Atypical morgagnian cataract. Case report.

OBJECTIVE: Describe an atypical case of a morgagnian cataract with diffusion of cortical material through the intact posterior capsule. CLINICAL CASE: 50-year-old male, with 24 hours of evolution, referring pain, photophobia, and seven year history of visual loss. Intraocular pressure of 36 mmHg, opaque cornea, anterior chamber with a whitish material, liquefied crystalline cortex. Ultrasound: intact posterior capsule, retrolental hyperechogenic material. He required maximum hypotensive treatment indicated, phacoemulsification and trabeculectomy. Retrolental material was found, with a posterior capsulotomy, through cut/aspiration with vitrector. CONCLUSIONS: Diffusion of cortical material towards Berger's space is rare, it is necessary to recognize for surgical approach.

OBJETIVO: Describir un caso atípico de catarata morgagniana con difusión de material cortical por la cápsula posterior intacta. CASO CLÍNICO: Varón de 50 años, con 24 horas de evolución refiriendo dolor, fotofobia y antecedente de baja visual de 7 años. Presión intraocular de 36 mmHg, córnea opaca, cámara anterior con material blanquecino, corteza cristaliniana licuefacta. Ecografía: cápsula posterior íntegra, material hiperecogénico retrolental. Requirió hipotensor máximo, facoemulsificación y trabeculectomía. Se encontró material retrolental y se realizó capsulotomía posterior, mediante corte/aspiración con vitrector. CONCLUSIONES: La difusión del material cortical al espacio de Berger es rara y resulta necesario reconocerla para el manejo quirúrgico.

Spatial Distribution of Aedes aegypti Oviposition Temporal Patterns and Their Relationship with Environment and Dengue Incidence.

Aedes aegypti, the mosquito species transmitting dengue, zika, chikungunya and yellow fever viruses, is fully adapted to thrive in urban areas. The temporal activity of this mosquito, however, varies within urban areas which might imply different transmission risk. In this work, we hypothesize that temporal differences in mosquito activity patterns are determined by local environmental conditions. Hence, we explore the existence of groups of temporal patterns in weekly time series of Ae. aegypti ovitraps records (2017-2019) by means of time series clustering. Next, with the aim of predicting risk in places with no mosquito field data, we use machine learning classification tools to assess the association of temporal patterns with environmental variables derived from satellite imagery and predict temporal patterns over the city area to finally test the relationship with dengue incidence. We found three groups of temporal patterns that showed association with land cover diversity, variability in vegetation and humidity and, heterogeneity measured by texture indices estimated over buffer areas surrounding ovitraps. Dengue incidence on a neighborhood basis showed a weak but positive association with the percentage of pixels belonging to only one of the temporal patterns detected. The understanding of the spatial distribution of temporal patterns and their environmental determinants might then become highly relevant to guide the allocation of prevention and potential interventions. Further investigation is still needed though to incorporate other determinants not considered here.

Observando la mentalización en psicoterapias con adolescentes: Diseño de un sistema de observación de la interacción terapéutica / Observing Mentalization in Psychotherapies with Adolescents: Design of an Observational System for Therapeutic Interaction

Resumen Objetivo: Basado en la falta de medidas que permitan evaluar la mentalización como variable de proceso en psicoterapias con adolescentes, el siguiente estudio apunta a presentar el diseño de un sistema observacional para evaluar el despliegue de esta variable tanto en pacientes como en terapeutas. Método: mediante el proceso de codificación abierta de la teoría fundamentada y análisis temático de tres niveles, se analizó el despliegue de la mentalización tanto en terapeutas como en pacientes en 10 episodios de ruptura y 10 episodios de resolución elegidos aleatoriamente de cinco psicoterapias con adolescentes. Resultados: A partir del análisis efectuado se desarrolló un sistema observacional de seis dimensiones emergentes (foco en los estados mentales, opacidad de los estados mentales, comunicación contingente, causalidad de los estados mentales, naturaleza dinámica de los estados mentales y foco en el momento presente) denominado "Sistema de Observación de la mentalización en Psicoterapia con adolescentes" (OMP-A) que permite evaluar cuantitativamente la mentalización de terapeutas y pacientes. Discusión y conclusiones: el OMP-A es un instrumento que responde a debilidades de otros sistemas para evaluar mentalización en psicoterapia con adolescentes, permitiendo la observación de aspectos lingüísticos y paralingüísticos del mentalizar y toma en consideración aspectos particulares que caracterizan las intervenciones con adolescentes. Se discute su posible uso para la formación y supervisión en psicoterapia, y los desafíos metodológicos para desarrollos futuros.

