Endoscopic Ventricular Lavage in Pediatric Pyogenic Cerebral Ventriculitis Associated with Shunt: Outcomes and Technical Notes.

OBJECTIVE: Pyogenic cerebral ventriculitis (PCV) is a rare infectious entity characterized by a potent inflammatory reaction of the ventricular ependyma, which in most cases leads to death. We aim to present the technical note and protocol, based on our center's 10-year experience of the use of endoscopic ventricular lavage (EVL) in pediatric patients with PCV and ventricular peritoneal shunt. METHODS: For this study, all pediatric patients (<16 years) with VP shunts and PCV who were treated with EVL between January 2012 and January 2022 were included. RESULTS: Thirty-four pediatric patients with ventriculitis were analyzed. The median age was 6 years, with 61.7% being male. Most consultations occurred on Day 2 of symptoms. Fever (38.2%) and altered consciousness (26.5%) were the most common initial symptoms. Early ventriculitis was observed in 67.7% of patients. Pathogen identification in the initial cerebrospinal fluid sample was 70.6%, while samples from ventricular peritoneal shunt yielded 23.53% and catheter culture 79.4%. Gram-positive bacteria, mainly S.epidermidis (44.1%), was the most commonly isolated agent. EVL was performed in 73.5% on the second or third day. Reinfection occurred in 23.5%, and 26.5% of patients died. Concordance analysis showed 85.3% agreement between LP and catheter tip samples. Functionality improved, with 55.88% achieving a Lansky score of 90. Early ventriculitis was associated with better Lansky scores. CONCLUSION: EVL can be a useful tool in the management of PCV in cases with VP shunts. Our study suggests a higher chance of isolating an infection-causing germ in the catheter tip culture specimen compared to the cerebrospinal fluid culture. However, future studies with a larger number of patients, or multicentric studies are required for further analysis.

Intersección de síntomas en el trastorno del espectro autista y trastornos psicóticos: a propósito de un caso / Intersection of symptoms in autism spectrum disorder and psychotic disorders: A case report

El rastorno de espectro autista es un trastorno del neurodesarrollo con una prevalencia que llega al 1% de la población. Es frecuente que los síntomas principales de este trastorno, tales como el deterioro de las interacciones sociales, los intereses restringidos o atípicos y las deficiencias cognitivas y de la comunicación verbal, puedan confundirse con la sintomatología de la esfera psicótica propia de la esquizofrenia. Una adecuada evaluación es necesaria, dado que ambas entidades pueden coexistir con una prevalencia variable del 12 al 50%. Presentamos el caso clínico de una mujer que a los 20 años inicia seguimiento en la unidad de salud mental por sintomatología compatible con un trastorno obsesivo-compulsivo junto a una clínica caracterizada por apatía, anhedonia, abandono del autocuidado y progresivo deterioro funcional. Tras varias sesiones de evaluación, llegamos al diagnóstico de un trastorno del espectro autista. Realizamos una revisión bibliográfica en la que concluimos que la intersección de síntomas entre el autismo y la esquizofrenia es común y se aportan recomendaciones clínicas para diferenciar ambas entidades clínicas. (AU)

Autism spectrum disorder is a neurodevelopmental disorder with a current global prevalence of approximately 1%. It is common that the main symptoms of this disorder, such as deterioration in social interactions, restricted or atypical interests, and cognitive and verbal communication deficiencies, can be confused with symptoms of the psychotic sphere typical of schizophrenia. An adequate evaluation is necessary due that both entities can coexist with a variable prevalence of 12 to 50%. Moreover, both disorders can coexist with a variable prevalence of 12 to 50%. We present the clinical case of a woman who, at the age of 20, began follow-up in the mental health unit due to symptoms compatible with an obsessive-compulsive disorder along with a clinic characterized by apathy, anhedonia, abandonment of self-care and progressive functional deterioration. After several evaluation sessions, we diagnosed an autism spectrum disorder. We carry out a bibliographic review with which we conclude that the intersection of symptoms between autism and schizophrenia is common and clinical recommendations are provided to differentiate both clinical entities. (AU)

