Bloqueo caudal más anestesia general balanceada en un paciente con pentalogía de Cantrell, presentación de un caso clínico / Caudal block plus inhaled general anesthesia in a patient with pentalogy of Cantrell, presentation of a clinical case

The pentalogy of Cantrell is a disorder characterized by congenital abnormalities in the abdominal wall, lower sternum, anterior diaphragm, diaphragmatic pericardium, and cardiac anomalies. It is a rare disease with 250 cases registered around the world. The anesthetic implications will require a specialized management given the ventilatory mechanics and cardiac function which are compromised by the disease in the newborn. We present the case of a female patient with pentalogy of Cantrell without prenatal diagnosis, who had an operative procedure to correct patent ductus arteriosus and abdominal mesh placement under balanced general anesthesia with sevoflurane and fentanyl plus caudal block. This case is reported to provide our experience in the anesthetic management of this type of patients.

La pentalogía de Cantrell es una enfermedad caracterizada por anormalidades congénitas de la pared abdominal supraumbilical, esternón inferior, diafragma, pericardio diafragmático y anomalías cardiacas. Se trata de una enfermedad rara con 250 casos registrados alrededor del mundo. Las implicaciones anestésicas requieren de un manejo especializado debido a la mecánica ventilatoria y función cardíaca que se encuentran comprometidas en el recién nacido. Se presenta el caso de una recién nacida portadora de pentalogía de Cantrell, no diagnosticada prenatalmente, quien fue sometida a corrección de ductus arterioso persistente y colocación de malla abdominal bajo anestesia general balanceada con sevofluorano y fentanilo más bloqueo caudal. Se reporta el presente caso para brindar nuestra experiencia en el manejo anestésico de este tipo de pacientes.

Reporte de caso: Manejo anestésico en un paciente pediátrico con ictiosis más deshidratación grave / Case report: Anesthetic management of an infant patient with ichthyosis plus severe dehydration

INTRODUCTION: Ichthyosis are hereditary disorders of keratinization which are characterized for the presence of hyperkeratosis and/or peeling. This disorder group can put in danger the life of the patient because of the severe alteration of the skin barrier, associated with a severe transdermic loss of water, different grades of hypothermia and a hypernatremic dehydration. OBJECTIVE: Introducing the clinic case of an infant patient with the diagnosis of ichthyosis plus severe dehydration who is scheduled for placement of CVC. CLINICAL CASE: Male infant, 3 months old, with the diagnosis of ichthyosis and severe dehydration, scheduled for placement of CVC. CONCLUSIONS: Due to the urgency of our patient, who presented severe dehydration, an inhaled general anesthesia with sevoflurane and oxygen was decided, without instrumenting the airway which in these patients has the risk of being potentially difficult, from the placement of the face mask itself, until finding lesions within the oral cavity, ventilatory assis- tance should be maintained by the pediatric anesthesiologist, once venous access is achieved, the fluids restitution is performed with loads of 10 to 20 ml/kg of the patient's weight, hyperthermia was controlled with physical means.

INTRODUCCIÓN: Las ictiosis son trastornos hereditarios de la queratinización caracterizadas por la presencia de hiperqueratosis y/o descamación. Este grupo de patologías pueden poner en peligro la vida del paciente debido a la severa alteración de la barrera cutánea, asociada a intensa pérdida transepidérmica de agua, diferentes grados de hipotermia y la deshidratación hipernatrémica. OBJETIVO: Presentar un caso clínico de paciente lactante menor con diagnóstico de ictiosis, cursando un cuadro grave por deshidratación, al que se le instala un CVC. CASO CLÍNICO: Lactante masculino, 3 meses de edad, con diagnóstico de ictiosis y deshidratación grave programado para colocación de CVC. CONCLUSIONES: Debido a la urgencia del paciente quien presentaba un caso de deshidratación severa se decide anestesia general inhalada con sevoflurano y oxígeno, sin instrumentación de la vía área, la cual en estos pacientes tiene el riesgo de ser potencialmente difícil, desde la propia colocación de la mascarilla facial hasta encontrar lesiones dentro de la cavidad oral; se debe mantener la asistencia ventilatoria por el anestesiólogo pediatra, una vez logrado el acceso venoso se procede a la restitución hídrica con cargas de 10 a 20 ml/kg de peso del paciente, el control de la hipertermia fue con medios físicos.

