A Structured Pre- and Post-Operative Voice Therapy Program for Benign Vocal Fold Lesions

Benign vocal fold lesions (BVFLs) are acquired structural anomalies of the vocal folds, and these are primarily a result of vocal abuse or phonotrauma. Phonotraumatic lesions are not generally regarded as recurrent, provided that appropriate behavioral changes are made after resolution or surgical removal. Voice therapy plays a crucial role in this aspect. The aim of this article is to propose a structured pre- and post-operative voice therapy program for patients undergoing surgical intervention for BVFLs. Voice therapy post-surgery has been proven to reduce the rate of recurrence in BVFLs. Having a standard treatment protocol is a useful tool for the therapist, particularly one without extensive voice training.

Las lesiones benignas de los pliegues vocales (LBPV) son anomalías estructurales adquiridas de los pliegues vocales, y son principalmente el resultado de un abuso vocal o fonotrauma. Las lesiones fonotraumáticas generalmente no se consideran recurrentes, siempre que se realicen cambios apropiados en el comportamiento después de la resolución o la excisión quirúrgica. La terapia vocal juega un papel crucial en este aspecto. El objetivo de este artículo es proponer un programa estructurado de terapia de voz pre y postoperatorio para pacientes que son expuestos a una intervención quirúrgica para LBPV. Se ha demostrado que la terapia de voz después de la cirugía reduce la tasa de recurrencia en LBPV. Tener un protocolo de tratamiento estándar es una herramienta útil para el terapeuta, particularmente uno sin un entrenamiento extenso en patología de la voz.

Resting energy expenditure changes after antineoplastic treatment in gynecological cancer: a prospective pilot study / Cambios en el gasto energético en reposo tras el tratamiento antineoplásico en cáncer ginecológico: estudio piloto prospectivo

Introduction: energy metabolism in cancer patients is influenced by different factors. However, the effect of antineoplastic treatment is not clear, especially in women. Objective: to evaluate resting energy expenditure (REE) by indirect calorimetry (IC) before (T0) and after (T1) first cycle period of antineoplastic therapy: radiotherapy (RT), chemotherapy (CT), and concomitant chemoradiation therapy (CRT), quality of life (QoL) and accuracy of REE were compared with international guidelines recommendations per kilogram (European Society for Clinical Nutrition and Metabolism [ESPEN]). Methods: an observational, longitudinal study was conducted in women with gynecological cancer diagnosis undergoing antineoplastic treatment: RT, CT and CRT. Weight loss, actual body weight and height were measured. REE was evaluated in T0-T1 and compared with ESPEN recommendations. Kruskal-Wallis test and Bland-Alman analysis were used to determine the agreement (± 10 % of energy predicted) of REE adjusted by physical activity (TEE) compared with ESPEN recommendations, respectively. Results: fifty-four women with cancer were included: 31.5 % (n = 17) for RT group, 31.5 % (n = 17) for CT group and 37 % (n = 20) for CRT group. REE showed statistical differences between T0 and T1 in the total population (p = 0.018), but these were not associated with anticancer therapy groups (p > 0.05). QoL had no significant changes after treatment (p > 0.05). Accuracy of 25 and 30 kcal/kg compared to TEE was less than 30 %. Conclusion: REE in women with gynecological cancer decreased after antineoplastic treatments but this is not associated with a particular antineoplastic therapy. It is needed to develop research to determine the accuracy of ESPEN recommendations with TEE estimated by IC and clinical factors in women with cancer. (AU)

