Strengthening self-regulation and reducing poverty to prevent adolescent depression and anxiety: Rationale, approach and methods of the ALIVE interdisciplinary research collaboration in Colombia, Nepal and South Africa.

AIMS: Depression and anxiety are the leading contributors to the global burden of disease among young people, accounting for over a third (34.8%) of years lived with disability. Yet there is limited evidence for interventions that prevent adolescent depression and anxiety in low- and middle-income countries (LMICs), where 90% of adolescents live. This article introduces the 'Improving Adolescent mentaL health by reducing the Impact of poVErty (ALIVE)' study, its conceptual framework, objectives, methods and expected outcomes. The aim of the ALIVE study is to develop and pilot-test an intervention that combines poverty reduction with strengthening self-regulation to prevent depression and anxiety among adolescents living in urban poverty in Colombia, Nepal and South Africa. METHODS: This aim will be achieved by addressing four objectives: (1) develop a conceptual framework that identifies the causal mechanisms linking poverty, self-regulation and depression and anxiety; (2) develop a multi-component selective prevention intervention targeting self-regulation and poverty among adolescents at high risk of developing depression or anxiety; (3) adapt and validate instruments to measure incidence of depression and anxiety, mediators and implementation parameters of the prevention intervention; and (4) undertake a four-arm pilot cluster randomised controlled trial to assess the feasibility, acceptability and cost of the selective prevention intervention in the three study sites. RESULTS: The contributions of this study include the active engagement and participation of adolescents in the research process; a focus on the causal mechanisms of the intervention; building an evidence base for prevention interventions in LMICs; and the use of an interdisciplinary approach. CONCLUSIONS: By developing and evaluating an intervention that addresses multidimensional poverty and self-regulation, ALIVE can make contributions to evidence on the integration of mental health into broader development policy and practice.

Risk of complications after a non-ST segment elevation acute myocardial infarction in a Latin-American cohort: An application of the ACTION ICU score.

BACKGROUND: European Society of Cardiology (ESC) guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation (NSTEMI) recommend Intensive Care Unit (ICU) surveillance during the first 24-48 h. Interestingly, the in-hospital mortality of NSTEMI patients has consistently decreased, giving some patients the option to be managed in general hospital wards. The ACTION ICU score has been proposed to identify high-risk patients with NSTEMI and guide the selective risk-based need for ICU care. OBJECTIVE: To evaluate the usefulness of the ACTION ICU score to predict patients' risk of developing complications requiring ICU care in a Latin-American cohort with NSTEMI. METHODS: We applied the ACTION ICU score in a retrospective cohort. A composite primary outcome included: cardiorespiratory arrest, shock, high-grade atrio-ventricular block, respiratory failure, stroke, or death. The predictive performance of this model was estimated with a conditional multivariable logistic regression analysis. RESULTS: Of 1,062 patients with NSTEMI, the primary outcome was present in 75 patients (7.1%), and 1,019 (96%) were admitted to ICU. The most common event was respiratory failure (4.0%), followed by cardiogenic shock (3.7%), and cardiac arrest (1.7%). The presence of heart failure signs or symptoms had the highest association with the primary outcome (OR:2.16; 95%CI:1.61-2.92). The best cut-off point for this population was 3 (complications risk: 4.0%, SEN:96%, SP:15.4%, NPV:98.1%, PPV:7.9%). CONCLUSION: The ACTION ICU score may be a promising tool to identify the need for ICU care in Latin-American patients with NSTEMI. Furthermore, additional research is needed to evaluate the cost-effectiveness of this strategy.

Síndrome biliar obstructivo no litiásico o de Lemmel. ¿Es tan infrecuente como parece? / Non-lithiasic obstructive biliary syndrome or Lemmel's syndrome. Is it as rare as it seems?

