Evaluation of a Web-Based Training Model for Family Peer Advocates in Children's Mental Health.

OBJECTIVE: The aim of this study was to compare knowledge gains from a new online training program with gains from an existing in-person training program for family peer advocates. METHODS: Data were used from a pre-post study of individuals who enrolled in the Web-based Parent Empowerment Program training; 144 participants completed the training and pre-post tests, and 140 were admitted to the analyses. Knowledge was assessed with 34 questions, 29 of which were common to the online and in-person trainings. Pre-post knowledge scores were available from the in-person training. RESULTS: Statistically significant gains in knowledge were found with both the 34 questions and the 29 questions common to both trainings. Knowledge gains across the two training models did not differ. CONCLUSIONS: Data on knowledge gains from this accessible, affordable online model show promise for training the growing and important workforce of family peer advocates.

Disseminating clinical and fiscal practices across the New York State behavioral healthcare system.

In order to facilitate the adoption of innovative practices in the mental health service system, providers require access to both new information and methodologies, and ongoing training, supervision and consultation. Technical Assistance centers have been proposed as a way to disseminate effective interventions through the provision of resources including information, ongoing training and consultation. The purpose of this study is to describe the New York State Technical Assistance Center's reach across the child public mental health service system and variations in characteristics of training activities, including dosage, content and method of format. Between 2011 and 2015, 460 (92.6%) of all New York State mental health clinics attended a training. The most highly attended events focused on business practices, followed by evidence-based treatments and clinic practices, and trauma-informed care. All were delivered via a webinar format, and were less than one day in duration. The behavioral health service system must be equipped to adapt to changing clinical and business practices in order to provide quality care and remain fiscally viable. New York State's TA center reached the majority of child mental health service providers across the state. Next steps are to closely examine the impact of TA supports upon adoption and sustained use of practices. Implications of these findings and additional future directions are presented.

An Assessment of The New York State Behavioral Health System's Readiness to Transition to Medicaid Managed Care.

New York State has one of the most richly funded Medicaid programs in the United States. In an effort to achieve the triple aim New York State is undergoing a significant redesign of its Medicaid program including transitioning nearly all Medicaid funded behavioral health services into Medicaid managed care. In preparation for this transition, a state funded technical assistance center assessed the behavioral health care system's readiness to undergo this reform across 11 domains. Between September and November, 2014, the TA center electronically distributed a readiness survey to 897 mental health and substance abuse agencies: 313 (n = 269, 33%) organizations completed the assessment. As a whole, the sample felt partially ready to transition; analysis by domain revealed agencies were most ready to interface with managed care providers, and least ready to collect and evaluate outcome data. Significant differences in readiness were found depending by organizational characteristics (number of programs, licensure, and region). In anticipation of large-scale reforms, states would benefit from an initial needs assessment to identify gaps in knowledge and skills, which in turn, can then guide preparatory efforts and provide needed supports to facilitate major changes in service delivery and billing.

Características clínicas y diagnósticas de tuberculosis meníngea en adultos, Bogotá (Colombia) / Clinical and diagnostic characteristics of meningeal tuberculosis in adults, Bogota (Colombia)

Introducción: La infección por Mycobacterium tuberculosis es una enfermedad con presencia mundial, cuya principal manifestación clínica es pulmonar; la tuberculosis meníngea es la segunda presentación extrapulmonar más frecuente después de la pleural y ocasiona alta morbimortalidad, pero un diagnóstico y tratamiento tempranos disminuyen estos desenlaces. Objetivo: Establecer las características clínicas de pacientes con tuberculosis meníngea en nuestras instituciones y la evaluación de los resultados obtenidos con los métodos diagnósticos disponibles. Materiales y métodos: Se realizó un estudio observacional descriptivo de corte transversal, mediante revisión de historias clínicas de pacientes con tuberculosis meníngea en el periodo 2003-2012, en dos instituciones de tercer y cuarto nivel de atención en Bogotá. Resultados: Se evaluaron 36 pacientes con tuberculosis meníngea, con edad media de 52,4 años, 63,8% sexo masculino y 16,6% coinfección con virus de inmunodeficiencia humana. La presentación clínica subaguda y crónica fue de 49,9%; 86,1% tuvieron cefalea; otros síntomas fueron: fiebre, rigidez nucal. En líquido cefalorraquídeo, todos tuvieron hiperproteinorraquia y 88,8% hipoglucorraquia. En estudios microbiológicos 71,8% tuvieron adenosin deaminasa positiva, 30,4% reacción en cadena de polimerasa positiva y 41,1% cultivo positivo. La hiponatremia fue de 36,1%. En neuroimágenes 18,7% presentaron hidrocefalia y 17,6% paquimeningitis. Conclusión: La tuberculosis meníngea representa hoy un reto diagnóstico, ya que no existe un método disponible con las características ideales de una prueba diagnóstica, debiendo considerarse las manifestaciones clínicas de meningitis subaguda o crónica y los hallazgos en líquido cefalorraquídeo primordiales para el diagnóstico e inicio temprano del tratamiento.