Antecedentes: el metabolismo energético en pacientes con cáncer está influenciado por diferentes factores. Sin embargo, el efecto sobre el tratamiento antineoplásico no es claro, especialmente en mujeres. Objetivo: evaluar el gasto energético en reposo (GER) mediante calorimetría indirecta (CI) antes (T0) y después (T1) del primer ciclo del tratamiento antineoplásico: radioterapia (RT), quimioterapia (QT) y quimio-radioterapia concomitante (QRT), calidad de vida (CdV) y precisión del GER con las con las recomendaciones internacionales por kilogramo de peso (European Society for Clinical Nutrition and Metabolism [ESPEN]). Métodos: se realizó un estudio longitudinal, observacional en mujeres con diagnóstico de cáncer ginecológico en tratamiento antineoplásico. Se evaluó el GER en T0 y T1. Se midieron la pérdida de peso, el peso corporal y la talla. Se usaron las pruebas de Kruskal-Wallis y el análisis Bland-Altman para determinar la concordancia (± 10 % de GER) del REE ajustado por actividad física (TEE) en comparación con las recomendaciones de ESPEN. Resultados: se incluyeron 54 mujeres con cáncer; 31,5 % (n = 17) en el grupo RT, 31,5 % (n = 17) en el de QT y 37 % (n = 20) en el de QRT. GER mostró diferencias estadísticas entre T0 y T1 en la población total (p = 0,018); no se asoció con la terapia contra el cáncer (p > 0,05). La calidad de vida no tuvo cambios significativos después del tratamiento (p > 0,05). La precisión de 25 y 30 kcal/kg en comparación con TEE fue inferior al 30 %. Conclusión: el GER en mujeres con cáncer ginecológico disminuyó después del tratamiento antineoplásico, pero no se asoció a una terapia antineoplásica en particular. Es fundamental desarrollar más investigaciones que compare las recomendaciones de ESPEN y con los valores de la CI comparando más factores clínicos para ofrecer una intervención nutricional precisa (AU)

Resting energy expenditure changes after antineoplastic treatment in gynecological cancer: a prospective pilot study.

Introduction: Introduction: energy metabolism in cancer patients is influenced by different factors. However, the effect of antineoplastic treatment is not clear, especially in women. Objective: to evaluate resting energy expenditure (REE) by indirect calorimetry (IC) before (T0) and after (T1) first cycle period of antineoplastic therapy: radiotherapy (RT), chemotherapy (CT), and concomitant chemoradiation therapy (CRT), quality of life (QoL) and accuracy of REE were compared with international guidelines recommendations per kilogram (European Society for Clinical Nutrition and Metabolism [ESPEN]). Methods: an observational, longitudinal study was conducted in women with gynecological cancer diagnosis undergoing antineoplastic treatment: RT, CT and CRT. Weight loss, actual body weight and height were measured. REE was evaluated in T0-T1 and compared with ESPEN recommendations. Kruskal-Wallis test and Bland-Alman analysis were used to determine the agreement (± 10 % of energy predicted) of REE adjusted by physical activity (TEE) compared with ESPEN recommendations, respectively. Results: fifty-four women with cancer were included: 31.5 % (n = 17) for RT group, 31.5 % (n = 17) for CT group and 37 % (n = 20) for CRT group. REE showed statistical differences between T0 and T1 in the total population (p = 0.018), but these were not associated with anticancer therapy groups (p > 0.05). QoL had no significant changes after treatment (p > 0.05). Accuracy of 25 and 30 kcal/kg compared to TEE was less than 30 %. Conclusion: REE in women with gynecological cancer decreased after antineoplastic treatments but this is not associated with a particular antineoplastic therapy. It is needed to develop research to determine the accuracy of ESPEN recommendations with TEE estimated by IC and clinical factors in women with cancer.

Introducción: Antecedentes: el metabolismo energético en pacientes con cáncer está influenciado por diferentes factores. Sin embargo, el efecto sobre el tratamiento antineoplásico no es claro, especialmente en mujeres. Objetivo: evaluar el gasto energético en reposo (GER) mediante calorimetría indirecta (CI) antes (T0) y después (T1) del primer ciclo del tratamiento antineoplásico: radioterapia (RT), quimioterapia (QT) y quimio-radioterapia concomitante (QRT), calidad de vida (CdV) y precisión del GER con las con las recomendaciones internacionales por kilogramo de peso (European Society for Clinical Nutrition and Metabolism [ESPEN]). Métodos: se realizó un estudio longitudinal, observacional en mujeres con diagnóstico de cáncer ginecológico en tratamiento antineoplásico. Se evaluó el GER en T0 y T1. Se midieron la pérdida de peso, el peso corporal y la talla. Se usaron las pruebas de Kruskal-Wallis y el análisis Bland-Altman para determinar la concordancia (± 10 % de GER) del REE ajustado por actividad física (TEE) en comparación con las recomendaciones de ESPEN. Resultados: se incluyeron 54 mujeres con cáncer; 31,5 % (n = 17) en el grupo RT, 31,5 % (n = 17) en el de QT y 37 % (n = 20) en el de QRT. GER mostró diferencias estadísticas entre T0 y T1 en la población total (p = 0,018); no se asoció con la terapia contra el cáncer (p > 0,05). La calidad de vida no tuvo cambios significativos después del tratamiento (p > 0,05). La precisión de 25 y 30 kcal/kg en comparación con TEE fue inferior al 30 %. Conclusión: el GER en mujeres con cáncer ginecológico disminuyó después del tratamiento antineoplásico, pero no se asoció a una terapia antineoplásica en particular. Es fundamental desarrollar más investigaciones que compare las recomendaciones de ESPEN y con los valores de la CI comparando más factores clínicos para ofrecer una intervención nutricional precisa.

