Mortality Due to Acute Respiratory Distress Syndrome in Latin America.

OBJECTIVES: Mortality due to acute respiratory distress syndrome (ARDS) is a major global health problem. Knowledge of epidemiological data on ARDS is crucial to design management, treatment strategies, and optimize resources. There is ample data regarding mortality of ARDS from high-income countries; in this review, we evaluated mortality due to ARDS in Latin America. DATA SOURCES: We searched in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and Latin American and Caribbean Health Science Literature databases from 1967 to March 2023. STUDY SELECTION: We searched prospective or retrospective observational studies and randomized controlled trials conducted in Latin American countries reporting ARDS mortality. DATA EXTRACTION: Three pairs of independent reviewers checked all studies for eligibility based on their titles and abstracts. We performed meta-analysis of proportions using a random-effects model. We performed sensitivity analyses including studies with low risk of bias and with diagnosis using the Berlin definition. Subgroup analysis comparing different study designs, time of publication (up to 2000 and from 2001 to present), and studies in which the diagnosis of ARDS was made using Pa o2 /F io2 less than or equal to 200 and regional variations. Subsequently, we performed meta-regression analyses. Finally, we graded the certainty of the evidence (Grading of Recommendations Assessment, Development, and Evaluation). DATA SYNTHESIS: Of 3315 articles identified, 32 were included (3627 patients). Mortality was 52% in the pooled group (low certainty of evidence). In the sensitivity analysis (according to the Berlin definition), mortality was 46% (moderate certainty of evidence). In the subgroup analysis mortality was 53% (randomized controlled trials), 51% (observational studies), 66% (studies published up to 2000), 50% (studies after 2000), 44% (studies with Pa o2 /F io2 ≤ 200), 56% (studies from Argentina/Brazil), and 40% (others countries). No variables were associated with mortality in the meta-regression. CONCLUSIONS: ARDS mortality in Latin America remains high, as in other regions. These results should constitute the basis for action planning to improve the prognosis of patients with ARDS (PROSPERO [CRD42022354035]).

Artificial intelligence cloud platform improves arrhythmia detection from insertable cardiac monitors to 25 cardiac rhythm patterns through multi-label classification.

BACKGROUND: Electrocardiogram (ECG) is the gold standard for the diagnosis of cardiac arrhythmias and other heart diseases. Insertable cardiac monitors (ICMs) have been developed to continuously monitor cardiac activity over long periods of time and to detect 4 cardiac patterns (atrial tachyarrhythmias, ventricular tachycardia, bradycardia, and pause). However, interpretation of ECG or ICM subcutaneous ECG (sECG) is time-consuming for clinicians. Artificial intelligence (AI) classifies ECG and sECG with high accuracy in short times. OBJECTIVE: To demonstrate whether an AI algorithm can expand ICM arrhythmia recognition from 4 to many cardiac patterns. METHODS: We performed an exploratory retrospective study with sECG raw data coming from 20 patients wearing a Confirm Rx™ (Abbott, Sylmar, USA) ICM. The sECG data were recorded in standard conditions and then analyzed by AI (Willem™, IDOVEN, Madrid, Spain) and cardiologists, in parallel. RESULTS: In nineteen patients, ICMs recorded 2261 sECGs in an average follow-up of 23 months. Within these 2261 sECG episodes, AI identified 7882 events and classified them according to 25 different cardiac rhythm patterns with a pondered global accuracy of 88%. Global positive predictive value, sensitivity, and F1-score were 86.77%, 83.89%, and 85.52% respectively. AI was especially sensitive for bradycardias, pauses, rS complexes, premature atrial contractions, and inverted T waves, reducing the median time spent to classify each sECG compared to cardiologists. CONCLUSION: AI can process sECG raw data coming from ICMs without previous training, extending the performance of these devices and saving cardiologists' time in reviewing cardiac rhythm patterns detection.

Plasmid permissiveness of wastewater microbiomes can be predicted from 16S rRNA sequences by machine learning.