Abstract Objective: Based on the need for measures for assessing mentalization in adolescent psychotherapy, this study aims to design an observational system to evaluate the deployment of reflective function in both patients and therapists during psychotherapy sessions. Method: 10 episodes of rupture and 10 episodes of resolution randomly chosen within 5 videotaped and transcribed psychotherapies were analyzed using grounded theory "s open coding procedure and a three-level thematic analysis. Results: An observational system with 6 emergent dimensions (focus on mental states, opacity of mental states, contingent communication, causality of mental states, dynamic nature of mental states and focus on the present moment) and a 5-point scale was developed. Discussion and conclusions: The "Observational System for mentalization adolescent psychotherapy" (OMP-A) is an instrument that responds to certain weaknesses of other instruments by considering linguistic and paralinguistic aspects of mentalization and particular aspects that characterize interventions with adolescents. It "s possible use for training and supervision is discussed as well as some methodological challenges for future research.

Evidencia de validez en Chile del Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) / Validity evidence of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in Chile

El objetivo del estudio fue analizar la validez de la versión chilena de un instrumento para la identificación de diferentes niveles de riesgo asociado al consumo de alcohol, tabaco, marihuana y cocaína(Alcohol, Smoking and Substance Involvement Screening Test, ASSIST).Se evaluó la fiabilidad y consistencia del instrumento además dela validez concurrente y discriminante. La muestra fue de 400usuarios de servicios de tratamiento drogas y alcohol ambulatorios y residenciales de la atención primaria de salud, comisarías y empresas. La consistencia interna obtenida fue alta (Alcohol α= .86. marihuana α= .84 y cocaína α= .90). El coeficiente de correlación intraclase (CCI) con la comparación test-retest fue buena para Alcohol (CCI = .66), marihuana (CCI = .74) y cocaína (CCI =.80). Se observó una buena correlación entre los puntajes del ASSIST el puntaje del AUDIT (r de Pearson = .85), ASI-Lite (r entre .66 y .83 para tabaco, alcohol, marihuana y cocaína) y SDS (r = .65). El punto de corte original para la detección del riesgo alto es de 27 puntos, sin embargo, considerando un mejor balance entre sensibilidad y especificidad se modificó ese corte a 21. Los resultados obtenidos en éste estudio demostraron las buenas propiedades psicométricas del ASSIST para la detección de distintos niveles de riesgo asociados al consumo de sustancias en población general de Chile

This study aims to psychometrically validate the Chilean version of the Alcohol, Smoking and Substance Involvement Screening Test ASSIST. Specifically, this study is interested in evaluating the reliability, consistency and concurrent and discriminant validity of this instrument. The sample was composed for a total of 400 people from four different settings: treatment centers (residential and ambulatories), primary health care, police stations and companies. The reliability of the ASSIST was high (α = .86 for Alcohol, α = .84 for marijuana and α = .90 for cocaine). The intra class correlation coefficient (ICC) with test-retest comparison was statistically significant for Alcohol (ICC = .66), marijuana (ICC = .74) and cocaine (ICC = .80). There were statistically significant correlations between the ASSIST and the AUDIT score (Pearson’s r = .85), the ASSIST and the ASI-Lite score (r between .66 and .83 for tobacco, alcohol, marijuana and cocaine), and the ASSIST and the SDS score (r = .65). The original cutoff point for high risk detection was 27 points, however, in order to have a better balance between sensitivity and specificity the cut was changed to 21 points. The ASSIST presents good psychometric properties and therefore is a reliable and valid instrument to be used as a mechanism to detect risk levels of substance use in the Chilean population

Improving amphetamine therapeutic selectivity: N,N-dimethyl-MTA has dopaminergic effects and does not produce aortic contraction.