La catatonia. Diagnóstico y tratamiento a propósito de un caso / Catatonia. Diagnosis and treatment of a case report

El síndrome catatónico es un cuadro de etiología múltiple tanto médica como psiquiátrica, con una variada sintomatología que muchas veces escapa al ojo clínico, siendo por tanto un síndrome infradiagnosticado en la actualidad. Es necesario la realización de un abordaje multidisciplinar y global de estos pacientes, debido a la amplitud de factores predisponentes de tipo farmacológico, tóxico y orgánico y a la elevada morbimortalidad de este síndrome. Es por ello que presentamos un cuadro clínico de un síndrome catatónico inhibido en una paciente de 37 años con diagnóstico de esquizofrenia hebefrénica que presenta un cuadro de estupor, mutismo y negativismo.Es de vital importancia una formación en profundidad para los clínicos y la aplicación de escalas y criterios diagnósticos actualizados, para un diagnóstico, evolución y tratamiento de estos pacientes. La utilización de benzodiacepinas y la terapia electroconvulsiva de manera precoz son los tratamientos de primera línea, siempre asociados a medidas de soporte y prevención de complicaciones. (AU)

The catatonic syndrome present multiple etiologies, both medical and psychiatric, with a variety of symptoms that often escape the clinical eye; therefore, it is currently an underdiagnosed syndrome. A multidisciplinary and global approach is necessary in these patients, due to the wide range of pharmacological, toxic and organic predisposing factors and the high morbidity and mortality of this syndrome. That is why we show a clinical case of an inhibited catatonic syndrome in a 37-year-old patient diagnosed with hebephrenic schizophrenia who presents a clinical picture of stupor, mutism and negativism.In-depth training for clinicians and the application of up-to-date diagnostic scales and criteria are of vital importance for diagnosis, evolution and treatment of these patients. The use of benzodiazepines and early electroconvulsive therapy are the first-line treatments, always associated with support measures and prevention of complications. (AU)

Evaluation of Photobiomodulation and Boldine as Alternative Treatment Options in Two Diabetic Retinopathy Models.

Diabetic retinopathy causes progressive and irreversible damage to the retina through activation of inflammatory processes, overproduction of oxidative species, and glial reactivity, leading to changes in neuronal function and finally ischemia, edema, and hemorrhages. Current treatments are invasive and mostly applied at advanced stages, stressing the need for alternatives. To this end, we tested two unconventional and potentially complementary non-invasive treatment options: Photobiomodulation, the stimulation with near-infrared light, has shown promising results in ameliorating retinal pathologies and insults in several studies but remains controversial. Boldine, on the other hand, is a potent natural antioxidant and potentially useful to prevent free radical-induced oxidative stress. To establish a baseline, we first evaluated the effects of diabetic conditions on the retina with immunofluorescence, histological, and ultrastructural analysis in two diabetes model systems, obese LepRdb/db mice and organotypic retinal explants, and then tested the potential benefits of photobiomodulation and boldine treatment in vitro on retinal explants subjected to high glucose concentrations, mimicking diabetic conditions. Our results suggest that the principal subcellular structures affected by these conditions were mitochondria in the inner segment of photoreceptors, which displayed morphological changes in both model systems. In retinal explants, lactate metabolism, assayed as an indicator of mitochondrial function, was altered, and decreased photoreceptor viability was observed, presumably as a consequence of increased oxidative-nitrosative stress. The latter was reduced by boldine treatment in vitro, while photobiomodulation improved mitochondrial metabolism but was insufficient to prevent retinal structural damage caused by high glucose. These results warrant further research into alternative and complementary treatment options for diabetic retinopathy.