Depresión, ansiedad, apoyo interpersonal y dolor autopercibido en pacientes con síndrome de fibromialgia / Depression, Anxiety, Interpersonal Support, and Self-Perceived Pain in Fibromyalgia Syndrome Patients

Resumen El síndrome de fibromialgia (sf) es una patología que genera gran dificultad en los movimientos, fatiga y dolor en partes del cuerpo, afectando severamente la calidad de vida. El objetivo de este estudio fue determinar los indicadores de depresión, ansiedad, apoyo interpersonal, dolor autopercibido y su relación, en una muestra de pacientes con sfen Colombia. A 100 pacientes se les aplicaron las siguientes pruebas: Inventario de Ansiedad Rasgo Estado, Escala de depresión de Zung, Cuestionario para evaluación del apoyo interpersonal, y la Escala analógica del dolor. Se reportaron niveles moderados de depresión y ansiedad, dificultades específicas en el apoyo social y niveles altos en dolor autopercibido. Las puntuaciones en la escala de depresión se asociaron positivamente con la ansiedad estado y rasgo, pero se asociaron negativamente con el apoyo social. En conclusión, la salud mental, el apoyo interpersonal y el dolor autopercibido se encuentran afectados en los pacientes. Se requiere ajustar los protocolos de atención clínica con el propósito de conservar y potenciar la salud integral en los afectados.

Abstract The fibromyalgia syndrome (fs) is a pathology that generates great difficulty in movements, fatigue, and pain in different parts of the body, affecting severely the quality of life. This study was aimed to determine the indicators of depression, anxiety, interpersonal support, self-perceived pain, and their relationship in a sample of patients with fsin Colombia. The following tests were applied to 100 patients: State Trait Anxiety Inventory, Zung's Depression Scale, Interpersonal Support Evaluation List, and Analogue Pain Scale. Moderate levels of depression and anxiety were reported, specific difficulties in social support, and high levels of self-perceived pain. Depression scores were positively associated with state and trait anxiety scores but negatively associated with social support. In conclusion, mental health, interpersonal support, and self-perceived pain are affected in fs patients. It is necessary to adjust the clinical care protocols to preserve and enhance the integral health of those affected.

Factor structure models for the Post-Concussion Syndrome Scale with monolingual Spanish-speaking adults from Colombia.

PRIMARY OBJECTIVE: The Post-Concussion Syndrome Scale (PCSS) is a self-report questionnaire that measures post-concussive symptom severity and has been primarily normed on young Caucasian samples. This study aims to explore the factor structure models of a Spanish translation of the PCSS at a chronic post-traumatic brain injury (TBI) time point. RESEARCH DESIGN: Descriptive and exploratory research designs were utilized. METHODS AND PROCEDURES: The study consisted of a monolingual sample of Spanish-speaking adults from Colombia, with 100 subjects in the control group and 70 subjects in the TBI group. A t-test, chi-square, and MANOVA were calculated to compare group differences. Cronbach's alpha was calculated to investigate reliability. Confirmatory factor analysis compared item loadings onto an existing four-factor model. Exploratory factor analysis sought to identify a new factor model if the loadings did not fit. MAIN OUTCOMES AND RESULTS: There were no group differences in demographic variables. Internal consistency was acceptable. Model fit indices revealed a poor fit with the original four factors. Item loadings revealed a novel six-structure model. CONCLUSIONS: While the PCSS appears to capture general post-TBI sequelae, the underlying factors may differ due to cultural and linguistic differences in Spanish-speaking individuals. Clinical implications and future directions are further discussed.