Introducción. Aproximadamente el 5 % de los divertículos duodenales pueden causar síntomas y el 1 % presentar complicaciones, siendo la colangitis la más frecuente. El síndrome de Lemmel corresponde a un tipo de ictericia obstructiva intermitente, asociado a la presencia de divertículos periampulares y disfunción del esfínter de Oddi, sin presencia de coledocolitiasis. Método. Se realizó una revisión sistemática de la literatura en Pubmed, Google Académico y ProQuest, con los términos: síndrome de Lemmel, divertículo duodenal sintomático e ictericia obstructiva intermitente. Resultados. Se encontraron 38 casos, siendo España el país con mayor número, seguido de México, Japón y Colombia. No hay diferencias de distribución con respecto al género. El tratamiento más frecuentemente empleado fue la colangio pancreatografia retrógrada endoscópica. Conclusión. El síndrome de Lemmel es poco frecuente, sin un cuadro clínico especifico, con un incremento en los casos informados en los últimos años, posiblemente debido a la mejor disponibilidad de métodos diagnósticos. Es más frecuente en pacientes en la octava década de la vida y su tratamiento generalmente es endoscópico

Introduction. Approximately 5% of duodenal diverticula can cause symptoms and 1% have complications, cholangitis being the most common. Lemmel syndrome corresponds to a type of intermittent obstructive jaundice, associated with the presence of peri-ampullary diverticula and sphincter of Oddi dysfunction, without choledocholithiasis. Method. A systematic review of the literature was carried out in Pubmed, Google Scholar, ProQuest, with the terms: Lemmel syndrome, symptomatic duodenal diverticulum, and intermittent obstructive jaundice.Results. 38 cases were found, Spain being the country with the highest number, followed by Mexico, Japan and Colombia. There are no differences in distribution with respect to gender. The most frequently used treatment was endoscopic retrograde cholangiopancreatography.Conclusion. Lemmel syndrome is a rare disease, without a specific clinical presentation, with an increase in reported cases in recent years possibly due to the better availability of diagnostic methods. It is more frequent in patients in the eighth decade of life and its treatment is generally endoscopic

Diagnostic challenge presented by right atrial mass: A report of two cases.

Right atrial masses raised pose 3 major possibilities including tumors, thrombi, or vegetations. We present 2 cases: first, a 34-year-old male with no medical history, who presented with dyspnea, pleuritic pain, and fever; and the second, 65-year-old male with similar symptoms and a history of a left renal carcinoma. Both patients had right atrial masses found on a transthoracic echocardiogram. Cardiac magnetic resonance imaging and an 18 FDG-PET were necessary finding thrombi in the first patient; and tumoral thrombi in the second one. A multimodality imaging approach to right atrial masses is essential for proper diagnosis and therapeutic decision-making.

MitraClip® as bridging strategy for heart transplantation in Chagas cardiomyopathy: a case report.

BACKGROUND: Patients with end-stage heart failure, suffering from severe pulmonary hypertension (PH) and elevated pulmonary vascular resistance, are not eligible for heart transplant due to high mortality risk and primary graft dysfunction. Severe PH may be favoured by functional severe mitral regurgitation, which is present in many cardiopathies like end-stage Chagasic cardiomyopathy. CASE SUMMARY: We present a case of a young man with end-stage heart failure secondary to Chagas cardiomyopathy with severe functional mitral regurgitation (FMR) and severe PH. The patient received percutaneous correction with MitraClip® system reducing PH and making him a suitable candidate for heart transplant. DISCUSSION: In patients with advanced heart failure, FMR, and severe PH, optimal treatment according to current guide lines is recommended. MitraClip® therapy appears to be safe and effective for control of severe PH as a bridge measure for cardiac transplantation.

Recycling and Updating an Educational Robot Manipulator with Open-Hardware-Architecture.