Treatment Limitations for Pediatric Diffuse Intrinsic Pontine Gliomas in a Middle-Income Country.

Objectives To evaluate the surgical management outcomes in pediatric patients with diffuse intrinsic pontine gliomas (DIPGs) who underwent intended biopsies and partial resections in a middle-income country, highlighting the barriers and challenges of these procedures for further investigation. Methods A retrospective review of a prospective acquired series of patients who underwent biopsy or resection for DIPG between January 2012 and June 2018 at our institution was performed. Results A total of 43 patients with posterior fossa tumors were identified. From these, seven pediatric DIPG cases were enrolled. Five were males. The median age was 5 years (range: 1-12 years). Only one patient (14.3%) had a ganglioglioma, while the others presented pilocytic and diffuse astrocytomas. Two (28.6%) patients had an intentional biopsy, and the other five (71.4%) had a partial resection. In the three (28.6%) patients who presented with associated hydrocephalus, the endoscopic third ventriculostomy was performed in the same surgical time. The median preoperative Lansky play-performance scale (LPPS) was 80 (range: 60-100), while the median postoperative LPPS was 23 (range: 7-52). Conclusion A decrease in overall survival was noted compared with data reported in other series. Multifactorial barriers were discussed including the social, geographic, and economic features that may influence on final outcomes.

Aspirin desensitization in nonsteroidal anti-inflammatory exacerbated respiratory disease: The first prospective cohort in Chile.

Background: Nonsteroidal anti-inflammatory exacerbated respiratory disease (N-ERD) is characterized by the Samter triad: chronic rhinosinusitis with nasal polyps, asthma, and nonallergic hypersensitivity to NSAIDs. Its diagnosis is based on a complete clinical history and an aspirin (ASA) challenge test. Medical treatments include biological drugs and ASA desensitization. Objective: This study aims to evaluate the clinical response of patients with N-ERD undergoing functional endoscopic surgery (FES), followed by ASA desensitization and maintenance treatment, being the first prospective cohort study carried out in Chile. Methods: We conducted 1-year follow-up of 12 patients with N-ERD treated with FES, desensitization, and maintenance with ASA. For each control, the medication score, sinonasal symptomatology (SNOT-22), PEF (peak expiratory flow), nasal polyposis (Lildholdt score), and the appearance of adverse effects were recorded. Computed tomography (CT) of the paranasal cavities was performed at baseline and at the 12-month follow-up to calculate the Lund-Mackay score. Results: Patients presented a reduction of SNOT-22 after the FES, which was maintained at 12 months (p = 0.002); the symptoms that showed the greatest reduction were feeling embarrassed and nasal obstruction. The Lildholdt score was also significantly reduced (p = 0.001); in only three patients, the nasal polyps recurred, and all were small. The PEF showed a slight nonsignificant increase of 3.3%. In total, 75% of patients had an adverse effect, the most frequent being abdominal pain (66.7%), but none of the 12 patients required discontinuation of aspirin treatment in 1-year follow-up. The Lund-Mackay score had a significant reduction of 6.6 points (p < 0.001). Conclusion: ASA desensitization is safe and effective in reducing upper and lower respiratory symptoms in patients with N-ERD and delays the reappearance of nasal polyps, although it is not exempt from adverse effects, with the vast majority being mild.

Technology-Assisted Collaborative Care Program for People with Diabetes and/or High Blood Pressure Attending Primary Health Care: A Feasibility Study.