MOTIVATION: Wastewater treatment plants (WWTPs) harbor a dense and diverse microbial community. They constantly receive antimicrobial residues and resistant strains, and therefore provide conditions for horizontal gene transfer (HGT) of antimicrobial resistance (AMR) determinants. This facilitates the transmission of clinically important genes between, e.g. enteric and environmental bacteria, and vice versa. Despite the clinical importance, tools for predicting HGT remain underdeveloped. RESULTS: In this study, we examined to which extent water cycle microbial community composition, as inferred by partial 16S rRNA gene sequences, can predict plasmid permissiveness, i.e. the ability of cells to receive a plasmid through conjugation, based on data from standardized filter mating assays using fluorescent bio-reporter plasmids. We leveraged a range of machine learning models for predicting the permissiveness for each taxon in the community, representing the range of hosts a plasmid is able to transfer to, for three broad host-range resistance IncP plasmids (pKJK5, pB10, and RP4). Our results indicate that the predicted permissiveness from the best performing model (random forest) showed a moderate-to-strong average correlation of 0.49 for pB10 [95% confidence interval (CI): 0.44-0.55], 0.43 for pKJK5 (0.95% CI: 0.41-0.49), and 0.53 for RP4 (0.95% CI: 0.48-0.57) with the experimental permissiveness in the unseen test dataset. Predictive phylogenetic signals occurred despite the broad host-range nature of these plasmids. Our results provide a framework that contributes to the assessment of the risk of AMR pollution in wastewater systems. AVAILABILITY AND IMPLEMENTATION: The predictive tool is available as an application at https://github.com/DaneshMoradigaravand/PlasmidPerm.

A Case Report of Subacute Combined Degeneration Due to Nitrous Oxide-Induced Vitamin B12 Deficiency.

Nitrous oxide, also known as "laughing gas," is a naturally occurring gas that is colorless, odorless, nonflammable, and nontoxic. It has been used as an inhalant anesthetic in the medical field for more than 150 years for dental and surgical procedures. Due to its wide availability and ability to cause euphoria, its recreational use is on the rise. We present a case of subacute combined degeneration (SCD) due to nitrous oxide-induced vitamin B12 deficiency. The patient presented with bilateral lower extremity paresthesia, weakness, and ataxic gait. The patient was found to have vitamin B12 deficiency. An MRI of the cervical spine revealed an abnormal T2 signal within the cervical spinal cord extending from the level of C2-C6 affecting only the posterior column. On the fifth day of hospitalization, the patient reported that he had been inhaling nitric oxide from whipped cream cans for recreational use. According to his clinical presentation and laboratory and imaging findings, we concluded that the patient had SCD. The patient slowly improved after receiving vitamin B12 supplementation therapy. Patients presenting with paresthesia, weakness, and laboratory studies indicating vitamin B12 deficiency should be questioned about nitrous oxide recreational use since the incidence is increasing.

Unexpected median SEPs fluctuations during brain cavernous malformation resection with no post-operative deficit.

Median nerve somatosensory evoked potentials (SEPs) may present changes during cavernous malformation (CM) resection unrelated to new post-operative sensory deficits. We performed intraoperative neurophysiological monitoring of median SEPs (m-SEPs) in three patients who underwent CM resection (surgery) near the sensory-motor cortex. The only preoperative clinical manifestations in all patients were seizures. All patients presented m-SEPs alterations on the side of the lesion during the procedure. Two patients presented permanent changes in the cortical potentials. In the third patient, the cortical and subcortical components suffered temporal fluctuations to return to baselines at the end of the surgery. None of these patients developed new post-operative clinical deficits. During brain cavernous malformation resection, significant fluctuations in the amplitude of different components of m-SEPs may occur. These changes may be due to excitability variations on m-SEP generators and do not translate into new post-operative neurological deficits.

Multiple Sclerosis Followed by Neuromyelitis Optica Spectrum Disorder: From the National Multiple Sclerosis Society Case Conference Proceedings.