Introduction: Infection with Mycobacterium Tuberculosis is a worldwide disease whose main clinical manifestation is pulmonary, meningeal tuberculosis is the second most common extra-pulmonary presentation after pleural represents a high morbidity and mortality, early diagnosis and treatment reduces these outcomes. Objective: The aim of the study was to establish the clinical characteristics of patients with meningeal tuberculosis in our institutions and evaluation of the results obtained with the diagnostic methods available. Materials and methods:A descriptive cross-sectional study was conducted by reviewing the medical records of patients with meningeal tuberculosis; in the period between 2003-2012, two institutions third and fourth level of care in Bogotá. Results: 36 patients with meningeal tuberculosis, with a mean age of 52.4 years, 63.8% male, 16.6% coinfection with human immunodeficiency virus were evaluated. The subacute and chronic clinical presentation was 49.9%, 86.1% had headache, other symptoms were fever, neck rigidity, among others. In cerebrospinal fluid protein levels were 100%, 88.8% hypoglycorrhachia. 71.8% in microbiological studies were positive adenosine deaminase, 30.4% positive chain reaction polymerase and 41.1% positive culture. Hyponatremia was 36.1%. In neuroimaging, 18.7% and 17.6% had hydrocephalus Pachymeningitis. Conclusion: The meningeal tuberculosis today represents a diagnostic challenge because there is no method available with the ideal characteristics of a diagnostic test, having considered the clinical manifestations of subacute or chronic meningitis and cerebrospinal fluid findings in primary for diagnosis and initiation early treatment.

Chemical composition of the essential oil from the leaves of Carapa guianensis collected from Venezuelan Guayana and the antimicrobial activity of the oil and crude extracts.

The essential oil obtained by hydrodistillation of Carapa guianensis Aubl. (Meliaceae) leaves was analyzed by GC-FID and GC-MS. Twenty-three components were identified, which made up 93.7% of the oil. The most abundant constituents were bicyclogermacrene (28.5%), alpha-humulene (17.2%), germacrene B (11.9%), and trans-beta-caryophyllene (9.9%). Antimicrobial activity of the essential oil, as well as the crude extracts of the leaves obtained by refluxing the dried leaves with n-hexane, dichloromethane, and methanol, was determined using the disc diffusion assay. Activity against Staphylococcus aureus ATCC 29923 and Enterococcus faecalis ATCC 29212 was only found for the essential oil and the methanolic extract, at minimal inhibitory concentrations (MIC) of 400 microg/mL and 50 microg/mL.

Pentoxifylline decreases serum levels of tumor necrosis factor alpha, interleukin 6 and C-reactive protein in hemodialysis patients: results of a randomized double-blind, controlled clinical trial.