The comorbidity of depression with physical chronic diseases is usually not considered in clinical guidelines. This study evaluated the feasibility of a technology-assisted collaborative care (TCC) program for depression in people with diabetes and/or high blood pressure (DM/HBP) attending a primary health care (PHC) facility in Santiago, Chile. Twenty people diagnosed with DM/HBP having a Patient Health Questionnaire-9 score ≥ 15 points were recruited. The TCC program consisted of a face-to-face, computer-assisted psychosocial intervention (CPI, five biweekly sessions), telephone monitoring (TM), and a mobile phone application for behavioral activation (CONEMO). Assessments of depressive symptoms and other health-related outcomes were made. Thirteen patients completed the CAPI, 12 received TM, and none tried CONEMO. The TCC program was potentially efficacious in treating depression, with two-thirds of participants achieving response to depression treatment 12 weeks after baseline. Decreases were observed in depressive symptoms and healthcare visits and increases in mental health-related quality of life and adherence to treatment. Patients perceived the CPI as acceptable. The TCC program was partially feasible and potentially efficacious for managing depression in people with DM/HBP. These data are valuable inputs for a future randomized clinical trial.

Understanding the Relationship between Depression and Chronic Diseases Such as Diabetes and Hypertension: A Grounded Theory Study.

There is a bi-directional relationship between depression and chronic illnesses such as diabetes and hypertension. This comorbidity is associated with higher mortality risk and diminishes the efficacy of interventions. The specific mechanisms of this mutual influence are still not fully understood, and most intervention protocols address these conditions separately. This study aims to improve our understanding of this relationship. We interviewed 18 patients and 24 health care professionals, focusing on understanding the different ways in which depression and chronic illness could influence each other. Our results show a common cyclical pattern and specific situations where the reported bi-directional relationship does not occur. We discuss the importance of opening a space for the patient's grief process after the chronic illness diagnosis, managing the demands and stress of the patient's treatment, and how to adjust the treatment to the different needs and possibilities of each person.

Analytical Validation of Two Point-of-Care Assays for Serum Amyloid A Measurements in Cats.

Serum Amyloid A (SAA) is one of the most sensitive tests to detect inflammation in cats. In this study, two point-of-care assays for SAA measurements in cats (FUJI DRI-CHEM IMMUNO AU CARTRIDGE vf-SAA (method A), and CUBE-VET analyser (Method B), were analytically evaluated. Regarding the imprecision precision only the method A showed intra-assay and inter-assay CV < 10% at all concentrations. Both assays showed linearity with r close to 1 and the recovery were in the range of 81-112% for assay A and 85-125% for assay B and the limit of detection were 3.75 and 0.5 mg/dL for method A and B, respectively. A previously validated method for SAA quantification SAATIA; LZ-SAA (method C) was used as gold-standard to evaluate the accuracy of the assays. Significant correlations (p < 0.0001) were found between assays A and C (r = 0.94) and B and C (r = 0.91). In addition, an overlap performance test was made using serum samples from cats with non-inflammatory and cats with inflammatory. Both assays showed higher median SAA concentrations in cats with inflammatory diseases than in cats without inflammatory diseases (p < 0.0001). In conclusion, this manuscript provides data about the possible application of two point-of-care assays for the measurement of SAA concentration in cats.

A collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care: protocol for a cluster randomized controlled trial.