This article presents a methodology to recycle and upgrade a 4-DOF educational robot manipulator with a gripper. The robot is upgraded by providing it an artificial vision that allows obtaining the position and shape of objects collected by it. A low-cost and open-source hardware solution is also proposed to achieve motion control of the robot through a decentralized control scheme. The robot joints are actuated through five direct current motors coupled to optical encoders. Each encoder signal is fed to a proportional integral derivative controller with anti-windup that employs the motor velocity provided by a state observer. The motion controller works with only two open-architecture Arduino Mega boards, which carry out data acquisition of the optical encoder signals. MATLAB-Simulink is used to implement the controller as well as a friendly graphical interface, which allows the user to interact with the manipulator. The communication between the Arduino boards and MATLAB-Simulink is performed in real-time utilizing the Arduino IO Toolbox. Through the proposed controller, the robot follows a trajectory to collect a desired object, avoiding its collision with other objects. This fact is verified through a set of experiments presented in the paper.

Síndrome de desgaste profesional (SDP): definición e importancia en varias especialidades de la medicina / Professional Burnout Syndrome (BOS): definition and importance in various medical specialties / Síndrome de Burnout (esgotamento profissional) (SB): definição e importância em várias especialidades da medicina

El Síndrome de desgaste profesional (SDP), también conocido como "Burnout", es un término que define una caída del entusiasmo, sumado a síntomas de ansiedad, depresión y agresividad. Consta de tres etapas: agotamiento personal, despersonalización y déficit de realización personal. Pese a que todos los profesionales pueden llegar a experimentar el SDP, este es más frecuente entre los trabajadores de la salud, en especial los que trabajan en el área de oncología y en unidades de cuidados intensivos. La prueba de elección para medir el SDP es el cuestionario de Maslach Burnout Inventory (MBI) realizado por Christina Maslach en 1986 y validado en Colombia por la Universidad de Antioquia en el 2004. Existen intervenciones de dos tipos para el SDP, a nivel del individuo y a nivel de su entorno. A nivel del individuo existe el control del estrés, el ejercicio, las estrategias de higiene del sueño y los pasatiempos, entre otros. En cuanto al entorno del paciente, se tiene el adecuado manejo de los horarios de trabajo, evitar la sobrecarga laboral, cuidar los ambientes físicos del trabajo y priorizar el trabajo en equipo. En esta revisión narrativa se examina el tema del SDP y se describe cómo se desarrolla este en varios campos de la medicina: en la oncología, medicina de emergencias, la cirugía plástica, cirugía general, ortopedia y cuidado paliativo.

Professional Burnout Syndrome (BOS), also known as "Burnout" is a term that defines a reduction in enthusiasm, together with the symptoms of anxiety, depression, and aggressiveness. It has three stages: personal exhaustion, depersonalization, and personal performance deficit. Despite the fact that all professionals can experience BOS, it is most frequent among healthcare workers, especially those that work in oncology and intensive care units. The selection test to measure BOS is the Maslach Burnout Inventory (MBI) questionnaire carried out by Christina Maslach in 1986 and validated in Colombia by the Universidad de Antioquia in 2004. There are two types of interventions for BOS, on an individual and environmental level. On an individual level, there are stress control, exercise, sleep hygiene strategies, and pastimes, etc. Regarding the patient's environment, there is correct handling of work hours, avoiding work overload, looking after the physical workplace environment, and prioritizing teamwork. This literature review examines the subject of BOS and describes how it develops in various fields of medicine, in oncology, emergency medicine, plastic surgery, general surgery, orthopedics, and palliative care.

A Síndrome de Esgotamento Profissional (SEP), também conhecida como "Síndrome de Burnout" (SB), é um termo que define uma queda no entusiasmo, somada a sintomas de ansiedade, depressão e agressividade. É composta por três fases: exaustão pessoal, despersonalização e déficit de autorrealização. Embora todos os profissionais possam experimentar a SB, ela é mais frequente entre os profissionais da saúde, principalmente aqueles que atuam na área de oncologia e em unidades de terapia intensiva. O teste de escolha para medir a SB é o questionário Maslach Burnout Inventory (MBI) desenvolvido por Christina Maslach em 1986 e validado na Colômbia pela Universidade de Antioquia em 2004. Existem dois tipos de intervenções para a SB, ao nível do indivíduo e ao nível do seu ambiente. Ao nível do indivíduo há gerenciamento do estresse, exercícios, estratégias de higiene do sono, passatempos, entre outros. Em relação ao ambiente do paciente, há gerenciamento adequado dos horários de trabalho, evitando sobrecarga de trabalho, cuidando dos ambientes físicos de trabalho e priorizando o trabalho em equipe. Esta revisão narrativa examina o tema da SB e descreve como se desenvolve em vários campos da medicina: oncologia, medicina de emergência, cirurgia plástica, cirurgia geral, ortopedia e cuidados paliativos.