Refugee visa insecurity disrupts the brain's default mode network.

BACKGROUND: Research has largely focused on the psychological consequences of refugee trauma exposure, but refugees living with visa insecurity face an uncertain future that also adversely affects psychological functioning and self-determination. OBJECTIVE: This study aimed to examine how refugee visa insecurity affects the functional brain. METHOD: We measured resting state brain activity via fMRI in 47 refugees with insecure visas (i.e. temporary visa status) and 52 refugees with secure visas (i.e. permanent visa status) residing in Australia, matched on key demographic, trauma exposure and psychopathology. Data analysis comprised independent components analysis to identify active networks and dynamic functional causal modelling tested visa security group differences in network connectivity. RESULTS: We found that visa insecurity specifically affected sub-systems within the default mode network (DMN) - an intrinsic network subserving self-referential processes and mental simulations about the future. The insecure visa group showed less spectral power in the low frequency band in the anterior ventromedial DMN, and reduced activity in the posterior frontal DMN, compared to the secure visa group. Using functional dynamic causal modelling, we observed positive coupling between the anterior and posterior midline DMN hubs in the secure visa group, while the insecure visa group displayed negative coupling that correlated with self-reported fear of future deportation. CONCLUSIONS: Living with visa-related uncertainty appears to undermine synchrony between anterior-posterior midline components of the DMN responsible for governing the construction of the self and making mental representations of the future. This could represent a neural signature of refugee visa insecurity, which is marked by a perception of living in limbo and a truncated sense of the future.

Refugee visa insecurity disrupts default mode network (DMN) connectivity ­ a core network that supports the internal construction of the self.Refugees living with insecure visa status showed decreased connectivity in the DMN and more negative coupling between midline anterior­posterior hubs of the DMN, compared to refugees living with secure visas.Diminished DMN connectivity may represent a neural basis for the psychological effects of refugee visa insecurity, which is associated with prolonged uncertainty regarding the future self and increased risk for psychological distress.

Resting-state functional nuclear magnetic resonance imaging in patients with bipolar disorder: Beyond euthymia.

INTRODUCTION: Functional nuclear magnetic resonance imaging in the resting state (R-fMRI) allows the identification of complete functional connectivity networks and the possible neuronal correlations of psychiatric disorders. The literature on R-fMRI and bipolar disorder (BD) will be reviewed, emphasising the findings in the phases of mania, hypomania and depression. METHODS: It is a narrative review of the literature in which articles were searched in PubMed and Embase, with the key words in English "bipolar disorder" AND "resting state", without limit on the date of publication. RESULTS: The studies of BD patients in the mania and hypomania phases who underwent R-fMRI show concordant results in terms of decreased functional cerebral connectivity between the amygdala and some cortical regions, which indicates that this functional connection would have some implication in the normal affect regulation. Patients in the depressive phase show a decrease in functional brain connectivity, but as there are several anatomical structures involved and neural networks reported in the studies, it is not possible to compare them. CONCLUSIONS: There is a decrease in functional connectivity in patients with BD, but current evidence does not allow establishing specific changes in specific functional brain connectivity networks. However, there are already some findings that show correlation with the patients' symptoms.