BACKGROUND: Depression and chronic diseases are frequently comorbid public health problems. However, clinical guidelines often fail to consider comorbidities. This study protocol describes a cluster randomized trial (CRT) aimed to compare the effectiveness of a collaborative, computer-assisted, psycho-educational intervention versus enhanced usual care (EUC) in the treatment of depressed patients with hypertension and/or diabetes in primary care clinics (PCC) in Santiago, Chile. METHODS: Two-arm, single-blind, CRT carried out at two municipalities in Santiago, Chile. Eight PCC will be randomly assigned (1:1 ratio within each municipality, 4 PCC in each municipality) to the INTERVENTION or EUC. A total of 360 depressed patients, aged at least 18 years, with Patient Health Questionnaire-9 Item [PHQ-9] scores ≥15, and enrolled in the Cardiovascular Health Program at the participating PCC. Patients with alcohol/substance abuse; current treatment for depression, bipolar disorder, or psychosis; illiteracy; severe impairment; and resident in long-term care facilities, will be excluded. Patients in both arms will be invited to use the Web page of the project, which includes basic health education information. Patients in the INTERVENTION will receive eight sessions of a computer-assisted, psycho-educational intervention delivered by trained therapists, a structured telephone calls to monitor progress, and usual medical care for chronic diseases. Therapists will receive biweekly and monthly supervision by psychologist and psychiatrist, respectively. A monthly meeting will be held between the PCC team and a member of the research team to ensure continuity of care. Patients in EUC will receive depression treatment according to clinical guidelines and usual medical care for chronic diseases. Outcome assessments will be conducted at 3, 6, and 12 months after enrollment. The primary outcome will be depression improvement at 6 months, defined as ≥50% reduction in baseline PHQ-9 scores. Intention-to-treat analyses will be performed. DISCUSSION: This study will be one of the first to provide evidence for the effectiveness of a collaborative, computer-assisted, psycho-educational intervention for depressed patients with chronic disease at primary care in a Latin American country. TRIAL REGISTRATION: retrospectively registered in ClinicalTrials.gov , first posted: November 3, 2020, under identifier: NCT04613076 .

Development of a PHBV nanoparticle as a peptide vehicle for NOD1 activation.

NOD1 is an intracellular receptor that, when activated, induces gene expression of pro-inflammatory factors promoting macrophages and neutrophils recruitment at the infection site. However, iE-DAP, the dipeptide agonist that promotes this receptor's activation, cannot permeate cell membranes. To develop a nanocarrier capable of achieving a high and prolonged activation over time, iE-DAP was encapsulated in nanoparticles (NPs) made of poly (3-hydroxybutyrate-co-3-hydroxyvalerate) (PHBV). The physicochemical properties, colloidal stability, encapsulation efficiency, and cellular uptake of iE-DAP-loaded PHVB NPs were analyzed. Results evidenced that physicochemical properties of iE-DAP-loaded NPs remained stable over time, and NPs were efficiently internalized into cells, a process that depends on time and concentration. Moreover, our results showed that NPs elicited a controlled cargo release in vitro, and the encapsulated agonist response was higher than its free form, suggesting the possibility of activating intracellular receptors triggering an immune response through the release of NOD1 agonist.

Long-term monitoring for conservation: closing the distribution gap of Arctocephalus australis in central Chile.

OBJECTIVES: Here, we present the first record of stable colonies of the South American fur seal (Arctocephalus australis), in an area where their presence has never been documented (hereafter distribution gap), as well as an update of the current distribution range of the species in central Chile. RESULTS: A national synoptic aerial census of pinnipeds was performed during the austral summer of 2019 on the Chilean coast. An additional aerial census was conducted in the same area during the austral spring of 2019 as well as a maritime census during the austral summer of 2020. The data showed the presence of South American fur seals in central Chile within their well-known distribution gap. The total abundance was registered in three colonies where fur seals were sighted: one non-breeding colony, Punta Topocalma (summer 2019: mean = 46 ± 3; spring 2019: mean = 9 ± 1); and two breeding colonies, Punta Curaumilla (summer 2019: mean = 595 ± 7; spring 2019: mean = 45 ± 4; summer 2020: mean = 744 ± 5) and Isla Santa María (summer 2019: mean = 246 ± 6). Specifically, we suggest that it is crucial to elucidate the origin of the described settled colonies, and to determine whether there has been an augment in the distribution range from either the northern population, the southern population, or both simultaneously.

Effect of the type of wood used for ageing on the volatile composition of Pedro Ximénez sweet wine.