Correlation between videothoracoscopy and biopsy in patients with pleural effusion and suspected tuberculosis in a high complexity military hospital / Correlación entre videotoracoscopia y biopsia en pacientes con derrame pleural y sospecha de tuberculosis en Hospital Militar de alta complejidad

Background: In the diagnostic process of pleural tuberculosis, the findings from video-assisted thoracoscopy (VATS) can be highly suggestive for the diagnosis of infection. Methods: We reviewed VATS records between the years 2012 to 2016 of patients over 16 years of age with pleural effusion and suspected pleural tuberculosis. Symptoms, macroscopic and chemical characteristics of the fluid, surgical descriptions and visual diagnosis of the surgeon were recorded and were compared with the histopathology. Results: 106 patients were selected, most of them men (71.7%), of whom approximately half were active military (51.3%). The predominant symptoms were dyspnea, pleuritic pain, fever and evolution time greater than 15 days (94.3%, 80.2%, 50% and 46,2%, respectively). These symptoms, in turn, were present more frequently in pleural tuberculosis patients than in non-tuberculosis patients. The fluid was mostly turbid yellow (44%) and lymphocytic cellularity exudate (77.4%). The VATS findings in patients with confirmed TBC included nodules (96.9%), adhesions (87.5%) and thickening (78.1%). The diagnosis made by the surgeon in relation to the histopathological diagnosis showed a sensitivity of 88.6% and a specificity of 98.4%. Conclusion: There are highly suggestive characteristics of the macroscopic report of VATS that would allow a quicker diagnosis of pleural tuberculosis.

Antecedentes: Los hallazgos de toracoscopia asistida por video (VATS) durante el diagnostico de tuberculosis pleural, que son altamente sugestivos de la infección han sido poco descritos. Metodos: Se revisaron los registros de VATS entre los años 2012 a 2016 of de pacientes mayores de 16 años con efusión pleural y sospechosos de etiología tuberculosa. Se analizaron los síntomas, las características macroscópicas y bioquímicas del líquido, la descripción quirúrgica y el diagnostico visual y se compararon con los resultados de la histopatologia. Resultados: Se estudiaron los registros de 106 pacientes, la mayoría fueron sexo masculino (71.7%), y aproximadamente la mitad en servicio militar activo (51.3%). Los síntomas predominantes fueron disnea, dolor pleuritico, fiebre y tiempo de evolución mayor a 15 días (94.3%, 80.2%, 50% y 46,2%, respectivamente). Estos sintomas a su vez fueron más frecuentes en tuberculosis pleural que en no tuberculosis. El liquido fue más amarillo turbio (44%) y con exudado de tipo linfocitario (77.4%). Los hallazgos de VATS en pacientes con tuberculosis confirmada incluyeron nodulos (96.9%), adhesiones (87.5%) y engrosamiento (78.1%). El diagnóstico hecho por el cirujano con relación al histopatológico, tuvo una sensibilidad de 88.6% y una especificidad de 98.4%. Conclusion: Existen características en el VATS altamente sugestivas de tuberculosis pleural.