Resonancia magnética nuclear funcional en estado de reposo en pacientes con trastorno bipolar: más allá de la eutimia / Resting-state functional nuclear magnetic resonance imaging in patients with bipolar disorder: beyond euthymia

Resumen Introducción: La resonancia magnética funcional en estado de reposo (RMf-ER) permite identificar redes de conectividad funcional completas y los posibles correlatos neuronales de trastornos psiquiátricos. Se revisa la literatura sobre RMf-ER y trastorno bipolar (TB) haciendo énfasis en los hallazgos en las fases de manía, hipomanía y depresión. Métodos: Es una revisión narrativa de la literatura en la que se buscaron artículos en PubMed y EMBASE con las palabras clave en inglés "bipolar disorder" AND "resting state", sin límite en la fecha de publicación. Resultados: Los estudios de pacientes con TB en fases de manía e hipomanía sometidos a RMf-ER muestran resultados concordantes en cuanto a la disminución de la conectividad funcional cerebral entre la amígdala y algunas regiones corticales, lo cual indica que esta conexión funcional tendría alguna implicación en la regulación normal del afecto. Los pacientes en fase depresiva muestran disminución en la conectividad funcional cerebral, pero como son varias las estructuras anatómicas implicadas y las redes neuronales reportadas en los estudios, no es posible compararlos. Conclusiones: Hay disminución en la conectividad funcional en los pacientes con TB, pero la evidencia actual no permite establecer cambios específicos en redes de conectividad funcional cerebral puntuales. Sin embargo, ya hay algunos hallazgos que muestran correlación con la clínica de los pacientes.

ABSTRACT Introduction: imaging in the resting state (R-fMRI) Functional nuclear magnetic allows the identification of complete functional connectivity networks and the possible resonance neuronal correlations of psychiatric disorders. The literature on R-fMRI and bipolar disorder (BD) will be reviewed, emphasising the findings in the phases of mania, hypomania and depression. Methods: It is a narrative review of the literature in which articles were searched in PubMed and Embase, with the key words in English "bipolar disorder" AND "resting state", without limit on the date of publication. Results: The studies of BD patients in the mania and hypomania phases who underwent R-fMRI show concordant results in terms of decreased functional cerebral connectivity between the amygdala and some cortical regions, which indicates that this functional connection would have some implication in the normal affect regulation. Patients in the depressive phase show a decrease in functional brain connectivity, but as there are seve-ral anatomical structures involved and neural networks reported in the studies, it is not possible to compare them. Conclusions: There is a decrease in functional connectivity in patients with BD, but current evidence does not allow establishing specific changes in specific functional brain connectivity networks. However, there are already some findings that show correlation with the patients' symptoms.

Physical therapy protocols to attenuate skeletal muscle atrophy in critically ill patients: narrative review / Protocolos de terapia física para atenuar la atrofia del músculo esquelético en pacientes críticos: revisión narrativa

SUMMARY: To describe the physical therapy protocols used in critically ill patients to attenuate skeletal muscle atrophy. We conducted a search in PubMed and Embase from inception to November 2020. Observational or experimental studies published in English or Spanish that evaluated the effect of physical therapy protocols on the attenuation of skeletal muscle atrophy in critically ill patients through muscle strength or mass measurement were considered eligible. Studies were only included if they reported a detailed description of the dosing of the interventions. Seventeen studies met the eligibility criteria. We included randomised clinical trials (n = 16) and observational studies (n = 1). The total population of the included studies was 872 critically ill patients. The studies aimed to evaluate the reliability, safety or effectiveness of neuromuscular electrical stimulation (n = 10) protocols, early mobilisation (n = 3), ergometer training (n = 2), transfers in tilt table (n = 1), and blood flow restriction (n = 1). Physical therapy protocols are part of the critically ill patient's integral management. Strategies such as passive mobilisation, in-bed and out-of-bed transfers, gait training, ergometer training, and neuromuscular electrical stimulation substantially impact critically ill patients' prognoses and quality of life after hospital discharge.