A woman presented at age 18 years with partial myelitis and diplopia and experienced multiple subsequent relapses. Her MRI demonstrated T2 abnormalities characteristic of multiple sclerosis (MS) (white matter ovoid lesions and Dawson fingers), and CSF demonstrated an elevated IgG index and oligoclonal bands restricted to the CSF. Diagnosed with clinically definite relapsing-remitting MS, she was treated with various MS disease-modifying therapies and eventually began experiencing secondary progression. At age 57 years, she developed an acute longitudinally extensive transverse myelitis and was found to have AQP4 antibodies by cell-based assay. Our analysis of the clinical course, radiographic findings, molecular diagnostic methods, and treatment response characteristics support the hypothesis that our patient most likely had 2 CNS inflammatory disorders: MS, which manifested as a teenager, and neuromyelitis optica spectrum disorder, which evolved in her sixth decade of life. This case emphasizes a key principle in neurology practice, which is to reconsider whether the original working diagnosis remains tenable, especially when confronted with evidence (clinical and/or paraclinical) that raises the possibility of a distinctively different disorder.

Median nerve somatosensory evoked potential alarm related to head and neck positioning for carotid surgery.

Head positioning in carotid surgery represents an often overlooked but sensitive period in the surgical plan. A 53-year-old male presented a significant decrement in median nerve somatosensory evoked potential (mSEP) following head and neck positioning for carotid pseudoaneurysm repair before skin incision.Neurophysiological monitoring was performed with mSEP and electroencephalography early during the patient's preparation and surgery. Within five minutes after rotation and extension of the head to properly expose the surgical field, the contralateral m-SEP significantly decreased in both cortical (N20/P25) and subcortical (P14/N18) components. Partial neck correction led to m-SEP improvement, allowing to proceed with the carotid repair. We discuss possible underlying pathophysiological mechanisms responsible for these changes and highlight the relevance of an early start on monitoring to avoid neurological deficits.

A disciplina psicologia do esporte nos cursos de psicologia e educação física / Sports psychology in psychology and physical education courses / La materia psicología del deporte en los cursos de psicología y educación física

Este discute a representatividade da disciplina Psicologia do Esporte nos cursos de Psicologia e Educação Física em instituições de ensino superior reconhecidas pelo MEC e situadas na região Sul do país. Foi realizado um estudo documental, com base nos currículos das Instituições. Os resultados revelaram que no Sul do Brasil 21,02% dos cursos de Psicologia, 41,96% dos cursos de bacharelado em Educação Física e apenas 14,83% dos cursos de licenciatura em Educação Física apresentam a disciplina Psicologia do Esporte em sua grade curricular. Observou-se que a disciplina é ofertada mais frequentemente em regime obrigatório nos cursos de bacharelado em Educação Física. Nos cursos de Psicologia, quando ofertada, costuma ser optativa. Os resultados evidenciam uma maior oferta da disciplina para os estudantes de Educação Física, em relação aos de Psicologia, o que pode estar relacionado ao próprio contexto de surgimento da disciplina e sua popularização no meio acadêmico. Para que esse panorama possa mudar e se possa oferecer uma formação adequada no curso de Psicologia para fomentar essa opção de carreira, há necessidade de se repensar o currículo e o próprio perfil do egresso, de forma a dar mais oportunidade aos estudantes para que conheçam as bases teóricas e os campos de aplicação da Psicologia do Esporte. Tal lacuna pode acarretar a fragilização da disseminação desse conhecimento aos estudantes de graduação e a consequente ocupação do mercado de trabalho.(AU)

