Psychometric properties of the Spanish version of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) in Chile.

OBJECTIVE: To examine the psychometric properties of the Spanish version of the 34-item Clinical Outcomes in Routine Evaluation-Outcome Measure questionnaire (CORE-OM). METHOD: Psychometric exploration was conducted in two samples: non-clinical (n = 706) and clinical (n = 420) participants. The non-clinical sample comprised a subgroup of community members (n = 308) and students (n = 398). The clinical sample consisted of self-reported patients (n = 209) and outpatients (n = 211). The analysis included both internal and test-retest reliability, convergent validity, and principal component analysis. A reliable change index and clinical cut-off scores were established for assessing clinically significant change. RESULTS: The Spanish CORE-OM demonstrated good internal consistency and test-retest reliability, along with satisfactory convergent validity against the 45-item Outcome Questionnaire (OQ-45.2). There were strong differentiations between the clinical and non-clinical samples and the four sample subsets. The outpatient group reported the highest scores, while the community group exhibited the lowest scores. There were no marked gender effects. All observed patterns aligned closely with the established Spanish referential data. CONCLUSION: Our findings provide support for the utilization of the Spanish CORE-OM as a measure for tracking psychotherapeutic progress in the context of Chile.

Locking versus nonlocking plates for the treatment of posterior malleolar ankle fractures: A retrospective cohort study and cost analysis.

BACKGROUND: We hypothesized that, as posterior malleolar ankle fractures usually present one or two main fragments, the buttress plating principle can be successfully achieved either with conventional nonlocking or anatomic locking posterior tibia plates, and no clinical differences should be found. The aim of this study was to evaluate the outcomes of posterior malleolar ankle (PM) fractures treated with conventional nonlocking (CNP) or anatomic locking plates (ALP), and also to compare both constructs in terms of crude costs. METHODS: A retrospective cohort study was designed. CNP was used in 22 patients and ALP was used in 11 patients. American Orthopedic Foot and Ankle Society (AOFAS) score was registered at four weeks, 3-6 months, 12 and 24 months to assess all patients' functional status. The primary outcome was ankle and hindfoot AOFAS score at 12 months follow-up visit. All complications, radiographic evaluation and implant construct costs were also registered and compared. The average follow-up was 25.4 (range, 12-42) months. RESULTS: No significant difference was observed between both cohorts, in terms of AOFAS score and complication rate (P > .05). We found that ALP construct is 17 times more expensive than CNP construct in our institution (P < .001). CONCLUSION: Anatomic locking posterior tibial plates may be an interesting device when poor bone quality is present or when a true multifragmentary pilon fracture is faced. Anatomic locking posterior tibia plate should not become a regular implant for any PM fracture since equivalent clinical and radiological results were obtained in our study using CNP with a significant reduced cost.

Implementation of an integrated care strategy for child contacts of tuberculosis patients: a quasi-experimental study protocol.

BACKGROUND: Childhood tuberculosis continues to be a major public health problem. Although the visibility of the epidemic in this population group has increased, further research is needed. OBJECTIVE: To design, implement and evaluate an integrated care strategy for children under five years old who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients in Medellín and the Metropolitan Area. METHODS: A quasi-experimental study in which approximately 300 children who are household contacts of bacteriologically confirmed pulmonary tuberculosis patients from Medellín and the Metropolitan Area will be evaluated and recruited over one year. A subgroup of these children, estimated at 85, who require treatment for latent tuberculosis, will receive an integrated care strategy that includes: some modifications of the current standardized scheme in Colombia, with rifampicin treatment daily for four months, follow-up under the project scheme with nursing personnel, general practitioners, specialists, professionals from other disciplines such as social work, psychology, and nutritionist. Additionally, transportation and food assistance will be provided to encourage treatment compliance. This strategy will be compared with isoniazid treatment received by a cohort of children between 2015 and 2018 following the standardized scheme in the country. The study was approved by the CIB Research Ethics Committee and UPB. CLINICALTRIALS: gov identifier NCT04331262. DISCUSSION: This study is expected to contribute to the development of integrated care strategies for the treatment of latent tuberculosis in children. The results will have a direct impact on the management of childhood tuberculosis contributing to achieving the goals proposed by the World Health Organization's End TB Strategy. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT04331262 . Implementation of an Integrated Care Strategy for Children Contacts of Patients with Tuberculosis. Registered 2 April 2020.