Compromiso pulmonar en la enfermedad hepática: una actualización / Pulmonary commitment in hepatic disease: uma atualização / Compromisso pulmonar na doença hepática

La enfermedad Hepática es una causa importante de morbilidad y Mortalidad en el mundo; asociada a compromiso orgánico múltiple. En el pulmón, tres condiciones clínicas han sido descritas; estos cuadros Incluyen, el Síndrome Hepatopulmonar (SHP), que obedece a un trastorno de la oxigenación por dilatación de la vasculatura pulmonar. La hipertensión portopulmonar (HPP), mediada por desequilibrio entre agentes vasodilatadores y vasoconstrictores que conducen a un aumento de la presión media de la arteria pulmonar y por último el Hidrotórax Hepático (HH), que es la condición menos prevalente, se fundamenta principalmente en anomalías anatómicas del diafragma, con o sin relación a la presencia de ascitis. La presencia SHP o HPP es predictor independiente de mortalidad, resaltando su importancia en la elegibilidad de pacientes para trasplante hepático ortotópico como medida curativa.

Liver disease is a major cause of morbidity and mortality in the world; it is associated with multiple organ involvement. In the lung, three clinical conditions are described; these conditions include, Hepatopulmonary Syndrome (HPS), which is due to a oxygenation defect by the development of pulmonary vascular dilatation. Portopulmonary (HPP) hypertension, it's mediated by an imbalance between vasodilator and vasoconstrictor agents leading to an increase in mean pulmonary artery pressure and finally the Hydrothorax Liver (HH), that is the least prevalent condition, it's based on anatomical diaphragm abnormalities, with or without ascites. The presence of SHP or HPP is an independent predictor of mortality, highlighting its importance in the eligibility of patients for orthotopic liver transplantation as a curative measure.

A doença hepatica é uma das principais causas de morbidade e mortalidade no mundo; está associado ao compromisso de vários órgãos. No pulmão, três condições clínicas são descritas; estas condições incluem, Síndrome Hepatopulmonar (HPS), que é devido a um defeito de oxigenação do dilatação vascular pulmonar. A hipertensão portopulmonar (HPP), é mediada por um desequilíbrio entre vasodilatadores e agentes vasoconstritores, levando a um aumento da pressão arterial média da artéria pulmonar e, finalmente, ao hidrotorax hepatico (HH), essa é a condição menos prevalente, é baseada em anormalidades anatômicas do diafragma, com ou sem ascite. A presença de SHP ou HPP é um preditor independente de mortalidade, destacando sua importância na elegibilidade de pacientes para transplante de hepatico como medida curativa.

Terapia posimplante de cardiodesfibrilador como prevención primaria y secundaria de muerte súbita en la Fundación Abood Shaio: seguimiento a un año / Therapy after to the implant of cardioverter-defi brillator in the primary and secundary prevention of sudden death during the fi rst year of follow up in the a clinic of fourth level of complexity

Introducción: el implante de cardiodesfi briladores ha cambiado el pronóstico en la prevención primaria y secundaria en paciente con muerte súbita. Hay sufi ciente evidencia que soporta que las terapias del cardiodesfi brilador, antitaquicardia y choques; tienen impacto sobre la morbimortalidad de los pacientes portadores del mismo, además del efecto proarritmogénico. Objetivo: está por determinar cuál es la incidencia de terapias apropiadas e inapropiadas en nuestra población de pacientes portadores de cardiodesfi brilador por prevención primaria y secundaria de muerte súbita. Materiales y métodos: se describe una serie de casos de pacientes a quienes se les implantó un cardiodesfi brilador como prevención primaria y secundaria de muerte súbita en una institución de cuarto nivel de complejidad. Resultados: la incidencia de terapia delcardiodesfi brilador implantable posimplante en pacientes con prevención primaria y secundaria de muerte súbita al primer año de seguimiento fue 44%. La incidencia de terapia apropiada del cardiodesfi brilador posimplante en pacientes con prevención primaria de muerte súbita al primer año de seguimiento fue 26,3%.La incidencia de terapia apropiada del cardiodesfi brilador posimplante en pacientes con prevención secundariade muerte súbita al primer año de seguimiento fue 53%. La mitad de los pacientes posimplante decardiodesfi brilador implantable como prevención primaria o secundaria presentaron terapias apropiadasdurante el seguimiento a un año. Los pacientes que presentaron terapias inapropiadas durante el año deseguimiento posterior al primoimplante de cardiodesfi brilador fueron 36%. Conclusiones: la terapia posterioral implante de cardiodesfi brilador se presento casi en la mitad de los pacientes, siendo más frecuente enprevención secundaria. Estos episodios se pueden presentar en diferentes patologías y pueden ser apropiadose inapropiados. Las complicaciones del procedimiento pueden ser agudas y crónicas.

