocional y reevaluación positiva, así como con un aumento de la aceptación y resignación. Además, los individuos con Síndrome de Edorexia se relacionan con la realización de dietas, privación de alimentos, realización de actividad física y el consumo sin necesidad. Estos resultados se explican mediante la teoría de las cinco vías (Macht, 2008) que relaciona la falta de habilidades para gestionar las emociones con el abuso incontrolable de alimentos (AU)

The eating beahaviour of obese population can be influenced by various psychological factors such us eating restriction, lack of control or emotional eating. Although in most ocassions this variables have been studied in obese population, the aim of this study is to evaluate the relations between this factors with eating behaviour in non-obese population and relate this behaviour with Edorexia Syndrome. A battery of psychological tests was applied to 75 students of Murcia University, this battery consisted of the Edorexia Syndrome Questionnaire, Big Five Personality Questionnaire and the Coping Response Inventory (CRI-A). The results showed how the Edorexia Syndrome was related with a dicrease in emotional stability, emotional control and positive reevaluation as well as an increase in acceptance and resignation. In addition, people with Edorexia Syndrome were related to dieting, food deprivation, exercising and consumption without needing. This results are explained by the Five Ways Theory (Macht, 2008) which relates the lack of skills to cope with emotions with the uncontrollable abuse of food (AU)

Primary Sjögren's syndrome and bronchiolitis. An unusual association. / Síndrome de Sjögren primario y bronquiolitis. Una asociación no usual.

Sjögren's syndrome (SS) is a systemic autoimmune disease that mainly affects the exocrine glands. It has been reported that the association between SS and respiratory involvement occurs in 11% and 45% of cases, and can be the initial manifestation of the disease. The diagnosis is based on the integration of clinical, immunological and histopathological criteria. This paper examines a 58-year-old man with SS, severe dyspnea and recurrent exacerbations associated with bronchiolitis-bronchiectasis. The absence of anti-Ro and anti-La antibodies associated with severe bronchiolitis is a clinical presentation that is poorly characterized in this group of patients; moreover, how to treat them remains unclear.

Influence of renal dysfunction phenotype on mortality in decompensated heart failure with preserved and mid-range ejection fraction.

BACKGROUND: Natriuretic peptides or the blood urea nitrogen to creatinine ratio (BUN/creat) can identify high- vs low-risk renal impairment (RI) in patients with heart failure and reduced ejection fraction (HF-REF). However, the situation in HF patients with preserved ejection fraction (HF-PEF) and mid-range ejection fraction (HF-MREF) remains unclear. METHODS: We evaluated patients from the Spanish National Registry of Heart Failure (RICA) that were admitted to Internal Medicine units with acute decompensated HF. Median admission values were used to define elevated NT-proBNP and BUN/creat. RESULTS: A total of 935 patients were evaluated, 743 with HF-PEF and 192 with HF-MREF). In patients with both NT-proBNP and BUN/creat below median admission values, RI was not associated with mortality (HR 1.15; 95% CI 0.7-1.87, p=0.581 in HF-PEF and HR 1.27; 95% CI 0.58-2.81, p=0.548 in HF-MREF). However, in patients with both elevated NT-proBNP and BUN/creat, those with RI had worse survival than those without RI (HR 2.01, 95% CI 1.33-3.06, p<0.001 in HF-PEF and HR 2.79, 95% CI 1.37-5.67, p=0.005 in HF-MREF). In HF-PEF even patients with RI with only 1 of the 2 parameters elevated, had a substantially higher risk of death compared to patients without RI (HR 1.53; 95% CI 1.04 to 2.26; p=0.031). CONCLUSIONS: In this clinical cohort of acute decompensated HF-PEF and HF-MREF patients, the combined use of NT-proBNP and BUN/creat stratifies patients with RI into groups with significantly different prognoses.