Utilidad de la tomografía en la intoxicación por paraquat: reporte de caso / Serviceability of tomography in paraquat poisoning: a case report

Resumen El paraquat es un plaguicida del grupo de los herbicidas asociado a una gran morbimortalidad, luego de su ingesta con intención suicida. Dentro de las ayudas pronósticas, en el paciente intoxicado por esta sustancia, la literatura internacional considera la tomografía de tórax y sus hallazgos, sin embargo, en Colombia, no hay reportes a nivel nacional, ni inclusión de este parámetro dentro de las guías del Ministerio de Salud. Reportamos el caso de una paciente con diagnóstico tardío de intoxicación por paraquat, la tomografía de ingreso no indicó compromiso pulmonar así que se inició tratamiento y se obtuvo resultados favorables relacionados con la supervivencia de la paciente.

Abstract Paraquat is a pesticide from the group of herbicides associated with high morbidity and mortality after ingestion with suicidal intent. Within the prognostic aids, in the patient intoxicated by this substance, the international literature considers the chest tomography and its findings. However, in Colombia, there are no reports at the national level, nor is there any inclusion of this parameter within the guidelines of the Ministry of Health. We report the case of a patient with a late diagnosis of paraquat poisoning, admission tomography did not indicate pulmonary compromise, so treatment was started and favorable results related to the patient's survival were obtained.

Reproducibility of a protocol for standardized reading of chest X-rays of children household contact of patients with tuberculosis.

BACKGROUND: The interpretation of the chest radiograph may vary because it depends on the reader and due to the non-specificity of findings in tuberculosis (TB). We aim to assess the reproducibility of a standardized chest radiograph reading protocol in contacts of patients with pulmonary TB under the 5 years of age. METHODS: Descriptive, cross-sectional study with children under the age of five, household contacts of patients with confirmed pulmonary TB from Medellín, Bello and Itagüí (Colombia) between Jan-01-2015 and May-31-2016. Standardized reading protocol: two radiologists, blinded independent reading, use of template (Dr. Andronikou design) in case of disagreement a third reading was performed. Kappa coefficient for intra and inter observer agreement, and prevalence ratio were estimated of sociodemographic characteristics, TB exposure and interpretation of chest X-ray. RESULTS: From 278 children, standardized reading found 255 (91.7%) normal X-rays, 10 (3.6%) consistent with TB, and 13 (4.7%) other alterations. Global agreement was 91.3% (Kappa = 0.51). Inter-observer agreement between readers 1-2 was 90.0% (Kappa = 0.59) and 1-3 93.2% (Kappa = 0.59). Intra-observer agreement for reader 1 was 95.5% (Kappa = 0.86), 2 84.0% (Kappa = 0.51), and 3 94.7% (Kappa = 0.68). Greater inter-observer disagreement was between readers 1-2 for soft tissue density suggestive of adenopathy (4.6%), airspace opacification (1.17%) and pleural effusion (0.58%); between readers 1-3 for soft tissue density suggestive of adenopathy (4.2%), opacification of airspace (2.5%) and cavities (0.8%). CONCLUSIONS: Chest radiographs are an affordable tool that contributes to the diagnosis of TB, so having a standardized reading protocol showed good agreement and improves the reproducibility of radiograph interpretation.

Technique tip: 3D printing surgical guide for pes cavus midfoot osteotomy.