This study discusses the representativeness of Sports Psychology in Psychology and Physical Education courses at higher education institutions from Southern Brazil. A documentary study was conducted based on the institutions' curricula. Results show that 21.02% of the Psychology major, 41.96% of the bachelor's in Physical Education, and only 14.83% of the license in Physical Education offer Sports Psychology in their curricula. Sports Psychology is most often offered as a compulsory subject in the bachelor's program in Physical Education, whereas Psychology courses offer it mainly as an elective. Physical Education students have greater contact with the discipline when compared with Psychology students, which may be explained by its context of development and popularization in the academic environment. To change this scenario and offer adequate education in the Psychology programs to foster this career option, institutions must rethink their curriculum and the graduate profile itself. This would give students better opportunity to get to know its theoretical bases and fields of application. Such a gap can hinder the dissemination of this knowledge to undergraduate students and the consequent labor market occupation.(AU)

El objetivo de este estudio es discutir la representatividad de la materia Psicología del Deporte en los cursos de Psicología y Educación Física en instituciones de educación superior de la región Sur de Brasil, reconocidas por el Ministerio de Educación (MEC). Se realizó un estudio documental, basado en los planes de estudio de las instituciones. Los resultados revelaron que, en el Sur de Brasil, el 21,02% de los cursos de Psicología, el 41,96% de los cursos de licenciatura en Educación Física y sólo el 14,83% de los cursos de profesorado en Educación tienen la materia Psicología del Deporte en sus planes de estudio. Se observó que la materia Psicología del Deporte se ofrece con mayor frecuencia como asignatura obligatoria en los cursos de licenciatura en Educación Física. Cuando se ofrece en los cursos de Psicología, es una materia optativa. Los resultados muestran una mayor oferta para los estudiantes de Educación Física en comparación con Psicología, lo que puede estar relacionado con el contexto del surgimiento de la Psicología del Deporte como materia y su popularización en el ámbito académico. Para que este escenario cambie y sea posible ofrecer una formación adecuada en el curso de Psicología con el fin de fomentar esta opción de carrera, es necesario repensar el plan de estudios y el perfil del egresado, así los estudiantes tendrán más oportunidades de conocer sus bases teóricas y sus campos de actuación. Tal brecha puede debilitar la difusión de este conocimiento a los estudiantes de grado y la consecuente ocupación en el mercado laboral.(AU)

Risk Predictors Associated with Firearm Use: A Scope Review / Preditores de Riscos Associados ao Uso da Arma de Fogo: Uma Revisão de Escopo / Predictores de Riesgo Asociados con el Uso de Armas de Fuego: Una Revisión del Alcance

Abstract The use of firearms is a complex issue which involves issues related to mental health and public policies. This scoping review aimed to analyze individual and social risk predictors for the use of firearms. Based on the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews - PRISMA-ScR, six databases were consulted and 605 studies, retrieved. After screening, 16 empirical studies were selected for this review. Individual predictors included psychiatric diagnosis, abusive use of alcohol, high anxiety, and use of psychiatric medication; whereas social ones, access to firearms, absence of laws restricting the possession of weapons, and war experiences. We find the need for further research on the subject, especially by Brazilian science, since 87.5% of the studies this review screened came from the United States.

Resumo O uso da arma de fogo pela população é um tema complexo que envolve questões relacionadas à saúde mental e políticas públicas. O objetivo dessa revisão de escopo foi analisar os preditores de riscos, individuais e sociais, para o uso da arma de fogo. Com base nas diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews - PRISMA-ScR, seis bases de dados foram consultadas com a identificação de 605 artigos. Após processo de triagem, 16 estudos empíricos foram selecionados para a revisão. Os preditores individuais identificados foram: diagnóstico de transtornos mentais, uso abusivo de álcool, ansiedade elevada, uso de medicação psiquiátrica. Os classificados como sociais compreenderam: acesso a armas de fogo, ausência de leis restritivas à posse de armas, experiência de guerra. Verificou-se a necessidade de mais pesquisas sobre o tema principalmente pela ciência brasileira, visto que 87,5% dos estudos triados nesta revisão foram provenientes dos Estados Unidos.

