cAMP regulates the progesterone receptor gene expression through the protein kinase A pathway during decidualization in human immortalized endometrial stromal cells.

Decidualization, a crucial process for successful pregnancy establishment and maintenance, involves endometrial stromal cell differentiation. This process is orchestrated by estradiol (E2), progesterone, and other stimuli that increase intracellular cyclic adenosine monophosphate (cAMP) levels. The intracellular progesterone receptor (PR), encoded by the PGR gene, has a key role in decidualization. This study aimed to understand the role of sex steroids and cAMP in regulating PGR expression during the in vitro decidualization of the human immortalized endometrial stromal cell line, T-HESC. We subjected the cells to individual and combined treatments of E2, medroxyprogesterone (MPA), and cAMP. Additionally, we treated cells with PR and estrogen receptor antagonists and a protein kinase A (PKA) inhibitor. We evaluated the expression of PGR isoforms and decidualization-associated genes by RT-qPCR. Our findings revealed that cAMP induced PGR-B and PGR-AB expression by activating the PKA signaling pathway, while MPA downregulated their expression through the PR. Furthermore, downstream genes involved in decidualization, such as those coding for prolactin (PRL), insulin-like growth factor-binding protein-1 (IGFBP1), and Dickkopf-1 (DKK1), exhibited positive regulation via the cAMP-PKA pathway. Remarkably, MPA-activated PR signaling induced the expression of IGFBP1 and DKK1 but inhibited that of PRL. In conclusion, we have demonstrated that the PKA signaling pathway induces PGR gene expression during in vitro decidualization of the T-HESC human endometrial stromal cell line. This study has unraveled some of the intricate regulatory mechanisms governing PGR expression during this fundamental process for implantation and pregnancy maintenance.

The role of progesterone receptor membrane component (PGRMC) in the endometrium.

PGRMC is a non-classical receptor that mediates the non-genomic responses to progesterone and is distributed in different subcellular compartments. PGRMC belongs to the membrane-associated progesterone receptor (MAPR) family. Two PGRMC subtypes (PGRMC1 and PGRMC2) have been characterized, and both are expressed in the human endometrium. PGRMC expression is differentially regulated during the menstrual cycle in the human endometrium. Although PGRMC1 is predominantly expressed in the proliferative phase and PGRMC2 in the secretory phase, this expression changes in pathologies such as endometriosis, in which PGRMC2 expression considerably decreases, promoting progesterone resistance. In endometrial cancer, PGRMC1 is overexpressed, its activation induces tumors growth, and confers chemoresistance in the presence of progesterone. Thus, PGRMCs play a key role in progesterone actions in the endometrium.

Ataxia with Ocular Apraxia Type 1 (AOA1) (APTX, W279* Mutation): Neurological, Neuropsychological, and Molecular Outlining of a Heterogenous Phenotype in Four Colombian Siblings.

Hereditary ataxias are a group of devastating neurological disorders that affect coordination of gait and are often associated with poor coordination of hands, speech, and eye movements. Ataxia with ocular apraxia type 1 (AOA1) (OMIM: 606,350.0006) is characterized by slowly progressive symptoms of childhood-onset and pathogenic mutations in APTX; the only known cause underpinning AOA1. APTX encodes the protein aprataxin, composed of three domains sharing homology with proteins involved in DNA damage, signaling, and repair. We present four siblings from an endogamic family in a rural, isolated town of Colombia with ataxia and ocular apraxia of childhood-onset and confirmed molecular diagnosis of AOA1, homozygous for the W279* p.Trp279Ter mutation. We predicted the mutated APTX with AlphaFold to demonstrate the effects of this stop-gain mutation that deletes three beta helices encoded by amino acid 270 to 339 rescinding the C2H2-type zinc fingers (Znf) (C2H2 Znf) DNA-binding, the DNA-repair domain, and the whole 3D structure of APTX. All siblings exhibited different ages of onset (4, 6, 8, and 11 years old) and heterogeneous patterns of dysarthria (ranging from absence to mild-moderate dysarthria). Neuropsychological evaluation showed no neurocognitive impairment in three siblings, but one sibling showed temporospatial disorientation, semantic and phonologic fluency impairment, episodic memory affection, constructional apraxia, moderate anomia, low executive function, and symptoms of depression. To our knowledge, this report represents the most extensive series of siblings affected with AOA1 in Latin America, and the genetic analysis completed adds important knowledge to outline this family's disease and general complex phenotype of hereditary ataxias.