BACKGROUND: Pes cavus can be defined as an abnormal elevation of the longitudinal arches, which is often secondary to a muscle imbalance. This deformity affects the foot's three dimensions (3D) and our osteotomies are usually planned on a lateral (two-dimension) X-ray. Are we really considering all the spatial components of the deformity? The aim of this study is to present a technique tip to identify the apical plane of the pes cavus deformity and perform a midfoot dorsal-based wedge resection osteotomy by using customized 3D printed surgical guides. METHODS: Three patients underwent the presented technique, all for the indication of symptomatic neuromuscular pes cavus with both anterior and posterior deformity. RESULTS: 3D-printed patient-specific guides help the surgeon to minimize human error, improving intraoperative accuracy, while reducing surgical time and intraoperative X-ray exposure. CONCLUSIONS: Closing wedge midfoot osteotomy to correct anterior pes cavus may be an interesting indication to use customized 3D printed surgical guides.

ZnO Semiconductor Nanoparticles and Their Application in Photocatalytic Degradation of Various Organic Dyes.

The biosynthesis of oxide semiconductor nanoparticles (NPs) using materials found in nature opens a wide field of study focused on sustainability and environmental protection. Biosynthesized NPs have the capacity to eliminate organic dyes, which pollute water and cause severe damage to the environment. In the present work, the green synthesis of zinc oxide (ZnO) NPs was carried out using Capsicum annuum var. Anaheim extract. The photocatalytic elimination of methylene blue (MB), methyl orange (MO), and Rhodamine B (RhB) in UV radiation was evaluated. The materials were characterized by scanning and transmission electron microscopy (SEM and TEM) and SEM-coupled energy dispersive spectroscopy (EDS), attenuated total reflectance-infrared (ATR-IR), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD), Photoluminescence (PL), and ultraviolet-visible spectroscopy (UV-Vis). The TEM analysis showed the NPs have an average size of 40 nm and quasi-spherical shape. ATR-IR showed the ZnO NPs contained functional groups from the extract. The analysis through XRD indicated that the NPs have a hexagonal zincite crystal structure with an average crystallite size of approximately 17 nm. The photoluminescence spectrum (PL) presented an emission band at 402 nm. From the UV-Vis spectra and TAUC model, the band-gap value was found to be 2.93 eV. Finally, the photocatalytic assessment proved the ZnO NPs achieved 100% elimination of MB at 60 min exposure, and 85 and 92% degradation of MO and RhB, respectively, at 180 min. This indicates that ZnO NPs, in addition to using a friendly method for their synthesis, manage to have excellent photocatalytic activity in the degradation of various organic pollutants.

Bioactive glass, a new tool for the treatment in the diabetic foot recalcitrant osteomyelitis: A case series with 24-month follow-up.

BACKGROUND: The bioactive glass (BAG) is a promising solution for the reconstruction of bone defects and the eradication of infection in patients with osteomyelitis, however references to the treatment of diabetic foot osteomyelitis are scarce in the literature. METHODS: Our experience in patients with diabetic foot osteomyelitis, who required surgical debridement and void filling, in which we use bioactive glass (n = 6), was evaluated. During a minimum follow-up of 24 months, the presence of persistent infection and healing rate, post-surgical complications, surgical reinterventions, degree of osseointegration and BAG-related side effects was analyzed. RESULTS: At the end of the follow-up, none of the patients showed signs of persistent infection and the healing rate was 66.6% (4/6). Postoperative complications were noted in 3 patients and two of the them required new surgical intervention, both due to skin coverage or vascular complications. A complete osseointegration in the 66.6% of the patients and no cases of local adverse effects were recorded. CONCLUSIONS: The bioactive glass can be a useful tool in the treatment of certain cases of diabetic foot osteomyelitis, provided that a multidisciplinary approach and strict patient selection is in place. LEVEL OF EVIDENCE: IV.