Resumen El uso de armas de fuego por parte de la población es un tema complejo que involucra cuestiones relacionadas con la salud mental y las políticas públicas. El objetivo de esta revisión de alcance fue analizar los predictores de riesgo individual y social para el uso de armas de fuego. Con base en los lineamientos de Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), se consultaron seis bases de datos, lo que generó la identificación de 605 artículos. Después de un proceso de selección, se seleccionaron 16 estudios empíricos para su revisión. Los predictores individuales identificados fueron: diagnóstico de trastornos mentales, abuso de alcohol, ansiedad elevada y uso de medicación psiquiátrica. Los predictores sociales: acceso a armas de fuego, ausencia de leyes que restrinjan la tenencia de armas y experiencia de guerra. Se observó una necesidad de más investigación sobre el tema, principalmente por parte de la ciencia brasileña, ya que el 87,5% de los estudios seleccionados en esta revisión provenían de los Estados Unidos.

When Sight and Cancer Collide: A Rare Case of Paraneoplastic Bilateral Optic Neuritis.

Bilateral acute optic neuritis is a rare and challenging clinical presentation, often associated with conditions like multiple sclerosis or neuromyelitis optica spectrum disorder. We present the case of a 40-year-old woman with a complex medical history, including poorly differentiated squamous cell carcinoma of the cervix (stage IIIC), who presented with a swift and profound bilateral vision loss. Despite initial treatment with high-dose methylprednisolone and therapeutic plasma exchange, her optic nerve enhancement on MRI and negative autoantibody results raised suspicion of paraneoplastic optic neuritis. This prompted consultation with oncology, and the patient initiated chemotherapy. The rapid onset and progression of bilateral optic neuritis in the context of cervical carcinoma emphasize the importance of considering paraneoplastic syndromes in such cases. A multidisciplinary approach involving neurology, ophthalmology, and oncology specialists is vital for the diagnosis and management of these complex presentations. This case underscores the need for heightened awareness of paraneoplastic etiologies in patients with malignancies and unexplained neurological symptoms.

Randic energy of digraphs.

We assume that D is a directed graph with vertex set V ( D ) = { v 1 , … v n } and arc set E ( D ) . A VDB topological index φ of D is defined as φ ( D ) = 1 2 ∑ u v ∈ E ( D ) φ d u + , d v - , where d u + and d v - denote the outdegree and indegree of vertices u and v, respectively, and φ i , j is a bivariate symmetric function defined on nonnegative real numbers. Let A φ = A φ ( D ) be the n × n general adjacency matrix defined as [ A φ ] i j = φ d v i + , d v j - if v i v j ∈ E ( D ) , and 0 otherwise. The energy of D with respect to a VDB index φ is defined as E φ ( D ) = ∑ i = 1 n σ i ( A φ ) , where σ 1 ( A φ ) ≥ σ 2 ( A φ ) ≥ ⋯ ≥ σ n ( A φ ) ≥ 0 are the singular values of the matrix A φ . We will show that in case φ = R is the Randic index, the spectral norm of A R is equal to 1, and rank of A R is equal to rank of the adjacency matrix of D. Immediately after, we illustrate by means of examples, that these properties do not hold for most well-known VDB topological indices. Taking advantage of nice properties the Randic matrix has, we derive new upper and lower bounds for the Randic energy E R in digraphs. Some of these generalize known results for the Randic energy of graphs. Also, we deduce a new upper bound for the Randic energy of graphs in terms of rank, concretely, we show that E R ( G ) ≤ r a n k ( G ) for all graphs G, and equality holds if and only if G is a disjoint union of complete bipartite graphs.

Relationship of cardiorespiratory control and vascular compliance in competitive young athletes / Relación entre el control cardiorrespiratorio y la distensibilidad vascular en atletas jóvenes de competición / Relação entre o controlo cardiorrespiratório e a conformidade vascular em jovens atletas competitivos