Socioeconomic inequalities and Black/White disparities in US cocaine-involved overdose mortality risk.

PURPOSE: This study examined whether socioeconomic inequalities account for Black/White disparities in: (a) the prevalence of potential risk factors for overdose among adults using cocaine; and (b) national mortality rates for cocaine-involved overdose. METHODS: Data from 2162 Non-Hispanic (NH) Black or White adults (26 +) who reported past-year cocaine use in the 2015-2019 National Survey of Drug Use and Health were analyzed to obtain predicted probabilities of potential overdose risk factors by race and sex, using marginal effects via regression analyses, adjusting for age and socioeconomic indicators. Next, National Center for Health Statistics data (for 47,184 NH Black or White adults [26 +] who died of cocaine-involved overdose between 2015 and 2019) were used to calculate cocaine-involved overdose mortality rates by race and sex across age and educational levels. RESULTS: Several potential overdose vulnerabilities were disproportionately observed among NH Black adults who reported past-year cocaine use: poor/fair overall health; cocaine use disorder; more days of cocaine use yearly; hypertension (for women); and arrests (for men). Adjusting for age and socioeconomic indicators attenuated or eliminated many of these racial differences, although predicted days of cocaine use per year (for men) and cocaine use disorder (for women) remained higher in NH Black than White adults. Cocaine-involved overdose mortality rates were highest in the lowest educational strata of both races; nonetheless, Black/White disparities were observed even at the highest level of education, especially for adults ages 50 + . CONCLUSION: Age and socioeconomic characteristics may account for some, yet not all, of Black/White disparities in vulnerability to cocaine-involved overdose.

The utility of the Edmonton Obesity Staging System for the prediction of COVID-19 outcomes: a multi-centre study.

BACKGROUND: Patients with obesity have an increased risk for adverse COVID-19 outcomes. Body mass index (BMI) does not acknowledge the health burden associated this disease. The performance of the Edmonton Obesity Staging System (EOSS), a clinical classification tool that assesses obesity-related comorbidity, is compared with BMI, with respect to adverse COVID-19 outcomes. METHODS: 1071 patients were evaluated in 11 COVID-19 hospitals in Mexico. Patients were classified into EOSS stages. Adjusted risk factors for COVID-19 outcomes were calculated and survival analysis for mechanical ventilation and death was carried out according to EOSS stage and BMI category. RESULTS: The risk for intubation was higher in patients with EOSS stages 2 and 4 (HR 1.42, 95% CI 1.02-1.97 and 2.78, 95% CI 1.83-4.24), and in patients with BMI classes II and III (HR 1.71, 95% CI 1.06-2.74, and 2.62, 95% CI 1.65-4.17). Mortality rates were significantly lower in patients with EOSS stages 0 and 1 (HR 0.62, 95% CI 0.42-0.92) and higher in patients with BMI class III (HR 1.58, 95% CI 1.03-2.42). In patients with a BMI ≥ 25 kg/m2, the risk for intubation increased with progressive EOSS stages. Only individuals in BMI class III showed an increased risk for intubation (HR 2.24, 95% CI 1.50-3.34). Mortality risk was increased in EOSS stages 2 and 4 compared to EOSS 0 and 1, and in patients with BMI class II and III, compared to patients with overweight. CONCLUSIONS: EOSS was associated with adverse COVID-19 outcomes, and it distinguished risks beyond BMI. Patients with overweight and obesity in EOSS stages 0 and 1 had a lower risk than patients with normal weight. BMI does not adequately reflect adipose tissue-associated disease, it is not ideal for guiding chronic-disease management.

Microstructure, corrosion rate, and mechanical properties of unidirectionally and cross-rolled Mg-0.375Ga and Mg-0.750Ga alloys.