Patterns of change: tracking the therapeutic focus

INTRODUCTION: Brief dynamic psychotherapy has been increasingly important in the actual clinical practice. For its brevity, focalization must be accomplished. The work on focus consolidates the material, abbreviates psychotherapy, and is considered to be a change mechanism. Operationalized Psychodynamic Diagnosis OPD-2 proposes a concept of focus as the specific problem areas that are significant for patient's psychodynamics, in terms of relational pattern, inner conflicts, and structural vulnerabilities. The study on foci becomes a research and clinical imperative, where change on foci must be considered. AIMS & METHODS: This study aimed to (1) identify foci in change episodes and (2) establish the relationship between them during the process. A multiple single-subject design was used, considering the analysis of 13 outpatient psychotherapies done as treatment as usual (average of 18 sessions each process). OPD-2and Level of Presence of Foci were used to identify foci worked by therapist and patient during change episodes, already codified in a previous research usign the list of Generic Change Indicators. RESULTS & DISCUSSION: 208 change episodes were analysed. Conflict focus relates inversely with structural focus at the initial phase, and the latter appears to increase during the process. Some focus relates to different levels of patients change. Results are discussed in their clinical relevance. (AU)

Discussion

In 1992, Sven Olaf Hoffmann, Wolfgang Schneider and Manfred Cierpka, the three psychiatrists, psychoanalysts and psychotherapists, met in a hotel bar to discuss the problem of diagnosis in psychiatry, psychoanalysis, psychosomatics and psychotherapy, thinking that "something had to be done" about it. In the heat of some wine glasses the idea of each of the axes of the OPD arose: prerequisites for treatment, relationship, conflict, structure and descriptive diagnosis. The three colleagues dedicated themselves to the task of bringing together important people from the academic and psychoanalytic scene to construct the first draft of the manual, which by 1995 was already constructed and tested. Subsequently, 120 clinicians were asked to code videotaped interviews with this draft and, after critical feedback, the OPD-1 Manual1 emerged. (AU)

Plasma Levels of Free Fatty Acids in Women with Gestational Diabetes and Its Intrinsic and Extrinsic Determinants: Systematic Review and Meta-Analysis.

BACKGROUND: Free fatty acids, also known as nonesterified fatty acids, are proinflammatory molecules that induce insulin resistance in nonpregnant individuals. Nevertheless, the concentration of these molecules has not been systematically addressed in pregnant women. OBJECTIVE: This meta-analysis is aimed at evaluating the difference in free fatty acid plasma levels between women with gestational diabetes and healthy pregnant controls and their intrinsic and extrinsic determinants. METHODS: We performed a systematic search to find relevant studies published in English and Spanish using PubMed, SCOPUS, and ISI Web of Knowledge. We included observational studies measuring the mean plasma levels of free fatty acids among gestational diabetes and healthy pregnant women, with at least ten subjects being analyzed in each group. The standardized mean difference (SMD) by random effects modeling was used. Heterogeneity was assessed using Cochran's Q, H, and I 2 statistics. RESULTS: Among the 290 identified studies, twelve were selected for analysis. A total of 2426 women were included, from which 21% were diagnosed as having gestational diabetes. There were significantly higher levels of free fatty acids among women with gestational diabetes (SMD: 0.86; 0.54-1.18; p < 0.001) when compared to healthy pregnant controls and between-study heterogeneity (I 2 = 91%). The metaregression analysis showed that the gestational age at inclusion was the only cofactor influencing the mean levels of free fatty acids, indicating a trend towards lower plasma levels of free fatty acids later in gestation (estimate: -0.074; -0.143 to -0.004; p = 0.036). No significant publication bias was found nor a trend towards greater results in small studies. CONCLUSIONS: Women with gestational diabetes have higher levels of free fatty acids when compared to healthy pregnant controls. More investigation is needed to assess the potential role of free fatty acids in the prediction of gestational diabetes earlier in pregnancy.