AIM: The aim of this study was to compare the effect of pentoxifylline versus placebo on serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6) and C-reactive protein (CRP) of hemodialysis (HD) patients. METHODS: This is a randomized double-blind, controlled clinical trial. HD patients without infection or drugs with anti-inflammatory effect were randomly allocated to a study (n = 18, pentoxifylline 400 mg/day) or control (n = 18, placebo) group; all patients had arteriovenous fistula. Besides clinical and laboratory monthly assessments, serum TNF-α and IL-6 (ELISA) and CRP (nephelometry) were measured at 0, 2 and 4 months. RESULTS: All the inflammation markers significantly (P < 0.05) decreased in the pentoxifylline group: TNF-α [baseline 0.4 (0-2) versus final 0 (0-0) pg/mL], IL-6 [baseline 9.4 (5-14) versus final 2.9 (2-5) pg/mL] and CRP [baseline 7.1 (3-20) versus final 2.6 (1-8) mg/L], whereas no significant changes were observed in the placebo group: TNF-α [baseline 0 (0-0) versus final 1.2 (0-4) pg/mL], IL-6 [baseline 8.0 (5-11) versus final 8.7 (4-11) pg/mL] and CRP [baseline 4.5 (2-9) versus final 3.8 (3-23) mg/L]. CONCLUSIONS: Pentoxifylline significantly decreased serum concentrations of TNF-α, IL-6 and CRP compared to placebo. Pentoxifylline could be a promising and useful strategy to reduce the systemic inflammation frequently observed in patients on HD.

Meningitis en paciente VIH negativo / HIV Negative Patient with Meningitis

Hombre de 54 años, agricultor, con cuadro agudo de cefalea global progresiva en intensidad, emesis, limitación física, asociado con un episodio de movimientos clónicos focales y alteración de la esfera mental. Antecedentes de consumo de alcohol ocasional y exposición a Eucalyptus globulus. Los hallazgos en el examen físico y laboratorio fueron: Paciente en regular estado general, alerta, signos meníngeos positivos, fuerza y reflejos conservados, sin déficit en pares craneanos. Hemograma con leucocitosis, neutrofilia y linfopenia, niveles de inmunoglobulinas normales, linfocitos CD4 disminuidos, relación CD4/CD8 normal, Elisa para VIH negativo; LCR con presión de apertura elevada, coloración de Gram negativa, leucorraquia con 54% de linfocitos, hipoglucorraquia, hiperproteinorraquia; Rx tórax y TAC cerebral normales.

Meníngitis en paciente VIH negativo / Negative Hiv Patient with Meningitis

Hombre de 54 años quien consulta por cuadro clínico de una semana de evolución de cefalea global progresiva en intensidad, asociada a emesis en varias ocasiones y limitación para actividades de la vida diaria, presentando tres días previos al ingreso movimientos clónicos en miembro inferior derecho de diez segundos de duración, sin compromiso del estado de conciencia, con alteración de la esfera mental.

A 54-year-old man consulted for a clinical picture of one week of evolution of progressive global headache in intensity, associated with emesis on several occasions and limitation of activities of daily living, presenting three days prior to admission with clonic movements in the right lower limb of ten seconds duration, without compromising the state of consciousness, with alteration of the mental sphere.

Epilepsia y menopausia / Epilepsy and menopause

Objetivo: describir el comportamiento de las crisis epilépticas en una población de mujeres menopaúsicas. Metodología: se realizó un estudio observacional descriptivo tipo serie de casos en que se incluyeron mujeres mayores de 45 años en un periodo de cuatro meses, que asistían a un servicio de neurología. Se obtuvieron datos relacionados con el tipo de crisis (Kyoto), tipo de epilepsia (Hamburgo), fecha de última regla para establecer el momento de la menopausia, antecedente de crisis catameniales, medicación recibida e información correspondiente a imágenes de TAC y/o RMN y EEG. Resultados: en nuestra serie de casos encontramos que el promedio de edad para inicio de la menopausia fue igual para quienes tenían la epilepsia antes de la misma (50,2 años) como para quienes la epilepsia tuvo un inicio posterior (49,8 años). Conclusiones: la literatura médica refiere que la menopausia se presenta en las mujeres con epilepsia a una edad más temprana que en las mujeres de la población general. Nuestro datos no confirmaron esa hipótesis

Enfermedad de hallervorden-spatz: manifestaciones clínico-radiológicas

Se presenta el caso de una paciente de 18 años con diagnóstico de enfermedad de Hallervorden-Spatz cuya sintomatología neurológica progrsiva con movimientos anormales en miembros inferiores y superiores, disartria y deterioro mental se inicio desde la edad de 4 años. El examen de resonancia magnética que demuestra depósitos de hiero anormales en los globos pálidos y en la sustancia nigra confirma la impresión clínica de la enfermedad