The effect of unidirectional and cross rolling on the corrosion rate, texture, tensile properties and hemolysis of the Mg-0.375Ga and Mg-0.750Ga alloys was evaluated. Pure Mg and as-cast alloys were processed by unidirectional and cross rolling at 400°C to obtain a total thickness reduction of 50%. The corrosion rate was measured by the weight loss method in simulated body fluid. Determination of the hemolysis percentage was carried out by direct contact of specimens with diluted blood. After hot rolling, the mechanical properties of the alloys were improved. The cross-rolled Mg-0.750Ga alloy showed the highest grain refinement (55 µm) and the highest ultimate tensile strength (240 MPa), however, lower elongation (13.9%) than the rolled Mg-0.375Ga alloy. While unidirectional rolling creates a strong basal texture, cross rolling weakens considerably this texture. The Ga addition weakens the basal texture. Corrosion rate of the Mg-Ga alloys was significantly reduced (<1 mm/yr) after heat treatment and hot rolling due the homogenization of the microstructure and the presence of gallium as alloying element. The cross-rolled samples showed higher corrosion than the heat-treated and unidirectionally rolled samples. After rolling, alloys showed hemolysis percentages between 7.1 and 9.3%, values lower than those presented by pure magnesium (>22.7%) and as-cast alloys (>24.2%); however, the alloys are still hemolytic (>5%).

Synthesis of Nylon 6/Modified Carbon Black Nanocomposites for Application in Uric Acid Adsorption.

High uric acid levels cause different clinic conditions. One of them is hyperuricemia, which leads to kidney damage. A solution for eliminating uric acid in the blood is by hemodialysis, which is performed using nanocomposite membranes. In this work, Nylon 6 nanocomposites were synthesized with modified carbon black (MCB), which were considered candidate materials for hemodialysis membranes. The modification of carbon black was made with citric acid using the variable-frequency ultrasound method. The new MCB was characterized by Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), X-ray diffraction (XRD), transmission electron microscopy (TEM), and dispersion tests. Nylon 6/MCB nanocomposites were processed using the ultrasound-assisted melt-extrusion method to improve the dispersion procedure of the nanoparticles. The Nylon 6/MCB nanocomposites were characterized by FTIR, TGA, and differential scanning calorimetry (DSC). These were assessed for the absorption of toxins and hemocompatibility. MBC and nanocomposites showed excellent uric acid removal (78-82%) and hemocompatibility (1.6-1.8%). These results suggest that Nylon 6/MCB nanocomposites with low loading percentages can be used on a large scale without compatibility problems with blood.

Graphene Nanoplatelets Modified with Amino-Groups by Ultrasonic Radiation of Variable Frequency for Potential Adsorption of Uremic Toxins.

Chronic kidney disease (CKD) is a worldwide public health problem. In stages III and IV of CKD, uremic toxins must be removed from the patient by absorption, through a treatment commonly called hemodialysis. Aiming to improve the absorption of uremic toxins, we have studied its absorption in chemically modified graphene nanoplatelets (GNPs). This study involved the reaction between GNPs and diamines with reaction times of 30, 45 and 60 min using ultrasound waves of different amplitudes and frequencies. Functionalized GNPs were analyzed by Fourier Fourier-transform infrared spectroscopy (FTIR), X-ray photoelectron spectroscopy (XPS), Scanning electron microscopy and energy dispersitive spectroscopy (SEM-EDS), and Thermogravimetric analysis (TGA). The analysis of the functional groups confirmed the presence of amide and hydroxyl groups on the surface of the GNPs by reactions of diamines with carboxylic acids and epoxides. Adsorption of uremic toxins was determined using equilibrium isotherms, where the maximum percentage of removal of uremic toxins was 97%. Dispersion of modified graphene nanoplatelets was evaluated in water, ethanol and hexane, as a result of this treatment was achieved a good and effective dispersion of diamines-modified graphene nanoplatelets in ethanol and hexane. Finally, the results of hemolysis assays of the modified graphene with amine demonstrated that it was not cytotoxic when using 500 mg/mL. The samples of modified graphene demonstrated low degree of hemolysis (<2%), so this material can be used for in vivo applications such as hemodialysis.