Eficácia adaptativa e indicadores genéricos de mudança em psicoterapia: um estudo exploratório / Adaptive efficacy and generic indicators of change in psychotherapy: An exploratory study

Esta pesquisa exploratória objetivou avaliar a relação entre evolução dos indicadores genéricos de mudança e qualidade da eficácia adaptativa de uma paciente adulta atendida em psicoterapia breve psicodinâmica. Os vídeos e transcrições das 11 sessões deste processo foram analisados com os Indicadores Genéricos de Mudança e com a Escala Diagnóstica Adaptativa Operacionalizada Redefinida. Os resultados demonstraram evolução dos indicadores de mudança e progresso nas respostas adaptativas. Se por um lado respostas mais adequadas sugeriram mudanças na vida da paciente, por outro, essas melhoras puderam ser captadas pelos Indicadores Genéricos de Mudança. As duas medidas usadas em conjunto podem auxiliar o terapeuta na avaliação de progresso do paciente e na compreensão dos fatores que ocasionam ou que limitam a mudança. Sugere-se a realização de pesquisas que compreendam maior número de casos, contem com processos considerados mal sucedidos e envolvam abandono por parte do paciente.

This exploratory study aimed to evaluate the relationship between the progress on generic indicators of change and the quality of adaptive efficacy in an adult patient who underwent brief psychodynamic psychotherapy. The videos and transcripts of 11 therapy sessions were analyzed using the "Indicadores Genéricos de Cambio" (Generic Change Indicators) and the "Escala Diagnóstica Adaptativa Operacionalizada Redefinida" (Operational Adaptive Diagnostic Scale Redefined). The results pointed to the progress on the indicators of change and progress in adaptive responses. More adequate responses suggested changes in the patient's life, and these improvements were detected by the Generic Change Indicators. Used together, these two measures may assist the therapist in evaluating patient's progress and understanding the factors that cause or limit change. Further studies with a larger number of psychotherapy processes and which take into account unsuccessful processes and patient abandonment are recommended.

Role of Personality Functioning in the Quality of Life of Patients with Depression.

Depression is associated with reduced quality of life (QoL), and personality pathology is associated with higher impairment and poorer treatment outcomes in patients with depression. This study aims to analyze the effects of personality functioning on the QoL of patients with depression. Severity of depressive symptoms (Beck Depression Inventory), level of personality functioning (Operationalized Psychodynamic Diagnosis Structure Questionnaire), and QoL (Medical Outcome Study 36-item Short-Form) were assessed in a sample of 84 depressive outpatients. Personality functioning showed main effects on both the mental and physical components of QoL. A moderating effect of personality functioning on the relationship between depressive symptoms and QoL was tested but not confirmed. Severity of depressive symptoms was found to mediate the effect of personality functioning on the mental component of QoL. These results suggest that the effect of personality functioning on the QoL of patients with depression may be related to the higher severity of depressive symptoms found in patients with lower levels of personality functioning.

Beyond Self-Criticism and Dependency: Structural Functioning of Depressive Patients and Its Treatment.

Van Praag states that the underlying psychic dysfunctions in psychopathology must be evaluated (and treated) in patient-centered treatments. In line with this idea, Blatt and colleagues propose the concept of self-critical (introjective) and dependent (anaclitic) functioning. The research program Millennium Initiative has studied self-critical and dependent functioning from different perspectives. The general aim of this paper is to share the results of the program that have contributed to clinical psychotherapeutic thinking. Its first specific aim is to summarize results reported elsewhere that support the predictive value of introjective and anaclitic functioning (Part I), while its second specific aim is to report original data that account for the structural functioning of personality underlying these two constructs (Part II). The results (Part I) show that self-critical functioning is associated with greater reactivity to stress (according to cortisol level in stress tasks) and less subjective awareness of stress, reduced performance in general tasks, and lower mentalization (errors in reading faces); also, patients with introjective (self-critical) depression receiving psychotherapy have more symptoms at onset, higher dropout rates, and poorer response to interventions than anaclitic (dependent) patients. Higher self-criticism was associated with higher depression scores; also, when comparing clinical and nonclinical samples, the latter showed less self-criticism. Therefore, self-critical functioning represents a challenge for researchers and clinicians. The evaluation of the structural functioning of personality showed (Part II) that self-critical functioning is associated with less integrated levels of structure and more depressive symptoms. This functioning is underlain by vulnerabilities in the abilities regulating object relationships and attachments to internal objects. Dependent functioning is associated with vulnerabilities in self-perception, self-regulation, and attachments to external objects. The psychotherapeutic implications of these results are discussed, paying special attention to aspects connected with structure-oriented psychotherapy.