RESUMEN: Describir los protocolos de terapia física usados en pacientes críticos para atenuar la atrofia muscular esquelética. Realizamos una búsqueda en PubMed y Embase desde el inicio hasta noviembre de 2020. Se consideraron los estudios observacionales o experimentales publicados en inglés o español que evaluaron el efecto de los protocolos de terapia física en la atenuación de la atrofia del músculo esquelético en pacientes críticos a través de la medición de la fuerza o la masa muscular. Los estudios solo se incluyeron si informaron una descripción detallada de la dosificación de las intervenciones. Diecisiete estudios cumplieron los criterios de elegibilidad. Se incluyeron ensayos clínicos aleatorizados (n = 16) y estudios observacionales (n = 1). La población total de los estudios incluidos fue de 872 pacientes en estado crítico. Los estudios tuvieron como objetivo evaluar la confiabilidad, seguridad o efectividad de los protocolos de estimulación eléctrica neuromuscular (n = 10), movilización temprana (n = 3), entrenamiento con ergómetro (n = 2), transferencias en mesa basculante (n = 1) y restricción del flujo sanguíneo (n = 1). Los protocolos de terapia física forman parte del manejo integral del paciente crítico. Es- trategias como la movilización pasiva, los traslados dentro y fuera de la cama, el entrenamiento de la marcha, el entrenamiento con ergómetro y la estimulación eléctrica neuromuscular tienen un impacto sustancial en el pronóstico y la calidad de vida de los pacientes críticos después del alta hospitalaria.

Nutrición en pancreatitis aguda: nuevos conceptos para un viejo problema / Nutrition in acute pancreatitis: new concepts for an old problem

Resumen El manejo de la nutrición en pancreatitis aguda ha sido cuestión de debate. Durante muchos años el concepto de reposo pancreático fue generalizado y aceptado en el manejo de la pancreatitis aguda. Actualmente se conoce que la nutrición temprana permite mantener la integridad de la barrera intestinal, que previene la aparición de complicaciones infeccionas y se asocia con una menor estancia hospitalaria, menos complicaciones y un mejor pronóstico. En esta revisión se discuten las principales ventajas de la nutrición temprana en pancreatitis aguda, la seguridad de la misma y la vía de administración.

Abstract Nutrition management in acute pancreatitis has been a matter of debate worldwide. For many years, the concept of pancreatic rest was widespread and accepted to treat acute pancreatitis. However, current knowledge of early nutrition allows maintaining the intestinal barrier's integrity, preventing the occurrence of infectious complications, which is associated with a shorter hospital stay, fewer complications, and better prognosis. This review presents the main advantages of early nutrition in acute pancreatitis, its safety, and the route of administration.

Efecto de las experiencias adversas durante la niñez sobre la actividad Electroencefalográfica en reposo: una revisión sistemática / Effect of adverse childhood experiences on resting Electroencephalography: a systematic review

Resumen El progresivo interés en estudiar los efectos negativos en la fisiología y estructura cerebral producto de las experiencias adversas durante la niñez (EAN) ha propiciado el análisis de registros psicofisiológicos por medio de la electroencefalografía (EEG) en estados de reposo. Por tanto, el objetivo de este estudio permitió realizar una revisión sistemática basada en la metodología PRISMA para identificar las investigaciones adelantadas en los últimos 30 años. Para ello se utilizaron cuatro bases de datos: Scopus, PubMed, EBSCO y Redalyc; y dos listas de términos referentes a los tipos de EAN prevalentes en Colombia y al EEG en reposo. Inicialmente, se encontraron 21 556 artículos que contaron con los términos de búsqueda; se excluyeron 21 545 estudios que no cumplían con los criterios, y, finalmente, se seleccionaron 11 artículos de texto completo. Los resultados sugieren que la actividad de las bandas alfa α frontales derechas predicen mayor respuesta emocional a estímulos negativos, y mayor probabilidad de presentar problemas afectivos; contrario a la actividad electroencefalográfica en estas mismas bandas en regiones frontales izquierdas. Se espera que este estudio promueva investigaciones relacionadas con el análisis de perfiles electroencefalográficos y favorezca el avance de procesos terapéuticos más precisos y eficaces en la intervención del trauma.