Encefalitis límbica con fenotipo de encefalitis por anticuerpos contra receptores NMDA en paciente con diagnóstico de novo de Lupus eritematoso sistémico. Reporte de caso / Limbic encephalitis with phenotypic NMDA receptor antibodies in patients with de novo diagnosis of Systemic Lupus Erythematosus. Case report

Malignancy-associated limbic encephalitis was first described in 1968. Since then, cases have been reported in association with the Herpes Simplex virus, Hashimoto's encephalopathy, lupus, Sjögren's syndrome and paraneoplasias. A syndrome with prominent psychiatric symptoms was described in 2005: consisting of memory loss, reduced level of consciousness and central hypoventilation in four young women with ovarian teratoma and antibodies against an antigen highly expressed in the hippocampus. Shortly afterwards, these patients were found to have autoantibodies against NMDA receptor NR1 (GluN1) subunit. This discovery has been of the greatest importance in clinical practice since it identifies a devastating, life-threatening neurological disorder that is treatable. In 2007, it was recognised as a nosologic entity and today it is the most common cause of autoimmune encephalitis after disseminated subacute encephalomyelitis. Case report presentation of a patient exhibiting almost all the clinical symptoms described in the syndrome characterised by NMDA receptor-associated encephalitis. Moreover, a neu-roradiological correlation was found, with involvement of limbic structures seen on brain magnetic resonance imaging. Reasonable exclusion was made of the presence of neoplasia and neuroinfection, and clinical and immunological criteria of systemic lupus erythemathosus were found, helping with the categorisation of lupus-associated limbic encephalitis. Mortality due to limbic encephalitis is 25%, and 75% of patients may have permanent sequelae. Given adequate response to immunosuppressive therapy, early and correct recognition are critically important.

La encefalitis límbica asociada con malignidad fue descrita porprimera vez en 1968. Posteriormente se han reportado casos en asociación con virus del Herpes Simplex, encefalopatía de Hashimoto, Lupus, Sjögren y paraneoplasias. En el año 2005 fue descrito un síndrome con prominentes síntomas psiquiátricos: pérdida de memoria, disminución del nivel de conciencia e hipoventilación central en cuatro mujeres jóvenes con teratoma de ovario y anticuerpos contra un antígeno altamente expresado en el hipocampo. Poco después se determinó que estos pacientes tenían auto anticuerpos dirigidos contra la subunidad NR1 (GluN1) del Receptor NMDA. Este descubrimiento ha sido de gran importancia en la práctica clínica puesto que identifica un trastorno neurológico devastador, potencialmente fatal y tratable. En el 2007 se reconoció como entidad nosológica y hoy es la causa más común de encefalitis autoinmune después de la encefalomielitis diseminada subaguda. Se reporta un caso que agrupa casi la totalidad de los síntomas clínicos descritos en el síndrome que caracteriza la encefalitis por receptores NMDA, se encontró además correlación neuroradiológica por compromiso de estructuras del sistema límbico en la resonancia cerebral. Se excluye de manera razonable la presencia de neoplasia y neuroinfección y se encuentran criterios clínicos e inmunológicos de Lupus eritematoso sistémico que permiten catalogarlo como una encefalitis Limbica asociada a LES. La encefalitis límbica tiene una mortalidad del 25% y un 75% de pacientes pueden tener secuelas permanentes. Como hay adecuada respuesta a la terapia inmunosupresora, su temprano y acertado reconocimiento es de suma importancia.

Ultrasound-assisted sol-gel synthesis of ZrO2.

Synthesis of tetragonal ZrO2 by both conventional sol-gel and ultrasound-assisted sol-gel methods and using a non-ionic surfactant Tween-20, was performed. A porous microstructure composed of nanometric particles was observed. Tetragonal ZrO2 was obtained using a low heat treatment temperature of powders, 500°C by both methods. A higher crystallinity and a shorter reaction time were observed when ultrasound was used in the sol-gel method due to the cavitation phenomenon.