[Emergence of CMY-2-type plasmid-mediated AmpC ß-lactamase in Shigella sonnei and Salmonella spp. in Costa Rica, 2003-2015]. / Emergencia de ß-lactamasa AmpC plasmídica del grupo CMY-2 en Shigella sonnei y Salmonella spp. en Costa Rica, 2003-2015.

Plasmid-mediated AmpC are enzymes belonging to the group of ß-lactamases and encoded by bla AmpC genes. Of these enzymes, those known as type CMY-2 are the most frequently reported worldwide. Detection of enterobacteria that produce CMY-2-type plasmid-mediated AmpC is clinically important since the use of ß-lactam antibiotics can result in treatment failure. It is also important from a public health standpoint owing to the capacity for conjugative plasmid transfer to other enterobacteria, both within the community and in nosocomial environments. Thus, bacteria of this kind are considered to have clear epidemic potential. To investigate the circulation of this resistance mechanism among Salmonella and Shigella isolates in Costa Rica, from January 2003 to May 2015 we carried out a retrospective review of the data contained in the laboratory surveillance databases of the National Reference Bacteriology Center (CNRB) of the Costa Rican Nutrition and Health Research Institute (Inciensa). Over this period, 4363 Shigella isolates and 1785 Salmonella isolates were examined. Among them, 15 Shigella sonnei isolates and nine Salmonella isolates (four from human clinical specimens and five of avian origin) displayed a phenotype suspected of carrying plasmid-mediated AmpC. Polymerase chain reaction confirmed that all these isolates belong to type CMY-2. In light of these results, we recommend that the microbiology laboratories in the national network continue to conduct surveillance and confirm any suspicious isolates using phenotypic and molecular methods. This is particularly relevant when dealing with bacterial isolates from extraintestinal infections so as to prevent treatment failure.

Prophylactic Chronic Zinc Administration Increases Neuroinflammation in a Hypoxia-Ischemia Model.

Acute and subacute administration of zinc exert neuroprotective effects in hypoxia-ischemia animal models; yet the effect of chronic administration of zinc still remains unknown. We addressed this issue by injecting zinc at a tolerable dose (0.5 mg/kg weight, i.p.) for 14 days before common carotid artery occlusion (CCAO) in a rat. After CCAO, the level of zinc was measured by atomic absorption spectrophotometry, nitrites were determined by Griess method, lipoperoxidation was measured by Gerard-Monnier assay, and mRNA expression of 84 genes coding for cytokines, chemokines, and their receptors was measured by qRT-PCR, whereas nitrotyrosine, chemokines, and their receptors were assessed by ELISA and histopathological changes in the temporoparietal cortex-hippocampus at different time points. Long-term memory was evaluated using Morris water maze. Following CCAO, a significant increase in nitrosative stress, inflammatory chemokines/receptors, and cell death was observed after 8 h, and a 2.5-fold increase in zinc levels was detected after 7 days. Although CXCL12 and FGF2 protein levels were significantly increased, the long-term memory was impaired 12 days after reperfusion in the Zn+CCAO group. Our data suggest that the chronic administration of zinc at tolerable doses causes nitrosative stress, toxic zinc accumulation, and neuroinflammation, which might account for the neuronal death and cerebral dysfunction after CCAO.

Emergencia de β-lactamasa AmpC plasmídica del grupo CMY-2 en Shigella sonnei y Salmonella spp. en Costa Rica, 2003-2015 / Emergence of CMY-2-type plasmid-mediated AmpC β-lactamase in Shigella sonnei and Salmonella spp. in Costa Rica, 2003–2015