Abstract The progressive interest in studying the negative effects on brain physiology and structure produced by Adverse Experiences during Childhood (AE), has led to the analysis of psychophysiological records by means of Electroencephalography (EEG) in resting states. Therefore, the objective of this study allowed a systematic review based on the PRISMA methodology to identify the research carried out in the last 30 years. Four databases were used for this purpose: Scopus, PubMed, EBSCO and Redalyc; and two lists of terms referring to the types of EANs prevalent in Colombia and to the EEG at rest. Initially 21,556 articles were found that had the search terms, 21,545 studies were excluded that did not meet the criteria, and finally 11 full text articles were selected. Results suggest that right frontal alpha band activity α predicts greater emotional response to negative stimuli, and greater likelihood of presenting affective problems; contrary to electroencephalographic activity in these same bands in left frontal regions. It is expected that this study will promote research related to the analysis of electroencephalographic profiles and will favour the advancement of more precise and effective therapeutic processes in trauma intervention.

Estabilidad de la actividad eléctrica no lineal durante condiciones basales con los ojos cerrados / Nonlinear electrical activity stability in basal, eyes closed conditions

Introducción: El electroencefalograma permite registrar la actividad eléctrica cerebral en estado de reposo y durante la ejecución de tareas cognitivas. Objetivo: Evaluar si la actividad cerebral, analizada como dinámica no lineal, se mantiene estable durante diferentes ventanas temporales en una condición basal con ojos cerrados. Métodos: Se realizaron registros con electroencefalograma durante dos minutos a 14 estudiantes universitarios varones. Posteriormente, se compararon las medias de índices de Hurst (H) en ventanas temporales de 60, 30 y 10 segundos. Resultados: Las medias de los índices H son estables a través de diferentes ventanas temporales en las regiones prefrontales, temporales y occipitales. Conclusiones: Los registros de electroencefalograma en condiciones basales con los ojos cerrados son válidos para comparar protocolos experimentales de resolución de problemas cognitivos utilizando el exponente de Hurst en los sujetos de la muestra y en otros con características similares(AU)

Introduction: Electroencephalography makes it possible to record brain electrical activity at rest and during the performance of cognitive tasks. Objective: Determine whether brain activity analyzed as nonlinear dynamics remains stable during various time windows in basal, eyes closed conditions. Methods: Electroencephalographic records of 14 male university students were taken during two minutes. Hurst's index means (H) were then compared in time windows of 60, 30 and 10 seconds. Results: H index means are stable throughout the various time windows in the prefrontal, temporal and occipital regions. Conclusions: Electroencephalographic records in basal, eyes closed conditions are valid to compare experimental protocols for cognitive problem solving using the Hurst exponent in subjects from the sample as well as others of similar characteristics(AU)

Establecimiento de una línea de base entomológica de malaria en la parroquia San Isidro del municipio Sifontes del estado Bolívar, Venezuela / Establishment of an entomological malaria baseline in the San Isidro parish of the Sifontes municipality of Bolívar state, Venezuela

La malaria en Venezuela es altamente heterogénea y focalizada. En 2016 se reportaron más de 242 mil casos nuevos en el país, de los cuales 73% provenían del estado Bolívar, 42% del municipio Sifontes y 29% de la parroquia San Isidro. Entre octubre 2016 y mayo 2017 se realizó en la parroquia San Isidro un estudio exploratorio, con el fin de establecer una línea basal entomológica en malaria que permitiera la evaluación posterior de Rociamientos Intradomiciliarios de Insecticida y Mosquiteros Tratados con insecticida de Larga Duracion.Las capturas de mosquitos adultos con Trampas Mosquito Magnet Independence™, atrayente humano y en reposo pre-hematofágico, permitieron determinar que en esta parroquia, hay por lo menos tres especies de anofelinos con actividad hematofágica antropofílica, An. darlingi, An. albitarsis s.l. y An. nuneztovari s.l., cuyos hábitos de reposo y actividad de picada fueron descritos. Asimismo, el muestreo de hábitats larvales permitió determinar que las lagunas residuales de la actividad minera son los más importantes y que An. albitarsis s.l. y An. triannulatus s.l. son las especies de mayor prevalencia en estos hábitats. Estos hallazgos permiten actualizar la data entomológica de este foco caliente de malaria y sientan las bases para la evaluación y seguimiento de las medidas de control de vectores implementadas(AU)