Manejo anestésico en la enfermedad de Von Recklinghausen. Reporte de un caso / Von Recklinghausen syndrome: Case report and anesthesis management

La enfermedad de Von Recklinghausen o neurofibromatosis tipo I es una enfermedad caracterizada por tendencia a la formación de tumores de tejidos del ectodermo y mesodermo. Existen diversas implicaciones anestésicas que incluyen la sensibilidad alterada a la succinilcolina y a relajantes neuromusculares no-despolarizantes, además de alteraciones en la anatomía normal de la vía aérea; se presenta el caso de una paciente de 58 años programada para la resección de tumoración cutánea temporo-parietal derecha, se utilizó succinilcolina como relajante muscular en donde a pesar de la vida media corta de éste, no se requirió de dosis subsecuentes durante el tiempo de duración de la cirugía; por lo que se corroboro una sensibilidad alterada hacia los relajantes musculares de tipo despolarizantes en este tipo de pacientes.

Von Recklinghausen disease or neurofibromatosis type I is a disease characterized by the tendency to form tissue tumors of the ectoderm and mesoderm. There are several anesthetic implications that include altered sensitivity to succinylcholine and non-depolarizing neuromuscular relaxants, in addition to alterations in the normal anatomy of the airway; we present the case of a 58 year old patient scheduled for the resection of the right temporo-parietal cutaneous tumor. Succinylcholine was used as a muscle relaxant. Despite its short half-life, no subsequent doses were required during the treatment period duration of surgery; Therefore, an altered sensitivity towards muscle relaxants of depolarizing type was corroborated in this type of patients.

Comparative In Vitro Study of 11C-Methionine and 11C-Deuterodeprenyl Uptake in Three Human Glioma Cell Lines.

AIM: To compare the uptake of 11C-deuterodeprenyl (11C-DED) and 11C-methionine (11C-MET) in three human glioma cell lines and study the relationship with glial fibrillary acid protein (GFAP) and monoamine oxidase B (MAO B) expression. 11C-DED is used in positron emission tomography imaging as a marker of astrocytosis in various central nervous system pathologies. It binds irreversibly to MAO B, a glial dimeric enzyme with increased activity in some neurological pathologies. MATERIALS AND METHODS: Binding and internalization studies of 11C-MET and 11C-DED were performed in astrocytoma grade III, glioblastoma grade IV, and radio-resistant glioblastoma grade IV cells. Immunofluorescence was used. RESULTS: 11C-MET specific activity bound to membrane was 9.0%-11.1% and that internalized was 88.9%-91.0%. 11C-DED specific activity bound to membrane was 34.8%-58.0% and that internalized was 38.7%-65.2%. Immunocytochemistry revealed GFAP and MAO B expression. CONCLUSIONS: The expression of MAO B measured by 11C-DED uptake or immunocytochemistry was not significantly different in grade III or IV cells. The GFAP signal was higher for grade IV compared to grade III. 11C-MET uptake was high in all the tumor cells. 11C-DED is a dopamine analogue and the transport across cell membranes is expected to be mediated by DAT receptors present in astrocytes. Reactive astrocytes surround tumor lesions; so the authors suggest that the 11C-DED uptake might be caused by the reactive astrocytosis and not by MAO B expression in tumor cells.

Synthesis of [18F]2B-SRF101: A Sulfonamide Derivative of the Fluorescent Dye Sulforhodamine 101.