Objective: To study the haemodynamic properties of the peripheral circulation and its relationship with cardiorespiratory control, during anaerobicmuscle fatigue test, in young competitive athletes.Method: Nine adolescent of national and international competition level were recruited (age: 15.6 ± 1.9 years; male = 7) and cross-evaluated. Morphological measurements (body mass, percentage of total body fat and height), blood pressure (systolic, diastolic, mean and pulse blood pressure),respiratory measures (spirometry and pimometry), power, and fatigue were recorded through Wingate test.Results: Weight, height, and fat-free mass were positively correlated with the power parameters of the Wingate test (p < 0.05). The respiratoryparameters of forced vital capacity, peak expiratory flow, maximum inspiratory pressure (MIP) and maximum sustained pressure (SMIP) were alsosignificantly correlated with the power parameters. Additionally, the cardiorespiratory parameters of MIP and SMIP were positively correlated with pulsepressure at rest (p < 0.05).Conclusion: The increase in MIP and SMIP is associated with a lower arterial compliance, which indicates that a lower vascular elasticity influences agreater diaphragmatic strength and endurance of the young athlete.(AU)

Objetivo: Estudiar las propiedades hemodinámicas de la circulación periférica y su relación con el control cardiorrespiratorio, durante la prueba de fatiga muscular anaeróbica, en jóvenes atletas de competición.Método: Se reclutaron nueve adolescentes de nivel de competición nacional e internacional (edad: 15.6 ± 1.9 años; hombres = 7) y se evaluaron de forma cruzada. Se registraron medidas morfológicas (masa corporal, porcentaje de grasa corporal total y altura), presión arterial (presión arterial sistólica, diastólica, media y pulso), medidas respiratorias (espirometría y pimometría), potencia y fatiga mediante el test de Wingate. Resultados: El peso, la altura y la masa libre de grasa se correlacionaron positivamente con los parámetros de potencia del test de Wingate (p < 0.05). Los parámetros respiratorios de capacidad vital forzada, flujo espiratorio máximo, presión inspiratoria máxima (MIP) y presión inspiratoria máxima sostenida (SMIP) también se correlacionaron significativamente con los parámetros de potencia. Además, los parámetros cardiorrespiratorios de MIP ySMIP se correlacionaron positivamente con la presión del pulso en reposo (p < 0.05).Conclusión: El aumento de la MIP y SMIP se asocia a una menor compliance arterial, lo que indica que una menor elasticidad vascular influye en una mayor fuerza y resistencia diafragmática del joven atleta.(A)

Objetivo: Estudar as propriedades hemodinâmicas da circulação periférica e sua relação com o controle cardiorrespiratório, durante o teste de fadigamuscular anaeróbica, em jovens atletas competitivos.Método: Nove adolescentes de nível de competição nacional e internacional foram recrutados (idade: 15.6 ± 1.9 anos; masculino = 7) e avaliados de formacruzada. Medidas morfológicas (massa corporal, percentual de gordura corporal total e altura), pressão arterial (sistólica, diastólica, média e pulso),medidas respiratórias (espirometria e pimometria), potência e fadiga foram registradas através do teste Wingate.Resultados: Peso, altura e massa livre de gordura foram correlacionados positivamente com os parâmetros de potência do teste Wingate (p < 0.05). Osparâmetros respiratórios de capacidade vital forçada, pico de fluxo expiratório, pressão inspiratória máxima (MIP) e pressão inspiratória máximasustentada (SMIP) também foram significativamente correlacionados com os parâmetros de potência. Além disso, os parâmetros cardiorespiratórios daMIP e SMIP foram positivamente correlacionados com a pressão de pulso em repouso (p < 0.05).Conclusão: O aumento da MIP e SMIP está associado a uma menor complacência arterial, o que indica que uma menor elasticidade vascular influenciauma maior resistência diafragmática e resistência do jovem atleta.(AU)

Computation method of the Hosoya index of primitive coronoid systems.

Coronoid systems are natural graph representations of coronoid hydrocarbons associated with benzenoid systems, but they differ in that they contain a hole. The Hosoya index of a graph G is defined as the total number of independent edge sets, that are called k-matchings in G. The Hosoya index is a significant molecular descriptor that has an important position in QSAR and QSPR studies. Therefore, the computation of the Hosoya index of various molecular graphs is needed for making progress on investigations. In this paper, a method based on the transfer matrix technique and the Hosoya vector for computing the Hosoya index of arbitrary primitive coronoid systems is presented. Moreover, the presented method is customized for hollow hexagons by using six parameters. As a result, the Hosoya indices of both each arbitrary primitive coronoid system and also each hollow hexagon can be computed by means of a summation of four selected multiplications consisting of presented transfer matrices and two vectors.