The implant of Cardioverter-Defi brillator has changes the pronostic in the primary and secondary prevention in the patients with suden death. There are a lot of evidence that supports that the therapies of the CDI (antitachycardia and shocks) have impact on the morbimortality of the patients with Implantable Cardioverter-Defi brillators, besides the effect proarritmogenic. Objective: It is for determining which is the incidence of appropriate and inappropriate therapies in our population of patients with Implantable Cardioverter-Defi brillators for primary and secondary prevention of sudden death. Materials and Methods: we describe a case series of patients with cardioverter-Defi brillator as the primary and secondary prevention of sudden death in a clinic of fourth level of complexity. Results: the incidence of therapy of the Implantable Cardioverter-Defi brillators after implant in patients with primary and secondary prevention of sudden death to the fi rst year of follow-up was 44%. The incidence of apropiate therapy of the Implantable Cardioverter-Defi brillators after implant in patients with primary prevention of sudden death to the fi rst year of follow-up was the 26.3%.

The incidence of apropiate therapy of the Implantable Cardioverter-Defi brillators after implant in patients with secondary prevention of sudden death to the fi rst year of follow-up was the 53%. The half of the patients with Implantable Cardioverter-Defi brillators afterimpant for primary prevention or secondary had apropiate therapies during the fi rst year of follow-up. 36% of the patients presented inappropriate therapies during the year of follow-up after fi rst implat of the Implantable Cardioverter-Defi brillators. Conclusions: the therapies after to the implant of cardioverter-Defi brillator were near to the half of the patients, being more frecuent in the secundary prevention. These events may be present in the different pathologies, and to be apropiate and inapropiate. The complications of procedure may be acutes and chronics.

Effect of platelet-derived growth factor on the development and persistence of asbestos-induced fibroproliferative lung disease.

Platelet-derived growth factor (PDGF) isoforms and PDGF receptor-alpha are upregulated in fibroproliferative lesions in response to asbestos exposure. To examine the functional role of PDGF in asbestos-induced lung disease, we have evaluated the impact of PDGF-B overexpression in the lung on the development of pulmonary fibrosis induced by asbestos inhalation. Transgenic mice expressing PDGF-B from the surfactant protein C promoter and wild-type C57BL/6 mice were exposed to aerosolized chrysotile asbestos fibers via three different exposure regimens: 3 consecutive days to 9 mg/m(3), once a week for 5 weeks to 12 mg/m(3), or once a week for 8 weeks to 11 mg/m(3). The 3-day exposure did not produce fibroproliferative lesions in SPC-PDGFB or wild-type mice, indicating that PDGF expression did not increase susceptibility to a subthreshold dose of asbestos. Transgenic and wild-type mice subjected to the 5-week exposure protocol exhibited similar fibrogenic lesions histologically 48 hours and 8 weeks postexposure, but lungs from transgenic mice had elevated lung hydroxyproline content 8 weeks postexposure relative to wild-type mice. In addition, SPC-PDGFB transgenic mice developed pronounced thickening of arterioles following the 5-week exposure regimen. Mice exposed to asbestos for 8 weeks and examined 10 months later showed pronounced, diffuse fibrotic lesions of terminal bronchioles and alveolar ducts, but no histological differences between transgenic and nontransgenic mice were observed. These results indicated that PDGF-B overexpression can stimulate increased collagen deposition and vascular smooth muscle hyperplasia following asbestos inhalation and that a limited exposure (8 times) to chrysotile aerosol can produce long-lasting fibrotic lesions. The 8-week exposure regimen provides an animal model that encompasses an important aspect of human asbestosis-i.e., persistence of fibrosis for long periods after cessation of asbestos exposure.