BACKGROUND: The present study investigated the volatile composition of a Pedro Ximénez sweet wine that had been aged in barrels made of different types of wood (Spanish oak, French oak, American oak and chestnut) and subjected to different degrees of toasting (medium toasting and intense toasting). The analyses were carried out using stir bar sorptive extraction gas chromatography-mass spectrometry after validation of the matrix in this case. RESULTS: Good values of linearity, precision, limits of detection and limits of quantification were obtained for the 36 compounds studied, six of which were identified for the first time in Pedro Ximénez (propyl acetate, cis-3-hexenyl acetate, benzyl acetate, guaiacol, trans-whiskeylactone and 4-ethylguaiacol). The volatile composition of the samples varied as the ageing process progressed, and higher volatile concentrations were obtained in samples aged in barrels that had been intensely toasted compared to in those with medium toasting. A multivariate statistical study allowed the samples to be correctly classified according to ageing time, wood toasting and the type of wood used for ageing. CONCLUSION: The organoleptic analysis performed on the Pedro Ximénez sweet wine samples resulted in differences between the wines aged in the different types of wood during the early weeks of ageing, and scarce differences towards the end of the study period. At the end of the process, all of the wines were better valued and wines aged in medium toasted barrels were the best rated by the panel of judges for all four woods under investigation. This fact could indicate the suitability of alternative woods for the ageing of Pedro Ximénez sweet wines. © 2020 Society of Chemical Industry.

Detección de COVID -19 (SARS-CoV-2) mediante la saliva: una alternativa diagnóstica poco invasiva / Detection of COVID-19 (SARS-CoV-2) by saliva: a low-invasive diagnostic alternative

La nueva enfermedad por coronavirus, también denominada COVID 19 es la última enfermedad infecciosa de preocupación internacional. Originada en Wuhan, China, se extendió a nivel mundial, resultando en la pandemia 2019-2020 y una Emergencia de Salud Pública de Preocupación Internacional (ESPII) según lo declarado por la Organización Mundial de la Salud (OMS). Esta enfermedad suele cursar con fiebre, tos, dolor de garganta, dificultad respiratoria, fatiga y malestar general, sin embargo, también se han presentado casos asintomáticos. Su diagnóstico se realiza con una combinación tanto de exámenes clínicos, radiológicos y moleculares, donde la prueba de reacción en cadena de la polimerasa con transcriptasa inversa (RT-PCR) ha sido el examen de elección para el análisis de material genético viral de muestras extraídas del tracto respiratorio superior. Se ha reportado que COVID-19 se transmite persona a persona o por contacto indirecto por gotas, lo que tiene fundamental importancia en procedimientos clínicos dentales y donde la saliva tendría una función crítica en la transmisión de SARS-CoV-2 en la población. Es por esto, que los diagnósticos salivales no invasivos podrían proporcionar una plataforma de detección rápida, temprana y poco invasiva de la infección por COVID-19. El objetivo de esta revisión es determinar los beneficios de la saliva como muestra no invasiva para el diagnóstico de COVID-19.

The new coronavirus disease, also called COVID 19, is the latest infectious disease of international concern. Originating in Wuhan, China, it spread globally, resulting in the 2019-2020 pandemic and a Public Health Emergency of International Concern (ESPII) as declared by the World Health Organization (WHO). This disease usually presents with fever, cough, sore throat, respiratory distress, fatigue and general discomfort; however, asymptomatic cases have been reported. The diagnosis is made with a combination of clinical, radiological and laboratory molecular tests, where the reverse transcriptase polymerase chain reaction (RT-PCR) test has been the alternative of choice for the analysis of viral genetic material from samples taken of upper respiratory tract. COVID-19 has been reported to be transmitted person-to-person or by indirect fluids drop contact, which is of fundamental importance for clinical dental procedures and where saliva would play a critical role in the transmission of SARS-CoV-2 from human to human. For this reason, non-invasive salivary diagnoses could provide a platform for rapid, early and non-invasive detection of COVID19 infection. The objective of this review is to determine the benefits of saliva as a non-invasive sample for the diagnosis of COVID-19.