Malaria in Venezuela is highly heterogeneous and focused. In 2016, more than 242,000 malaria cases were reported in the country, from which 73% came from Bolivar state, 42% from Sifontes municipality and 29% from the San Isidro parish. Between October 2016 and May 2017, an exploratory study was carried out in order to establishing an entomologic baseline that would allow posterior evaluations of indoors insecticide spraying and long lasting insecticidal nets. Adults captures with Mosquito Magnet Independence™ traps, human landing, and pre-feedingresting habits allowed to determine that in San Isidro there are at least three anopheline species with significant anthropophilic activity: An darlingi, An. albitarsis s.l. and An. nuneztovari s.l. Resting habits and biting activities were described for the three species. Likewise, larval sampling were carried out which allowed to identify that abandoned gold mine dugouts are the most important habitatsfor these species. Particularly, An. albitarsis s.l. and An. triannulatus s.l. were the most prevalent anophelines colonizing these breeding sites. Our results update entomologic data of this malaria hot spot area and establish the baseline for further evaluations ofthe vector control measures implemented(AU)

Aspectos históricos de la clinoterapia / Historical aspects of clinotherapy

Resumen La clinoterapia o "reposo en la cama" fue introducida como tratamiento para dolencias mentales en 1852, con el propósito de inhibir la "conciencia de movimiento" y la excitación periférica y, así, posibilitar un "reposo psíquico". En un primer momento la clinoterapia, junto con otras medidas como el open door y el non restraint, significó una alternativa a las celdas de reclusión, las camisas de fuerza y otros métodos restrictivos. Sin embargo, a la postre se vio reducida al simple aislamiento en una habitación, muchas veces en condiciones muy poco apropiadas.

Summary Clinotherapy or "bed rest" was first introduced as a treatment for mental illness in 1852, with the aim of inhibit the "consciousness of movement" and peripheral excitation, in order to make it possible a "psychological rest". At the beginning, clinotherapy, along with open door and non-restraint principles, meant an alternative to seclusion rooms, straitjackets and other restrictive practices. However, over time it became a simple seclusion in a room, many times in inappropriate conditions.

Serial prolactin sampling as a confirmatory test for true hyperprolactinemia.

INTRODUCTION: Hyperprolactinemia may be due to physiological or pathological causes, and may be asymptomatic or induce hypogonadism, infertility, and/or galactorrhea. It is important to take prolactin samples while avoiding stress, as this may increase prolactin levels. Therefore, our aim was to assess the value of prolactin serial sampling after brachial vein cannulation. PATIENTS AND METHODS: Sixty-six patients (34.9±11.8 years of age, 92.4% female) with an initial elevated random prolactin level were included. A prolactin sample was drawn at baseline and after a 30min rest. RESULTS: The median referral prolactin level was 37.4ng/ml (interquartile range [IQR* 23.3), the baseline prolactin level at serial sampling was 19.5ng/ml (IQR 8), and the value after a 30min rest was 17.1ng/ml (IQR 7.9). Hyperprolactinemia was not confirmed by serial sampling in 45 patients (68.2%). There were no statistically significant differences in referral prolactin levels between patients with and without confirmed hyperprolactinemia (41.2ng/ml and 36.7ng/ml respectively, p=0.3). Galactorrhea was found in 13.6% of patients, amenorrhea or oligomenorrhea in 28.8%, infertility in 7.6%, erectile dysfunction in 4.6%, and gynecomastia in 3%, while 45.5% were asymptomatic. There were no statistical differences regarding the presence or absence of any of these symptoms and subsequent confirmed hyperprolactinemia. Fifty-seven patients (86.4%) were discharged after the results of the prolactin serial sampling were obtained. CONCLUSIONS: Prolactin serial sampling may be a useful test to detect artefactual hyperprolactinemias, thus avoiding unnecessary additional tests and treatments.

Resting-state functional nuclear magnetic resonance imaging in patients with bipolar disorder: beyond euthymia. / Resonancia magnética nuclear funcional en estado de reposo en pacientes con trastorno bipolar: más allá de la eutimia.