Diseño y características de los participantes de un programa para el desarrollo positivo de escolares (Medellín, Colombia) / Design of a program for the positive development of schoolchildren and characteristics of participants (Medellin, Colombia)

El diseño del Programa para la promoción de potencialidades personales y prevención de conductas de riesgo para la salud en escolares, PILAS! mejores adultos, mejor infancia, se realizó basándose en evidencia local e internacional sobre programas de prevención de violencia basados en la escuela. El programa ofrece formación a padres, madres, maestros y maestras, por medio de metodologías activas, y asesoría durante 10 meses sobre temas que conducen al desarrollo personal de niños/as y a la deslegitimación de la violencia en las interacciones cotidianas. Se beneficiaron 306 maestros y maestras, 800 padres y madres, y 12.800 niños y niñas. La medición inicial a 1751 infantes, según sus cuidadores/as, mostró una media de 80, en una escala de 0 a 100, en competencias sociales, pero una alta frecuencia de agresión. En padres y madres, fallas en la comunicación y supervisión, y uso de castigos con agresión psicológica y física; además, una baja cohesión social en el barrio (AU)

The design of the program for the promotion of personal potential and prevention of risky health behaviors in school-aged children, PILAS! Better Adults, Better Kids, was based on local and international evidence on programs for the prevention of school-based violence. The program offers a training process for parents and teachers through active methodologies and advice (provided for 10 months) based on topics that encourage individual child development and the delegitimization of violence in everyday interactions. A total of 306 teachers, 800 parents and 12,800 children benefited from the program. An initial measurement was conducted using a scale ranging from 0 to 100 in a sample of 1751 children. The results showed an average of 80 in the children's social skills, but caregivers reported high levels of aggression. Communication and supervision failures were found among parents, as well as punishment practices through psychological and physical aggression. Another finding was low social cohesion in the neighborhood (AU)

[Design of a program for the positive development of schoolchildren and characteristics of participants (Medellin, Colombia)]. / Diseño y características de los participantes de un programa para el desarrollo positivo de escolares (Medellín, Colombia).

The design of the program for the promotion of personal potential and prevention of risky health behaviors in school-aged children, PILAS! Better Adults, Better Kids, was based on local and international evidence on programs for the prevention of school-based violence. The program offers a training process for parents and teachers through active methodologies and advice (provided for 10 months) based on topics that encourage individual child development and the delegitimization of violence in everyday interactions. A total of 306 teachers, 800 parents and 12,800 children benefited from the program. An initial measurement was conducted using a scale ranging from 0 to 100 in a sample of 1751 children. The results showed an average of 80 in the children's social skills, but caregivers reported high levels of aggression. Communication and supervision failures were found among parents, as well as punishment practices through psychological and physical aggression. Another finding was low social cohesion in the neighborhood.

The burden of blood-pressure-related cardiovascular mortality in Mexico.

This study shows that in Mexico, a country at an advanced stage in the epidemiologic transition, with the national burden of disease dominated by noncommunicable diseases, elevated blood pressure is a major clinical and public health problem. 31.7% of the Mexican individuals aged 50 and over had systolic hypertension, and 47.3% were at systolic prehypertensive levels. Also, approximately half of all cardiovascular deaths that occurred annually in the population of Mexico aged ≥50 years are attributable to above optimal levels of systolic blood pressure. We think these estimates may help order health priorities in Mexico (and other middle-income countries) at a time when the costs of medical care take a considerable share of the gross national product in most countries.

Prevalence of Trypanosoma cruzi in dogs (Canis familiaris) and triatomines during 2008 in a sanitary region of the State of Mexico, Mexico.