Amphetamine derivatives have therapeutic potential in diseases such as attention deficit hyperactivity disorder, narcolepsy and obesity. However, their prolonged use has been associated with cardiovascular toxicity and addiction. In recent years, we have studied the pharmacological effects of amphetamine derivatives such as methylthioamphetamine (MTA) and N,N-dimethyl-thioamphetamine, with the aim of improving their therapeutic selectivity. In this work, we show that similarly to MTA, N,N-dimethyl-thioamphetamine has effects on the dopamine system, producing a significant increase in extracellular levels of dopamine (as measured by in vivo brain microdialysis) and locomotor activity, which is a behavioural measure of dopaminergic activation. However, unlike MTA, N,N-dimethyl- thioamphetamine does not produce aortic contraction in vitro. Our results show that N,N-dimethyl-thioamphetamine is a drug that retains the dopaminergic effects of amphetamine derivatives but exhibits a lower potential for producing cardiovascular side effects.

[Validity evidence of the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) in Chile]. / Evidencia de validez en Chile del Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).

This study aims to psychometrically validate the Chilean version of the Alcohol, Smoking and Substance Involvement Screening Test ASSIST. Specifically, this study is interested in evaluating the reliability, consistency and concurrent and discriminant validity of this instrument. The sample was composed for a total of 400 people from four different settings: treatment centers (residential and ambulatories), primary health care, police stations and companies. The reliability of the ASSIST was high (α = .86 for Alcohol, α = .84 for marijuana and α = .90 for cocaine). The intra class correlation coefficient (ICC) with test-retest comparison was statistically significant for Alcohol (ICC = .66), marijuana (ICC = .74) and cocaine (ICC = .80). There were statistically significant correlations between the ASSIST and the AUDIT score (Pearson’s r = .85), the ASSIST and the ASI-Lite score (r between .66 and .83 for tobacco, alcohol, marijuana and cocaine), and the ASSIST and the SDS score (r = .65). The original cutoff point for high risk detection was 27 points, however, in order to have a better balance between sensitivity and specificity the cut was changed to 21 points. The ASSIST presents good psychometric properties and therefore is a reliable and valid instrument to be used as a mechanism to detect risk levels of substance use in the Chilean population.

Afecciones de salud mental y el proceso de retorno al trabajo: una revisión sistemática / Mental health illness and the return to work process: a systematic review

Antecedentes: Para el tratamiento de las afecciones de salud mental relacionadas con el trabajo se requiere considerar como parte del tratamiento a los agentes laborales causales de la patología y el proceso de retorno al trabajo. Un diseño adecuado de intervenciones psicoterapéuticas en el ámbito ocupacional requiere la consideración de las últimas investigaciones en estas materias. Objetivo: Describir las investigaciones recientes cuyo objetivo sea el estudio del retorno al trabajo en afecciones de salud mental relacionadas con el trabajo. Método: Mediante una revisión de la literatura publicada entre los años 2008 a 2012, se caracterizaron las principales líneas de investigación del tratamiento y reintegro laboral de pacientes con afecciones de salud mental relacionadas al trabajo. Resultados: Sobre 63 artículos seleccionados, se identificó que los países europeos lideraron la investigación, destacando entre ellos Holanda. El 80% de los estudios abordan el proceso de retorno laboral. La mayoría de los diseños de investigación no son de tipo cuantitativo, descriptivo y longitudinal, y están enfocados en: a) producir indicadores para pronosticar factores protectores del tratamiento y, b) generar indicadores de alerta para la relación terapia y reintegro al trabajo. La terapia cognitivo-conductual y los tratamientos entregados en el lugar de trabajo, comandadas por terapeutas (sin profesión específica), psicólogos y psiquiatras son las formas de intervención preferidas. El rol del supervisor de retorno al trabajo es una figura nueva, usualmente poco considerada en el tratamiento estándar. Conclusiones: El estudio del vínculo entre el tratamiento clínico y el proceso del reintegro al trabajo en afecciones de salud mental abre una nueva ventana local para la investigación en salud ocupacional.