Revisão sistemática internacional sobre agravos à saúde mental de professores / International Systematic Review on Strains to Teacher's Mental Health / Revisión sistemática internacional sobre problemas de la salud mental de los docentes

A docência é a segunda categoria profissional, em nível mundial, a manifestar mais doenças de caráter ocupacional. O objetivo deste estudo foi caracterizar o perfil epidemiológico de agravos à saúde mental em professores no âmbito nacional e internacional. Foram conduzidas buscas nas bases de dados Scopus, Web Of Science, PsycNet, PubMede no portalbvs, consideran-do publicações dos últimos 10 anos (2008-2017), em inglês, espanhol e português. Foram incluídos estudos originais e empíricos, nos quais agravos à saúde mental foram abordados como variáveis dependentes em pesquisas com professores, totalizando 28 artigos. Os resultados indicam a sobrecarga de trabalho como um fator de risco psicossocial, e que os professores mais vulneráveis ao adoecimento, são do sexo feminino, não possuem companheiro, apresentam altos níveis de escolaridade e histórico familiar de transtorno mental.

Teaching is the occupation that, on a global level, presents the second highest number of occupational diseases. The aim of this study was to characterize the epidemiological profile of mental health problems in teachers at national and international levels. We searched the Scopus, Web of Science, PsycNet, PubMed, and bvsportals for publications from the last 10 years (2008-2017) in English, Spanish, and Portuguese. We included original empirical studies in which mental health complaints were approached as dependent variables in research with teachers, comprising 28 articles. The results indicate that work overload is a psychosocial risk factor and that the teachers who are vulnerable to illness are female, single, with high levels of formal education and a family history of mental disorders.

La docencia es la segunda categoría profesional, a escala mundial, en reportar más enfermedades laborales. El objetivo de este estudio fue caracterizar el perfil epidemiológico de los problemas de salud mental en docentes en los ámbitos nacional e internacional. Buscamos en los portales de Scopus, Web of Science, PsycNet, PubMed y bvs las publicaciones de los últimos 10 años (2008-2017), en inglés, español y portugués. Se incluyeron estudios empíricos, en los que las quejas de salud mental fueron variables dependientes en la investigación con docentes. Se totalizaron 28 artículos. Los resultados in-dican la sobrecarga de trabajo como un factor de riesgo psicosocial. Asimismo, que los docentes más vulnerables a la enfermedad son mujeres, personas sin pareja, con altos niveles de educación y antecedentes familiares de trastorno mental.

Sombor index of directed graphs.

Let D be a digraph with set of arcs A. The Sombor index of D is defined as SO ( D ) = 1 2 ∑ u v ∈ A ( d u + ) 2 + ( d v - ) 2 , where d u + and d v - are the out-degree and in-degree of the vertices u and v of D. When D is a graph, we recover the Sombor index of graphs, a molecular descriptor recently introduced with a good predictive potential and a great research activity this year. In this paper we initiate the study of the Sombor index of digraphs. Specifically, we find sharp upper and lower bounds for SO over the class D n of digraphs with n non-isolated vertices, the classes C n and S n of connected and strongly connected digraphs on n vertices, respectively, the class of oriented trees OT ( n ) with n vertices, and the class O ( G ) of orientations of a fixed graph G.

Hearing abnormalities in multiple sclerosis: clinical semiology and pathophysiologic mechanisms.