BACKGROUND: The red fluorescent dye Sulforhodamine 101 (SR101) has been used in neuroscience research as a useful tool for staining of astrocytes, since it has been reported as a marker of astroglia in the neocortex of rodents in vivo. The aim of this work is to label SR101 with positron emission radionuclides, in order to provide a radiotracer to study its biological behavior. This is the first attempt to label SR101 by [18F], using a chemical derivatization via a sulfonamidelinker and a commercially available platform. METHODS: The synthesis of SR101 N-(3-Bromopropyl) sulfonamide and SR101 N-(3- Fluoropropyl) sulfonamide (2B-SRF101) was carried out. The radiosynthesis of SR101 N-(3- [18F]Fluoropropyl) sulfonamide ([18F]2B-SRF101) was performed in a TRACERlab® FX-FN. Different labeling conditions were tested. Three pilot batches were produced and quality control was performed. Lipophilicity, plasma protein binding and radiochemical stability of [18F]2BSRF101 in final formulation and in plasma were determined. RESULTS: SR101 N-(3-Bromopropyl) sulfonamide was synthetized as a precursor for radiolabeling with [18F]. 2B-SRF101 was prepared for analytical purpose. [18F]2B-SRF101 was obtained with radiochemical purity of (97.0 ± 0.6%). The yield of the whole synthesis was (11.9 ± 1.7 %), nondecay corrected. [18F]2B-SRF101 was found to be stable in final formulation and in plasma. The octanol-water partition coefficient was (Log POCT = 1.88 ± 0.14). The product showed a high percentage of plasma protein binding. CONCLUSIONS: The derivatization of SR101 via sulfonamide-linker and the first radiosynthesis of [18 F]2B-SRF101 were performed. It was obtained in accordance with quality control specifications. In vitro stability studies verified that [18F]2B-SRF101 was suitable for preclinical evaluations.

Multiple mediation path model of pain's cascading influence on physical disability in individuals with SCI from Colombia, South America.

BACKGROUND: Research has begun to document the bivariate connections between pain in individuals with spinal cord injury (SCI) and various aspects of health related quality of life (HRQOL), such as fatigue, social functioning, mental health, and physical functioning. OBJECTIVE: The purpose of this study was to construct and test a theoretical path model illuminating the stage-wise and sequential (cascading) HRQOL pathways through which pain increases physical disability in individuals with SCI in a sample from Colombia, South America. It was hypothesized that increased pain would lead to decreased energy, which would lead to decreased mental health and social functioning, which both would lead to emotional role limitations, which finally would lead to physical role limitations. METHODS: A cross-sectional study assessed individuals with SCI (n = 40) in Neiva, Colombia. Participants completed a measure indexing various aspects of HRQOL. RESULTS: The path model overall showed excellent fit indices, and each individual path within the model was statistically significant. Pain exerted significant indirect effects through all possible mediators in the model, ultimately suggesting that energy, mental health, social functioning, and role limitations-emotional were likely pathways through which pain exerted its effects on physical disability in individuals with SCI. CONCLUSIONS: These findings uncover several potential nodes for clinical intervention which if targeted in the context of rehabilitation or outpatient services, could result in salubrious direct and indirect effects reverberating down the theoretical causal chain and ultimately reducing physical disability in individuals with SCI.

Pediatric SCI/D caregiver mental health and family dynamics in Colombia, South America.

OBJECTIVE: This study examined the connections between family dynamics and the mental health of caregivers of youth with spinal cord injuries/disorders (SCI/D) caregivers from Colombia, South America. It was hypothesized that lower family functioning would be associated with poorer caregiver mental health. METHODS: A cross-sectional study of self-report data collected from caregivers through the Hospital Universatario Hernando Moncaleano Perdomo in Neiva, Colombia. Thirty caregivers of children with SCI/D from Nevia, Colombia who were a primary caregiver for ≥3 months, providing care for an individual who was ≥6 months post-injury/diagnosis, familiar with the patient's history, and without neurological or psychiatric conditions. Caregivers' average age was 41.30 years (SD = 10.98), and 90% were female. Caregivers completed Spanish versions of instruments assessing their own mental health and family dynamics. RESULTS: Family dynamics explained 43.2% of the variance in caregiver burden and 50.1% of the variance in satisfaction with life, although family dynamics were not significantly associated with caregiver depression in the overall analysis. Family satisfaction was the only family dynamics variable to yield a significant unique association with any index of caregiver mental health (satisfaction with life). CONCLUSIONS: If similar findings emerge in future intervention research, interventions for pediatric SCI/D caregivers in Colombia and other similar global regions could benefit from including techniques to improve family dynamics, especially family satisfaction, given the strong potentially reciprocal connection between these dynamics and caregiver mental health. IMPLICATIONS FOR REHABILITATION: The degree of disability resulting from SCI/D can vary greatly depending on the severity and level of the lesion, though permanent impairment is often present that profoundly impacts both physical and psychological functioning. Very little is known about the impact of pediatric SCI/D in developing countries, despite the high rates of injury reported in these areas. Family interventions could contribute significantly to the lives of children with SCI/D and their families.