Background: It is generally accepted that mental health illnesses require treatment for the patient’s recovery. But if such illness is work-related, standard clinical treatment alone could be insufficient. Thus, should work-related issues and the return to work process considered as part of a standard treatment. Objective: To describe scientific research whose aim is the return to work process in workrelated mental illness. Methods: A literature review from 2008 to 2012 was conducted to describe research trends in mental health work-related treatment, and the return-to-work process. Results: 63 papers met requirements. Research is mainly done in Europe, led by Holland. 80% of articles are focused on the return to work process. Most of the research done is quantitative, descriptive and longitudinal, focused on a) generating parameters to forecast treatment’s positive outcomes and, b) to determine warning indicators for the therapy - return to work relationship. Cognitive - behavioural therapy and workplace interventions are the preferred methods, led by therapists (without specific occupation), psychologists and psychiatrists. The return-to-work supervisor role is a new element, slightly considered in standard clinical treatment. Conclusions: This work places the clinical treatment - return-to-work relationship as its subject, opening a new local research trend in occupational health.

La variable personalidad en el estudio de la psicoterapia: ¿medida de resultado o proceso / Personality as a variable in psychotherapy research: outcome or process measurement

La investigación sobre efectividad psicoterapéutica y el estudio de la personalidad han ocurrido de manera más o menos paralela. Actualmente es posible plantear al menos dos puntos de convergencia: el estudio del efecto de la psicoterapia sobre el cambio de la personalidad y la investigación de los efectos de las variables de personalidad de los pacientes sobre el proceso psicoterapéutico. En el presente artículo se exponen algunos avances de la investigación de proceso-resultado en psicoterapia que incluyen la personalidad como variable. En particular, se presenta el problema del cambio de la personalidad y se revisan algunas investigaciones en psicoterapia que la han incorporado como una medida de resultado o de proceso. Se concluye y discute el valor de la noción de personalidad en la investigación de la psicoterapia, integrando asuntos teóricos, prácticos y metodológicos.

Psychotherapeutic effectively research and personality research have developed in parallel ways. Nowadays, it is possible to identify two convergent perspectives: the study of the effect of the psychotherapy over personality change and the study of the effects of patients' personality variables over the psychotherapeutic process. In this paper some advances of process-outcome psychotherapy research, which includes personality as a variable, are shown. Specifically, the issue of personality change is presented and empirical studies, which include personality as an outcome or process measurement, are reviewed. The value of the concept of personality for psychotherapy research is discussed integrating theoretical, practical and methodological topics.

Entrevista de Prototipos de Apego Adulto (EPAA): propiedades psicométricas de su versión en Chile / Adult Attachment Prototype Rating (AAPR): psychometric properties of chilean version

En la extensa producción de instrumentos para evaluar apego en adultos ha surgido una alternativa en formato de entrevista: “Adult Attachment Prototype Rating (AAPR)”. Este artículo presenta los resultados de la adaptación al español y el estudio de las propiedades psicométricas de la AAPR en el contexto sociocultural chileno. A partir de un diseño muestral de dos etapas, el estudio de confiabilidad se llevó a cabo utilizando jueces ciegos y la validez fue probada con dos cuestionarios como criterio. Los resultados muestran una confiabilidad interjueces similar a estudios que emplean el instrumento original. El estudio de validez mostró resultados satisfactorios y consistentes. Se discuten los resultados a la luz de la problemática de utilizar instrumentos que evalúan constructos diferentes.(AU)

In the extensive production of adult attachments measures, an alternative has arisen in the format of an interview: the “Adult Attachment Prototype Rating (AAPR)”. This article presents the results of a Spanish adaptation and the AAPR´s psychometric properties in the sociocultural Chilean context. Based on two stages sample design, the study of reliability was achieved through blind judges and validity was proved by two questionnaires as criterion. The results show a similar interrater reliability to studies that have used the original instrument. The study of validity showed satisfactory and consistent results. These results are discussed in the light of the constraints of using instruments that assess different constructs.(AU)

Entrevista de Prototipos de Apego Adulto (EPAA): propiedades psicométricas de su versión en Chile / Adult Attachment Prototype Rating (AAPR): psychometric properties of chilean version

En la extensa producción de instrumentos para evaluar apego en adultos ha surgido una alternativa en formato de entrevista: “Adult Attachment Prototype Rating (AAPR)”. Este artículo presenta los resultados de la adaptación al español y el estudio de las propiedades psicométricas de la AAPR en el contexto sociocultural chileno. A partir de un diseño muestral de dos etapas, el estudio de confiabilidad se llevó a cabo utilizando jueces ciegos y la validez fue probada con dos cuestionarios como criterio. Los resultados muestran una confiabilidad interjueces similar a estudios que emplean el instrumento original. El estudio de validez mostró resultados satisfactorios y consistentes. Se discuten los resultados a la luz de la problemática de utilizar instrumentos que evalúan constructos diferentes.