Auditory manifestations from multiple sclerosis (MS) are not as common as the well-recognized sentinel exacerbations of optic neuritis, partial myelitis, motor weakness, vertiginous episodes, heat intolerance, and eye movement abnormalities. This paper discusses four cases of auditory changes, secondary to MS, and describes the first case, to our knowledge, of palinacousis, the perseveration of hearing, despite cessation of the sound stimulus. For each we characterize the initial complaint, the diagnostic work up, and ultimately, underscore the individualized treatment interventions, that allowed us to achieve a remission in all four cases. Individually codifying the treatment regimens served to mitigate, if not to abolish, the clinical derangements in hearing. Special attention is focused upon examination of the clinical manifestations and the pathophysiologic mechanisms which are responsible for them. We further emphasize the differential diagnostic considerations, and physical exam findings, along with the results of laboratory testing, neuro-imaging sequences, and lesion localization. Taken together, such information is germane to organizing cogently coherent strategic treatment plan(s). We believe that this small case series represents a clinically pragmatic example of 'precision medicine'; a principal theme and goal throughout this paper, the achievement of such in MS, but also as an illustration for the assessment and management schema for neuroimmunologic disorders in general.

Psychometric Evidence for the Lipp' Adult Stress Symptoms Inventory / Evidências psicométricas do Inventário de Sintomas de Stress para adultos de Lipp / Evidencia psicométrica del Inventario de Síntomas de Estrés en Adultos de Lipp

Abstract Although stress assessment is important in different health areas, there are few instruments with adequate psychometric evidence to assess it. The study aimed to present new validity evidence of Lipp's Inventory of Stress Symptoms for Adults (LSSI), describe and discuss clinical characteristics of the LSSI with data obtained from patients seen in a hospital outpatient clinic and a Psychosocial Care Center (Centro de Atenção Psicossocial - CAPS). Sampling was based on post-stratification via the Raking method. In total, 4,500 participants from all over Brazil of both sexes, different age groups and academic levels composed the study. The results via Item Response Theory indicated a structure with high internal consistency. Symptoms of apathy, depression or prolonged anger were the most associated with stress and women scored higher. There was a significant correlation between the LSSI-R and another mental health measure (DASS-21) in the clinical group.

Resumo Apesar da avaliação do estresse ser importante em diferentes áreas da saúde, há um escasso número de instrumentos com adequadas evidências psicométricas para avaliá-lo. O estudo teve como objetivo apresentar novas evidências de validade do Inventário de Sintomas de Stress para Adultos de Lipp (ISSL), descrever e discutir características clínicas do ISSL com dados obtidos por pacientes atendidos em um ambulatório hospitalar e um Centro de Atenção Psicossocial (CAPS). A amostragem baseou-se em pós-estratificação via método Raking. No total, 4.500 participantes de todo o Brasil de ambos os sexos, diferentes faixas etárias e níveis acadêmicos compuseram o estudo. Os resultados via Teoria de Resposta ao Item indicaram uma estrutura com alta consistência interna. Sintomas de apatia, depressão ou raiva prolongada foram os mais associados ao estresse e mulheres tiveram resultados mais altos. Houve uma correlação significativa entre o ISSL-R e outra medida de saúde mental (DASS-21) no grupo clínico.

Resumen A pesar de la evaluación del estrés es importante en diferentes áreas de la salud, existe un número reducido de instrumentos con evidencia psicométrica adecuada para evaluarlo. El estudio tuvo como objetivo presentar nuevas evidencias de la validez del Inventario de Síntomas de Estrés de Lipp para Adultos (ISSL) describir y discutir las características clínicas del ISSL con datos obtenidos de pacientes atendidos en un Centro de Atención Psicosocial (CAPS). El muestreo se basó en la estratificación posterior mediante el método Raking. 4500 participantes de todo Brasil de ambos sexos, diferentes grupos de edad y niveles académicos integraron el estudio. La Teoría de Respuesta al Ítem indicaron una estructura con alta consistencia interna. Los síntomas de apatía, depresión ira prolongada fueron los más asociados con el estrés y las mujeres puntuaron más alto. Hubo una correlación significativa entre el ISSL-R y otra medida (DASS-21) en el grupo clínico.