Designing a Model of a Digital Ecosystem for Healthcare and Wellness Using the Business Model Canvas.

Wellness is a term often used to talk about optimal health as "dynamic balance of physical, emotional, social, spiritual, and intellectual health." While healthcare is a term about care offered to patients for improving their health. We use both terms, as well as the Business Model Canvas (BMC) methodology, to design a digital ecosystem model for healthcare and wellness called DE4HW; the model considers economic, technological, and legal asymmetries, which are present on e-services beyond geographical regions. BMC methodology was embedded into the global project strategy called: IBOT (Initiate, Build, Operate and Transfer); it is a methodology to establish a functional, integrated national telemedicine network and virtual education network; of which we took its phases rationale. The results in this work illustrate the design of DE4HW model, into the first phase of IBOT, enriched with the BMC, which enables us to define actors, their interactions, rules and protocols, in order to build DE4HW, while IBOT strategy manages the project goal, up to the transfer phase, where an integral service platform of healthcare and wellness is turned over to stakeholders.

Generic change indicators in therapeutic processes with different outcomes.

OBJECTIVES: This paper analyzes the relationship between ongoing change and final outcome in therapies carried out in natural settings with 39 clients. METHOD: Ongoing change was assessed through generic change indicators (GCIs), an observational method designed to label the content of change moments by selecting one specific GCI from the sequence of 19 that covers from more rudimentary and low complexity to more elaborated and complex changes. These GCIs can also be grouped into three broad stages of change, according to their level of complexity. Productivity indicators were generated to account for the number of GCIs (total and grouped by stage) adjusted by the length of therapy and the respective individual production of GCIs. Outcome, in turn, is understood as the final result of therapy and was measured by Lambert's Outcome Questionnaire (OQ 45.2). RESULTS: Using the Reliable Change Index of this measure, which qualifies the difference between initial and final scores, therapies were grouped into "good outcome" and "poor outcome" cases. Findings indicate that therapies with good final outcome show a greater presence of Stage III GCIs during the process. Furthermore, in these therapies there is a significant association between Stage I GCI productivity and the productivity of Stages II and III GCIs. This is not the case for poor outcome cases, where results show a greater productivity of initial stage GCIs, mostly in the second half of therapy and no relation of this productivity with Stage II and Stage III GCIs. CONCLUSIONS: Results support the relation of ongoing change and final outcome. Possibilities for the clinical use of GCIs, specifically for monitoring ongoing therapies, are discussed.

Vólvulo gástrico: presentación de un caso / Gastric volvulus: a case report

La torsión o vólvulo gástrico una afección rara, constituye una urgencia quirúrgica que necesita un reconocimiento rápido. Fue descrita por primera vez por Berti en 1866 mientras efectuaba una necropsia. Se trata de un paciente CLRN masculino de 93 años, raza negra, con antecedentes de hipertensión crónica y cardiopatía isquémica, refiriendo que hace 3 días viene presentando dolor abdominal el cual ha ido aumentando en intensidad, acompañado de náuseas, sin vómitos. Se decide intervenir quirúrgicamente de urgencia y se constató en acto quirúrgico un vólvulo gástrico mesenterio-axial sin compromiso vascular, el mismo evoluciona tórpidamente y fallece(AU)

Gastric torsion or volvulus is a rare condition, a surgical emergency that requires fast recognition. It was described at first time by Berti in 1866 while performing a necropsy. This is a male patient, CLRN, 93 years old, black race, a history of hypertension and chronic ischemic heart disease, referring to; three days ago he has been presenting abdominal pain which has been increasing in intensity, accompanied by nausea, without vomiting. It was decided to applied emergency surgery and was found in, one-mesentery axial gastric volvulus without vascular action, his evolution was weak and finally dies