American trypanosomiasis is a public health problem in Latin America and southern parts of the United States. Infection in triatomines (vector) and domestic dogs (reservoir host) is a good indicator of Trypanosoma cruzi circulation and human risk of infection. The State of Mexico, Mexico, has been considered free of T. cruzi, and no detailed epidemiologic study has been conducted to assess the intricacies of the transmission cycle of the parasite in the region. Such studies would enhance our understanding of the epidemiology of T. cruzi infection in this geographic region and provide regional sanitary authorities with stronger fundamental knowledge for making decisions and allocating funds for Chagas disease control programs in the State of Mexico. The objective of this study was to determine the prevalence of T. cruzi infection in dogs (seroprevalence) and triatomines (fecal parasites) in a previously identified, discrete endemic region of parasite circulation and to widen our studies in the Tejupilco Sanitary Region located in the southern part of the State of Mexico. Dog blood samples (n=102) were analyzed for the presence of anti-T. cruzi antibodies by two assays, namely indirect hemagglutination assay and enzyme-linked immunosorbent assay. Triatomines (n=88) were collected and fecal aliquots were analyzed for the presence of parasites by light microscopy. Average seroprevalence in dogs in the Tejupilco Sanitary region was 24.5%, and the overall triatomine infection rate was 34.01%. Triatoma pallidipennis was the only triatomine species found in this region. Our data demonstrate that T. cruzi is actively circulating in the Tejupilco Sanitary Region and emphasize the requirement for epidemiologic surveillance programs throughout the putative endemic areas of the State of Mexico.

Trombosis del seno venoso transverso en un paciente con cefalea tipo migraña: reporte de caso y revisión de la literatura / Transverse venous sinus thrombosis in a patient with migraine headache: case report and literature review

La trombosis de senos venosos cerebrales es una enfermedad de difícil diagnóstico por la variabilidad de sus presentaciones clínicas. Es una causa poco común de infarto cerebral, si se le compara con el infarto de origen arterial. Tiene una gran morbilidad y puede causar la muerte en 10 por ciento de los pacientes. Se describe el caso clínico de una paciente con cefalea tipo migraña con aura, en terapia con anticonceptivos orales combinados desde hacía tres meses, que consulta por una crisis inusual de su migraña, en quien, por angioresonancia contrastada cerebral, se hace diagnóstico de trombosis de seno transverso izquierdo. Se inició tratamiento anticoagulante con heparina de bajo peso molecular con evolución favorable y se remite a valoración por Ginecología para establecer tratamiento de ovario poliquístico. A propósito de este caso, se ha hecho una revisión del tema junto con el enfoque diagnóstico y tratamiento de la trombosis venosa cerebral y su asociación con la migraña.

Venous Sinus thrombosis is an important disease, for recognizing it can be difficult, as the clinical picture may be very diverse. It is an uncommon cause of brain infarction when comparing it to that of arterial origin, which has a great morbility. It may cause death in 10% of the cases in which it blossoms. In the following article, the clinical case of a patient with migraine with aura who was in therapy with oral contraceptives three months ago is described. The patient seeked medical attention due to an unusual crisis of her migraine; later, with the help of a contrasted brain Angioresonance, a left transverse sinus thrombosis diagnosis was performed. Anticoagulation treatmentis started with low molecular weight heparin and the disease evolution is favorable and she was remitted to assessment by gynecology to establish treatment of polycystic ovary. On behalf of this case, the authors present a review on diagnosis and focus of cerebral venous sinus thrombosis and it’s association with migraine.

Enfermedad de creutzfeldt-jakob esporádico: síntomas neuropsiquíatricos seguidos de daño cognitivo progresivo: reporte de caso / Sporadic creutzfeldt-jakob disease: neuropsychiatric symptoms followed by a progressive congnitive decline: a case report

La enfermedad de Creutzfeldt-Jakob (ECJ) es la enfermedad por priones más común y es la única entre los desórdenes humanos que se puede presentar en forma familiar, esporádica y transmitida. La hipótesis prevalente, basada en numerosos estudios en ratones transgénicos, sugiere que la ECJ y otras enfermedades por priones se inician y propagan por conversión de una proteína prionica normal (PrP) en una isoforma conformacional anormal (PrPreS). Esta última se acumula en el cerebro y es una de las características bioquímicas importantes en ECJ. Se reporta el caso de una mujer de 37 años de edad, quien murió en un hospital de tercer nivel por ECJ esporádico comprobado por autopsia. Este caso muestra la importancia de un examen post-mortem para confirmar el diagnóstico. A la luz de la observación clínica, discutimos el caso, el cual debe ser considerado en pacientes queevolucionan a una demencia rápidamente progresiva.