Spinal Cord Injury Functional Impairment and Caregiver Mental Health in a colombian sample: An exploratory study / Deficiencias funcionales en pacientes con lesiones de la médula espinal y la salud mental del cuidador: un estudio exploratorio en una muestra colombiana

Limited literature has examined the connections between caregiver mental health and the physical and psychosocial functioning of individuals with spinal cord injury (SCI) in Latin America, despite the dearth of services and unique needs of this population. The purpose of the current study was to examine the relationships between caregiver mental health (anxiety, burden, depression, satisfaction with life, and self-esteem) and SCI physical and psychosocial functional impairments in a Colombian sample. Forty SCI caregivers were recruited from Neiva, Colombia, and completed measures of SCI impairments and their own mental health. Greater SCI impairments, and caregiver stress due to those impairments, were associated with higher caregiver depression and anxiety, although only patient psychosocial functional impairments and related caregiver stress were uniquely associated with caregiver depression. Due to the collectivist nature of and the importance of family in many Latino cultures, mental health interventions for family members who provide care for an individual with SCI having greater psychosocial impairments may be particularly important.

Poca literatura ha examinado las relaciones entre salud mental del cuidador y funcionamiento físico y psicosocial de las personas con traumatismo de médula espinal en América Latina, a pesar de la escasez de servicios y necesidades únicas de esta población. El propósito del presente estudio fue examinar las relaciones entre la salud mental del cuidador (ansiedad, sobrecarga, depresión, satisfacción con la vida y autoestima) y las discapacidades físicas y psicosociales de personas con traumatismo de médula espinal en una muestra colombiana. Cuarenta cuidadores de personas con traumatismo de médula espinal fueron reclutados en Neiva, Colombia, quienes completaron medidas de discapacidad del traumatismo de médula espinal y de su propia salud mental. Mayores niveles de discapacidad en personas con traumatismo de médula espinal y niveles de estrés del cuidador debido a esas discapacidades, fueron asociadas con mayores niveles de depresión y ansiedad en el cuidador, aunque sólo las discapacidades psicosociales de los pacientes y el estrés relacionado con el cuidador fueron asociados con la depresión en el cuidador. Debido a la naturaleza colectivista y la importancia de la familia en la mayoría de las culturas latinas, las intervenciones centradas en la salud mental de los familiares que cuidan de personas con traumatismo de la medula espinal pueden ser particularmente importantes.

Sexual Functioning, Desire, and Satisfaction in Women with TBI and Healthy Controls.

Traumatic brain injury (TBI) can substantially alter many areas of a person's life and there has been little research published regarding sexual functioning in women with TBI. Methods. A total of 58 women (29 with TBI and 29 healthy controls) from Neiva, Colombia, participated. There were no statistically significant differences between groups in sociodemographic characteristics. All 58 women completed the Sexual Quality of Life Questionnaire (SQoL), Female Sexual Functioning Index (FSFI), Sexual Desire Inventory (SDI), and the Sexual Satisfaction Index (ISS). Results. Women with TBI scored statistically significantly lower on the SQoL (p < 0.001), FSFI subscales of desire (p < 0.05), arousal (p < 0.05), lubrication (p < 0.05), orgasm (p < 0.05), and satisfaction (p < 0.05), and the ISS (p < 0.001) than healthy controls. Multiple linear regressions revealed that age was negatively associated with some sexuality measures, while months since the TBI incident were positively associated with these variables. Conclusion. These results disclose that women with TBI do not fare as well as controls in these measures of sexual functioning and were less sexually satisfied. Future research is required to further understand the impact of TBI on sexual function and satisfaction to inform for rehabilitation programs.

Health related quality of life and mental health in children with SCI/D from Neiva, Colombia.