In the extensive production of adult attachments measures, an alternative has arisen in the format of an interview: the “Adult Attachment Prototype Rating (AAPR)”. This article presents the results of a Spanish adaptation and the AAPR´s psychometric properties in the sociocultural Chilean context. Based on two stages sample design, the study of reliability was achieved through blind judges and validity was proved by two questionnaires as criterion. The results show a similar interrater reliability to studies that have used the original instrument. The study of validity showed satisfactory and consistent results. These results are discussed in the light of the constraints of using instruments that assess different constructs.

Structure-affinity relationships of halogenated predicentrine and glaucine derivatives at D1 and D2 dopaminergic receptors: halogenation and D1 receptor selectivity.

Halogenation of the aporphine alkaloid boldine at the 3-position leads to increased affinity for rat brain D(1)-like dopaminergic receptors with some selectivity over D(2)-like receptors. A series of 3-halogenated and 3,8-dihalogenated (halogen=Cl, Br or I) derivatives of predicentrine (9-O-methylboldine) and glaucine (2,9-di-O-methylboldine) were prepared and assayed for binding at D(1) and D(2) sites. Halogenation of predicentrine led to strong increases in affinity for D(1)-like receptors, while the affinities for D(2)-like receptors were either practically unchanged or reduced three- to fourfold. Halogenated glaucine derivatives did not show any clear trend towards enhanced selectivity, and the affinities were poor and similar to or worse than the values previously recorded for glaucine itself. Together with earlier work on boldine derivatives, these results suggest that the 2-hydroxy group on the aporphine skeleton may determine a binding mode favoring D(1)-like over D(2)-like receptors, with enhanced affinity when the C-3 position is halogenated.

Monoamine oxidase inhibitory properties of optical isomers and N-substituted derivatives of 4-methylthioamphetamine.

(+/-)-4-Methylthioamphetamine (MTA) was resolved into its enantiomers, and a series of N-alkyl derivatives of the parent compound, as well as its alpha-ethyl analogue, were prepared. The monoamine oxidase (MAO) inhibitory properties of these substances were evaluated in vitro, using a crude rat brain mitochondrial suspension as the source of enzyme. All compounds produced a selective, reversible and concentration-related inhibition of MAO-A. (+)-MTA proved to be the most potent inhibitor studied, while all the other derivatives were less active than the parent compound, with (-)-MTA being about 18 times less potent than the (+) isomer. The analysis of structure-activity relationships indicates that the introduction of alkyl substituents on the amino group of MTA leads to a reduction in the potency of the derivatives as MAO-A inhibitors, an effect which increases with the size of the substituent.

La técnica de intervención en crisis en el servicio de urgencia del Instituto Psiquiátrico José Horwitz Barak / The crisis intervention technique in the emergency service at the Instituto Psiquiátrico José Horwitz Barak

Durante seis meses se implementó un plan piloto de intervención en crisis dentro del servicio de urgencia (SU) del Instituto Psiquiátrico. Este programa fue realizado por un psicólogo con experiencia en la técnica y estuvo estrechamente coordinado con el programa de psicoterapia del consultorio adosado de especialidades (CAE) del mismo Instituto. La experiencia fue evaluada con un instrumento de resultados terapéuticos. Se describe el programa y la experiencia realizada, enfatizando el impacto directo del tratamiento en los pacientes, como también el beneficio que un programa como este puede tener en un servicio público de salud mental

Ilustración clínica de la técnica de intervención en crisis / Clinical ilustration of the crisis intervention technique

La atención psicológica en personas que están en situación de crisis emocional es un tipo de tratamiento que se fundamenta en una teoría específica: La teoría de la Crisis. El presente trabajo describe la técnica de intervención en crisis de orientación psicodinámica, en su rol tanto paliativo como preventivo. Se ilustran sus características a través del análisis de un caso clínico tratado en el policlínico del Instituto Psiquiátrico. Se destaca la amplitud del arsenal de intervenciones terapéuticas utilizado para tratar el caso y la postura del terapeuta a través del proceso de tratamiento. Asimismo, se subraya la especificidad de la técnica y la necesidad de capacitarse en ella