Las AmpC plasmídicas son enzimas del grupo de las β-lactamasas, codificadas por genes blaAmpC. Entre ellas, las del tipo CMY-2 son las que se reportan con mayor frecuencia a nivel mundial. La detección de enterobacterias productoras de AmpC plasmídicas CMY-2 es de importancia clínica, ya que pueden conducir a fracasos terapéuticos al emplear antibióticos b-lactámicos. Además, tienen importancia para la salud pública por su capacidad de transferirse por conjugación a otras enterobacterias, tanto en la comunidad como en ambiente nosocomial, por lo que se considera que tienen un claro potencial epidémico. Con el fin de conocer la circulación de este mecanismo de resistencia entre aislamientos de Salmonella y Shigella en Costa Rica, se realizó un análisis retrospectivo de la información contenida en las bases de datos de vigilancia de laboratorio del Centro Nacional de Referencia de Bacteriología (CNRB) del Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud (Inciensa), entre enero de 2003 y mayo de 2015. En dicho período se analizaron 4 363 aislamientos de Shigella y 1 785 aislamientos de Salmonella. Entre ellos se detectaron 15 aislamientos de Shigella sonnei y nueve de Salmonella (cuatro de origen clínico humano y cinco de origen aviar) con fenotipo sospechoso de portar AmpC plasmídica, todos los cuales se confirmaron pertenecientes al tipo CMY-2 mediante reacción en cadena de la polimerasa. Considerando estos resultados, se recomienda a los laboratorios de microbiología de la Red Nacional mantener la vigilancia y realizar la confirmación correspondiente de cualquier aislamiento sospechoso por métodos fenotípicos y moleculares. Lo anterior es especialmente importante en bacterias aisladas de infecciones extraintestinales, para evitar fallas en el tratamiento.

Plasmid-mediated AmpC are enzymes belonging to the group of β-lactamases and encoded by blaAmpC genes. Of these enzymes, those known as type CMY-2 are the most frequently reported worldwide. Detection of enterobacteria that produce CMY-2-type plasmid-mediated AmpC is clinically important since the use of β-lactam antibiotics can result in treatment failure. It is also important from a public health standpoint owing to the capacity for conjugative plasmid transfer to other enterobacteria, both within the community and in nosocomial environments. Thus, bacteria of this kind are considered to have clear epidemic potential. To investigate the circulation of this resistance mechanism among Salmonella and Shigella isolates in Costa Rica, from January 2003 to May 2015 we carried out a retrospective review of the data contained in the laboratory surveillance databases of the National Reference Bacteriology Center (CNRB) of the Costa Rican Nutrition and Health Research Institute (Inciensa). Over this period, 4363 Shigella isolates and 1785 Salmonella isolates were examined. Among them, 15 Shigella sonnei isolates and nine Salmonella isolates (four from human clinical specimens and five of avian origin) displayed a phenotype suspected of carrying plasmid-mediated AmpC. Polymerase chain reaction confirmed that all these isolates belong to type CMY-2. In light of these results, we recommend that the microbiology laboratories in the national network continue to conduct surveillance and confirm any suspicious isolates using phenotypic and molecular methods. This is particularly relevant when dealing with bacterial isolates from extraintestinal infections so as to prevent treatment failure.

Atelectasia lobar. Manifestación infrecuente de traqueobroncomalacia en adultos / Lobar atelectasis unusual presentation of tracheobronchomalacia in adults

Resumen Las alteraciones dinámicas del sistema respiratorio que condicionan colapso del lumen traqueobronquial durante la espiración favorecen síntomas inespecíficos o no atribuibles a una enfermedad respiratoria en particular. El diagnóstico preciso de la entidad clínica tiene implicaciones terapéuticas y pronosticas. La traqueobroncomalacia se diagnostica cuando existe una disminución en el lumen traqueobronquial mayor al 50% visible mediante exploración con broncoscopía. La etiología más frecuente en adultos es la forma adquirida y es rara la asociación con atelectasia.

Abstract Respiratory dynamic abnormalities that contributes with collapse of the airway luminal during expiration can cause nonspecific symptoms or not related to a respiratory disease. Accurate diagnosis of the clinical entity has therapeutic implications and is important for the prognosis. Tracheobronchomalacia is diagnosed when there is a decrease in the lumen tracheobronchial greater than 50% visible through exploration with Bronchoscopy. The main etiology in adults was the acquired form and association with lung atelectasis was rare.