Creutzfeldt-Jakob disease (CJD) is the most common human prion disease and is unique among all known human disorders in being comprised of familial, sporadic, and transmitted forms. Theprevailing hypothesis, based largely on studies in transgenic animals, suggests that CJD and other prion diseases are initiated and propagated by conversion of normal host-encoded prion protein (PrP) into a conformationally abnormal isoform (PrPreS). The latter has been shown to accumulate in the brain and is the biochemical hallmark of CJD. We report the case of a 37-year-old woman who died in third level hospital of sporadic CJD proven by autopsy. This case illustrates the great importance of apost mortem exam in such context. In light of this clinical observation, we discuss this rare diagnosis which should be considered in patients when confronted with a rapidly progressive dementia.

Validación de la escala de envolvimiento emocional y criticismo familiar (FEICS) en la población clínica psiquiátrica colombiana / Validation of the Family Emotional Involvement and Criticism Scale (FEICS) in Colombian Psychiatric Clinical Population

Objetivo: validar la escala de envolvimiento emocional y crítica familiar (FEICS) en la población clínica psiquiátrica colombiana. Métodos: se tradujo la escala y luego se hizo el mismo proceso en sentido inverso. Se evaluaron: validez de apariencia por un grupo de expertos, validez de contenido y conceptos mediante análisis factorial de componentes principales, validez concurrente mediante comparación con "monólogo de cinco minutos" y subescala de cohesión de la Escala de Evaluación de Adaptabilidad y Cohesión Familiar (FACES-III), consistencia interna y reproducibilidad test-retest. Resultados: en el análisis factorial se encontraron cuatro dominios: censura, envolvimiento, intrusión y apoyo, que explicaron el 57,4 de la varianza. La consistencia interna de la subescala de crítica fue buena con una alfa de Crombach de 0,76 y la subescala de envolvimiento fue baja con un alfa de Crombach de 0,54. La reproducibilidad test-retest de la subescala de criticismo fue excelente (CCI = 0,92) y de la subescala de envolvimiento, buena (CCI = 0,62). Hubo una correlación significativa entre la subescala de crítica y el número de comentarios críticos del "monólogo de cinco minutos" (r = 0,31, p = 0,0001). Conclusiones: la FEICS fue de fácil aplicación y mostró cuatro dominios, a diferencia de los dos de la escala original. La subescala de crítica tiene gran consistencia interna, reproducibilidad test-retest y validez de concepto, lo cual la hace útil para la práctica clínica y de investigación. A pesar de que la subescala de envolvimiento se correlacionó con la FACESIII y su reproducibilidad test-retest fue buena, su escasa consistencia interna hace pensar en la necesidad de estudiar con mayor profundidad factores culturales asociados con el envolvimiento para posiblemente modificar los ítems de esta subescala...

Terrorism in Peru.

Two major domestic terrorist groups have plagued Peru over the past 20 years, the Sendero Luminoso or "Shining Path" (SL) and the Revolutionary Movement Túpac Amaru (MRTA). On 28 August 2003, the Peruvian Truth and Reconciliation Commission reported that an estimated 69,280 persons were killed in the internal conflict in Peru from 1980 to 2000. Most of the victims were farmers (56%), most attacks occurred in rural settings (79%), and the SL was responsible for most of the deaths (54%). Aggressive anti-terrorism efforts by police and military during this period, often at the expense of basic human rights, also contributed to this large burden of terrorism on Peru. During the 1990s, terrorist attacks in Peru had spread to its urban areas. On 17 December 1996, 22 members of MRTA took over the Japanese ambassador's residence in Lima, holding 72 hostages until the grounds were stormed by Peruvian special forces on 23 April 1997. Until recently, emergency planning and preparedness for terrorism-related events in Peru were largely underdeveloped. In the last five years, Peru has taken two key steps towards developing a mature emergency response system, with the establishment of the country's first emergency medicine residency training program and the construction of the first dedicated trauma center in Lima.