OBJECTIVE: To date, no research has been published on the health related quality of life (HRQOL) and mental health of children with spinal cord injury and disorders (SCI/D) in Latin America, although limited previous research in Western countries has demonstrated the debilitating and chronic nature of these conditions in children. The aim was to examine the connections between HRQOL and mental health in children with SCI/D from Neiva, Colombia. STUDY DESIGN: Thirty children (8- 17 years) were recruited from the Hospital Universatario Hernando Mocaleano Perdomo in Neiva, Colombia. Participants completed self-report measures administered verbally by trained research staff. RESULTS: A correlation matrix generally suggested that higher HRQOL was robustly associated with better mental health. A series of multiple regressions found that HRQOL explained 50.5% of the variance in children's depression, 31.5% of the variance in worry, and 41.9% of the variance in social anxiety. Within these regressions, emotional and social functioning were uniquely associated with depression, and emotional functioning was uniquely associated with social anxiety. CONCLUSION: This is the first published study to examine psychosocial outcomes in children with SCI/D in Latin America, and its findings suggest that future research and interventions for children with SCI/D in Colombia - and possibly in other regions of Latin America - would benefit from emphasizing emotional and social functioning.

Mind and body: Mental health and health related quality of life in SCI caregivers from Neiva, Colombia.

BACKGROUND: Despite the body of research on caregivers of individuals with various types of disabilities, SCI caregivers have received comparably less attention, especially in regions like Latin America. OBJECTIVE: The purpose of this study was to examine the association between HRQOL and mental health in SCI caregivers from Colombia. METHOD: A cross sectional study assessed SCI caregivers (n = 40) in Neiva, Colombia. Participants completed a measure of their HRQOL (SF-36 Health Questionnaire) and four measures of mental health (Satisfaction With Life Scale, Zarit Burden Interview, Patient Health Questionnaire-9, and State-Trait Anxiety Inventory). RESULTS: A canonical correlation between variables revealed that 64% of the variance was shared between mental health and HRQOL. The domains that loaded highest within the canonical correlation were social functioning, general health, and anxiety, indicating that SCI caregivers with higher anxiety experienced lower social functioning and lower general health. Furthermore, 15 of the 24 bivariate correlations between mental health and HRQOL were statistically significant, suggesting a strong connection between these two sets of variables. CONCLUSION: Rehabilitation professionals in Latin America should consider the development of caregiver interventions focusing on both physical and mental health, as the two constructs are closely connected through social functioning, general health, and anxiety.

The relationship between physical and mental health variables in individuals with spinal cord injury from Latin America.

BACKGROUND: Previous research has examined the health-related quality of life (HRQOL) and mental health of persons with spinal cord injury (SCI), but the majority of the research has taken place in the United States, Western Europe, and other developed countries. Limited research has been conducted with persons with SCI in Latin America. OBJECTIVE: To examine the relationship between HRQOL and mental health in persons with SCI from Neiva, Colombia. DESIGN: Cross-sectional. SETTING: Participants were recruited from the Foundation for the Integral Development of People with Disabilities, a nonprofit community organization for persons with disabilities. PARTICIPANTS: Forty persons with SCI from Neiva, Colombia. METHODS: Caregivers completed the Spanish versions of questionnaires. MAIN OUTCOME MEASURES: Participants completed self-report measures of HRQOL (SF-36 Health Questionnaire) and mental health (Satisfaction with Life Scale, Patient Health Questionnaire-9, and State Trait Anxiety Inventory). RESULTS: The hypothesis that higher HRQOL would be related to better mental health found robust support, as the canonical correlation between these 2 sets of variables uncovered that 50.4% of the variance was shared, such that persons with lower HRQOL had reduced mental health. Within this canonical correlation, anxiety, fatigue, and general health loaded most highly, suggesting that persons with SCI who experienced lower energy and reduced general health tended to have high anxiety. Additionally, 9 out of the 18 bivariate correlations between these 2 variable sets were statistically significant. CONCLUSIONS: In Latin America, SCI rehabilitation services are extremely sparse and rarely include interventions that target postinjury mental health. The current study suggests that mental health issues in patients with reduced HRQOL warrant attention in SCI rehabilitation services, especially in this region.

With a little help from my friends: social support and mental health in SCI caregivers from Neiva, Colombia.