Diseño de un modelo predictivo de pesquisa cardiovascular utilizando árboles de decisión: propensión de pacientes a presentar diabetes tipo 2, hipertensión arterial o dislipidemia: estudio piloto, comuna de Quellón, Chiloé / Design of a predictive model of cardiovascular screening using decision trees: propensity of patients to present type 2 diabetes, arterial hypertension or dyslipidemia: pilot study commune of Quellón, Chiloé

Introducción : En la actualidad, la Minería de Datos es cada vez más popular en el campo de la salud porque existe una necesidad de eficiencia metodológica y analítica para detectar información desconocida y valiosa en datos de salud. Objetivo : Desarrollar un modelo predictivo utilizando técnicas de minería de datos, específicamente Arboles de Decisión, para pesquisar pacientes con propensión a desarrollar Diabetes Tipo II (DM II), Hipertensión Arterial (HTA) o Dislipidemia (DLP). Método : Se analizó el problema de los Factores de Riesgo Cardiovascular Mayores desde una perspectiva de procesos y se estudiaron las técnicas que permiten descubrir el conocimiento del fenómeno almacenado en las bases de datos de Examen de Medicina Preventiva del Adulto (EMPA) de la Población en Control Cardiovascular que presenta DM II, HTA o DLP Resultados : El Algoritmo C5, presenta un mayor poder predictivo, respecto de otros algoritmos de Árbol de Decisión. Se comprobó que las variables Edad y Circunferencia de Cintura fueron las de mayor poder de discriminación en el padecimiento de DM2, HTA o DLP. El algoritmo C5 alcanzó una precisión global de un 83,01% en la partición de prueba, luego en la misma partición el modelo logra discriminar un paciente con algunas de las patologías en el 85,25% de los casos, y uno que no presenta alguna de las patologías en un 80,27% de las oportunidades. Conclusión : La Minería de Datos y en este caso, específicamente los Modelos de Árboles de Decisión son una alternativa válida para la pesquisa cardiovascular temprana.

Introduction : Data Mining is increasingly popular in the health field because there is a need for an efficient analytical methodology to detect unknown and valuable information of health data. Objective : To develop a predictive model using data mining techniques, specifically Decision Trees, to investigate patients with a propensity to develop Type II Diabetes, Arterial Hypertension or Dyslipidemia. The data of adult patients presenting Type II diabetes, Hypertension or Dyslipidemia being followed in a preventive cardiovascular control program were analyzed with the aim of unveiling phenomena that could help develop the prediction of these risk factors. Results : With respect to other decision tree algorithms, Algorithm C 5, showed a greater predictive power. The variables age and waist circumference had the greatest power of discrimination for DM2, HTA or DLP. The C 5 algorithm reached a global precision of 83.01% in the test partition. Then, in the same partition the model managed to discriminate a patient with some of the risk factors in 85.25% of cases, and to rule out any of them in 80.27% of cases. Conclusion : Data Mining, specifically decisión tree models, is a valid alternative for early detection of cardiovascular of risk factors.

Reconstruction of the Ascending Reticular Activating System with Diffusion Tensor Tractography in Patients with a Disorder of Consciousness after Traumatic Brain Injury.

This work describes the reconstruction of the ascending reticular activating system (ARAS) with diffusion tensor tractography in three patients with altered consciousness after traumatic brain injury. A diffusion tensor tractography was performed in three patients with impaired consciousness after a severe traumatic brain injury. A 1.5 T scanner was used to obtain the tensor sequences; axial tensors were acquired. Post-processing was performed, and the mean fractional anisotropy (FA) values were recorded. The FA maps were used to do a manual tracing of the following regions of interest (ROIs): the ventromedial midbrain, the anterior thalamus, and the hypothalamus. Case 1 presented destruction of the right dorsal and ventral tegmental tracts as well as destruction of the right middle forebrain bundle, case 2 had destruction of the right dorsal tegmental tract, and case 3 had destruction of the bilateral ventral and dorsal tegmental tracts, as well as destruction of the right middle forebrain bundle. The affected fibers of the ascending reticular activating system with diffuse axonal injury and the FA values abnormalities in the ascending reticular activating system in three patients with a disorder of consciousness (DOC) after traumatic brain injury are described.