BACKGROUND/OBJECTIVE: The purpose of this study was to examine the influence of appraisal, belonging, and tangible social support on the mental health (depression, satisfaction with life, anxiety, and burden) of Colombian spinal cord injury (SCI) caregivers. METHODS: Forty SCI caregivers from Neiva, Colombia completed questionnaires assessing their perceived social support and mental health. RESULTS: Four multiple regressions found that the three social support variables explained 42.8% of the variance in caregiver depression, 22.3% of the variance in satisfaction with life, 24.1% of the variance in anxiety, and 16.5% of the variance in burden, although the effect on burden was marginally significant. Within these regressions, higher belonging social support was uniquely associated with lower depression, and higher tangible social support was uniquely associated with higher caregiver satisfaction with life. CONCLUSIONS: Social support may have a particularly important influence on SCI caregiver mental health in Colombia, due in part to the high levels of collectivism and strong family values shown to exist in Latin America, and may therefore be an important target for SCI caregiver interventions in this region.

Comparison of mental health between individuals with spinal cord injury and able-bodied controls in Neiva, Colombia.

Although research has investigated the mental health of individuals with spinal cord injury (SCI), an overwhelming majority of this research has been conducted in the United States, Western Europe, and other developed countries. The purpose of this study was to compare the mental health of individuals with SCI with able-bodied controls in Neiva, Colombia, South America. Subjects included 40 Colombians with SCI and 42 age- and sex-matched controls (N = 82). The groups did not differ based on age, sex, years of education, or socioeconomic status. However, controls were twice as likely to be married. Four measures assessed mental health, including satisfaction with life (Satisfaction with Life Scale), depressive symptoms (Patient Health Questionnaire-9), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State-Trait Anxiety Inventory). In comparison with able-bodied controls, individuals with SCI reported significantly lower mental health on both depressive symptoms and satisfaction with life. These effect sizes were medium and large, respectively. The groups did not differ significantly on measures of self-esteem or anxiety. Mental health of individuals with SCI should be considered a central part of SCI rehabilitation interventions, particularly in Latin America.

Examining the relationship between health-related quality of life in individuals with spinal cord injury and the mental health of their caregivers in Colombia, South America.

Although considerable research has been carried out on family caregivers of individuals with various types of disabilities, spinal cord injury (SCI) caregivers have received considerably less attention in terms of research, especially in regions such as Latin America. This study examined the relationship between health-related quality of life (HRQOL) in individuals with SCI and their family caregiver's mental health in Neiva, Colombia. Thirty-four individuals with SCI and their primary caregivers (34 dyads; n=68) from the Foundation for the Integral Development of People with Disabilities in Neiva, Colombia, were included in this study. Individuals with SCI completed eight subscales of the SF-36 that assessed HRQOL. Five aspects of caregiver mental health were assessed, including burden (Zarit Burden Interview), satisfaction with life (Satisfaction with Life Scale), depression (Patient Health Questionnaire-9), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State Trait Anxiety Inventory). A series of multiple regressions uncovered strong associations among the HRQOL of individuals with SCI and various aspects of caregiver mental health. In these regressions, patient physical functioning and pain were independently related to caregiver burden; patient pain and general health were independently related to caregiver satisfaction with life; and patient pain was independently related to caregiver anxiety. HRQOL in individuals with SCI was robustly related to their caregiver's mental health, suggesting that the two sets of variables are closely linked. These findings suggest that caregiver mental health should be a central part of SCI rehabilitation interventions, especially in Latin America.

Development of the family needs assessment tool for caregivers of individuals with neurological conditions in Latin America / Desarrollo del instrumento de evaluación de las necesidades familiares para cuidadores de personas con alteraciones neurológicas en Latinoamérica

This study developed and examined the psychometric proprieties of the Spanish Family Needs Assessment Tool (FNAT) for caregivers of individuals with neurological conditions in Latin America. Twentyseven items from previously published caregiver family needs scales were combined to represent nine types of needs. These items were administered to 308 caregivers of individuals with neurological conditions in Latin America. An exploratory factor analysis suggested the retention 14 items and five factors: Household Needs, Informational Needs, Financial Needs, Health Needs, and Social Support Needs. A confirmatory factor analysis then examined the fit of the five-factor solution and suggested adequate model fit. Cronbach's alphas for the overall scale and subscales suggested acceptable internal consistency. The FNAT holds promise to help researchers and clinicians assess the family needs of caregivers in Latin America.

El objetivo de este estudio fue evaluar las propiedades psicométricas del instrumento de evaluación de necesidades familiares (FNAT) en un grupo de 308 cuidadores de personas con alteraciones neurológicas en Latinoamérica. El FNAT consta de 27 ítems que miden algunas de las principales necesidades que experimentan los cuidadores de estas personas. Con el objetivo de determinar la estructura factorial del instrumento se realizó un análisis factorial exploratorio. Los resultados muestran que de los 27 ítems iniciales del instrumento se obtuvieron 5 factores (Necesidades de ayuda en tareas domésticas, necesidades de recibir información, necesidades apoyo financiero, necesidades de ayuda para mejorar la salud y necesidades de apoyo social) que estarían conformados por 14 ítems. Mediante un análisis factorial confirmatorio, se evaluó el nivel de ajuste de estos cinco factores cuyo resultado final muestra un ajuste adecuado del modelo y un nivel aceptable de consistencia interna tanto para la escala completa como para las subescalas. En conclusión, esta nueva versión del FNAT de 14 ítems posee buenas características psicométricas que lo hacen ser un instrumento confiable en la evaluación de las necesidades de cuidadores de personas con alteraciones neurológicas tanto en contextos clínicos como de investigación.

Health-related quality of life in individuals with spinal cord injury in Colombia, South America.

OBJECTIVE: To assess health-related quality of life (HRQOL) of individuals with Spinal Cord Injury (SCI) in Neiva, Colombia. DESIGN: Cross-sectional. PARTICIPANTS/METHODS: 40 Colombians with SCI and 42 age- and gender-matched controls completed the SF-36, a self-report measure composed of eight component areas (physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/fatigue, and general health perceptions). RESULTS: Compared to healthy controls, individuals with SCI had significantly lower means on five SF-36 subscales: physical functioning (22.5 vs. 94.0; p < 0.001), role limitations due to physical problems (54.4 vs. 77.4; p < 0.01), social functioning (67.5 vs. 80.1; p < 0.05), pain (65.4 vs. 79.5; p < 0.01), and general health (54.9 vs. 69.4; p < 0.01). Both groups scored similarly on the SF-36 emotional well-being subscale. CONCLUSION: Individuals with SCI from Neiva, Colombia report having poorer quality of life across various domains than healthy controls, primarily in the area of physical functioning. These findings suggest the need for rehabilitation health professionals to develop and implement interventions to improve HRQOL in individuals with SCI.

Astrocytic proliferation and mitochondrial dysfunction induced by accumulated glutaric acidemia I (GAI) metabolites: possible implications for GAI pathogenesis.

Glutaric (GA) and 3-hydroxyglutaric (OHGA) acids accumulate in glutaric acidemia I (GAI), a neurometabolic disease characterized by acute striatal degeneration and chronic progressive cortical atrophy. To explore the hypothesis that astrocytes are involved in GAI pathogenesis and targets of accumulating metabolites, we determined the effects of GA and OHGA on cultured rat cortical astrocytes. Remarkably, both acids induced mitochondria depolarization and stimulated proliferation in confluent cultures without apparent cell toxicity. Newborn rats injected with GA systemically also showed increased cell proliferation in different brain regions. Most of the proliferating cells displayed markers of immature astrocytes. Antioxidant iron porphyrins prevented both mitochondria dysfunction and increased in vitro and in vivo proliferation, suggesting a role of oxidative stress in inducing astrocytosis. Taken together, the data suggest that mitochondrial dysfunction induced by GA metabolites causes astrocytes to adopt a proliferative phenotype, which may underlie neuronal loss, white matter abnormalities and macrocephalia characteristics of GAI.