Understanding Non-Adherence From the Inside: Hypertensive Patients' Motivations for Adhering and Not Adhering.

Patients' low adherence to medical treatment in chronic illnesses is one of the biggest public health problems. Numerous studies attend to the diverse factors associated with patient adherence. However, little research has been done to explore patients' reasons for non-compliance from their own point of view. In this article, we aim to understand patient non-adherence using dialogical self-theory and qualitative research methods. We interviewed 51 hypertensive patients to explore their anti- and pro-adherence motivations. Results show that most patients adhere and non-adhere to different aspects of treatment programs (medication, exercise, diet) according to the way they construct meaning to those activities. Also, our findings support the notion that patients' non-adherent behavior aims to preserve important values such as self-esteem, autonomy, affiliation, well-being, freedom, and health (or that more adherence is not worth the extra effort). We discuss the therapeutic relevance of empathically understanding patients' worldview and implicit beliefs.

Tratamiento quirúrgico ambulatorio en pacientes con hernia inguinal / Ambulatory surgycal treatment in patient with inguinal hernia

Introducción: el tratamiento quirúrgico de la hernia inguinal ha aumentado en la última década y realmente se desconoce su prevalencia. Objetivo: evaluar los resultados del tratamiento quirúrgico ambulatorio de esta entidad desde enero de 2010 hasta diciembre de 2014. Métodos: se efectuó un estudio observacional, descriptivo y prospectivo de 380 pacientes con el diagnóstico de hernia inguinal, los cuales fueron operados de manera ambulatoria en el Hospital General Docente Enrique Cabrera desde enero de 2010 hasta diciembre de 2014. Se incluyeron los pacientes operados de urgencia. Resultados: la mayor incidencia de la hernia inguinal se encontró entre las edades de 60 y 80 años. La hernia inguinal derecha indirecta apareció con mayor frecuencia. La técnica quirúrgica anatómica de Desarda fue la más aplicada en 204 (51 por ciento) de los casos y la hernioplastia de Lichtenstein con 107 (28 por ciento) le siguió en frecuencia. Hubo un total de 2 (0,5 por ciento) de recidivas. Se aplicó la anestesia local en 345 (97 por ciento) de los pacientes, de forma ambulatoria fueron el 100 por ciento. El total de complicaciones fue de 14 (3,3 por ciento). Conclusiones: el tratamiento quirúrgico de la hernia inguinal de forma ambulatoria es un proceso adecuado. Asegura la comodidad de los pacientes, disminuye el riesgo de infección hospitalaria, reduce las listas de espera y los costos hospitalarios(AU)

Introduction: the surgical treatment of inguinal hernia has increased in the last ten years and its prevalence is really unknown. Objective: the objective of this study is to evaluate the results of the ambulatory surgical treatment of this entity between January 2010 and December 2014. Methods: an observational, descriptive and prospective study was carried out with 380 patients who presented inguinal hernia and were ambulatorily operated in Dr. Enrique Cabrera General Hospital between January 2010 and December 2014. Patients urgently operated were also included. Results: the highest incidence of inguinal hernia was found at ages 60-80 years. Indirect right inguinal hernia appeared more frequently. The anatomical surgical technique Desarda was the most applied (204 cases, 51 percent), followed in frequency by Lichtenstein hernioplasty (107 cases, 28 percent). There was sheer number of 2 (0.5 percent) relapses. Local anesthesia was used in 345 (90.8 percent) of the patients. Ambulatory surgical treatment was performed in 100 percent of the cases. The total number of complications was 14 (3.3 percent). Conclusions: ambulatory surgical treatment of inguinal hernia is an appropriate process. It ensures patient comfort, decreases the risk for hospital infection, and reduces waiting lists and hospital costs(AU)