INTRODUCTION: Functional nuclear magnetic resonance imaging in the resting state (R-fMRI) allows the identification of complete functional connectivity networks and the possible neuronal correlations of psychiatric disorders. The literature on R-fMRI and bipolar disorder (BD) will be reviewed, emphasising the findings in the phases of mania, hypomania and depression. METHODS: It is a narrative review of the literature in which articles were searched in PubMed and Embase, with the key words in English "bipolar disorder" AND "resting state", without limit on the date of publication. RESULTS: The studies of BD patients in the mania and hypomania phases who underwent R-fMRI show concordant results in terms of decreased functional cerebral connectivity between the amygdala and some cortical regions, which indicates that this functional connection would have some implication in the normal affect regulation. Patients in the depressive phase show a decrease in functional brain connectivity, but as there are several anatomical structures involved and neural networks reported in the studies, it is not possible to compare them. CONCLUSIONS: There is a decrease in functional connectivity in patients with BD, but current evidence does not allow establishing specific changes in specific functional brain connectivity networks. However, there are already some findings that show correlation with the patients' symptoms.

Intravascular ultrasound or optical coherence tomography-defined anatomic severity and hemodynamic severity assessed by coronary physiologic indices.

INTRODUCTION AND OBJECTIVES: Fractional flow reserve or instantaneous wave-free ratio has become a standard criterion for revascularization. We sought to evaluate the association between intravascular ultrasound (IVUS) or optical coherence tomography (OCT)-derived quantitative plaque characteristics and the severity of physiologic stenosis. METHODS: A total of 365 stenoses from 330 patients were evaluated. The association between IVUS or OCT-derived parameters and resting physiologic indices (instantaneous wave-free ratio, resting full-cycle ratio, and diastolic pressure ratio) and fractional flow reserve were explored. RESULTS: Among the total number of lesions, 50.7% and 58.1% showed an instantaneous wave-free ratio ≤ 0.89 and fractional flow reserve ≤ 0.80, respectively. IVUS or OCT-derived parameters showed significant correlations with resting physiologic indices (P values <.005). The best cutoff values of IVUS minimum lumen area (MLA), plaque burden, OCT-MLA, and OCT-area stenosis to predict functional significance were the same (IVUS-MLA: 3.4 mm2, plaque burden: 72.0%, OCT-MLA: 2.0 mm2, OCT-area stenosis: 68.0%) for all resting physiologic indices (instantaneous wave-free ratio, resting full-cycle ratio, and diastolic pressure ratio). The best cutoff values for fractional flow reserve were an IVUS-MLA of 3.8 mm2, plaque burden of 70.0%, OCT-MLA of 2.3 mm2, and OCT-area stenosis of 65.0%. Regardless of IVUS or OCT-derived parameters, the overall diagnostic accuracies of the parameters were lower than 70% and discrimination indices were less than 0.75 for resting physiologic indices or fractional flow reserve. CONCLUSIONS: The resting physiologic indices showed an identical relationship with IVUS or OCT-defined quantitative plaque characteristics. The diagnostic accuracy and discrimination ability of anatomical parameters were modest in predicting functional significance defined by resting and hyperemic invasive physiologic indices. This trial is registered at ClinicalTrials.gov (Identifier: NCT03795714).

Morphology of the interstitial tissue of active and resting testis of the Guinea fowl / Morfología del tejido intersticial del testículo activo y en reposo de la gallina de Guinea

SUMMARY: The morphology of the interstitial tissue of sexually active and resting testis of the guinea fowl were studied. Six adult health birds of active and resting phases of reproductive cycle were used for this study. The interstitial tissue consisted of loose connective tissue, interstitial cells (Leydig cells), few connective cells, blood vessels and adrenergic nerve fibres in the present study in both active and resting testes. The interstitial tissue was compact in sexually active testis whereas, the volume of the tissue was found to be increased in resting testis. The loose connective tissue of the interstitial tissue composed of mainly of collagen fibres and few reticular fibres whereas elastic fibres were absent in both groups studied. The interstitial cells appeared in clusters of a few cells and were relatively less in the active testis than the resting testis. The interstitial cells were pale staining or polygonal cells with euchromatic nuclei with few large lipid droplets in the active testis whereas the cells were flat and highly heterochromatic with numerous small lipid droplets in resting testis. Few macrophages were found only in resting testis. Interstitial cells showed negative reaction to alkaline, acid phosphatases and PAS in both groups studied but positive for lipids. The interstitial tissue was well vascularised with centrally located blood vessels in the active testis whereas the blood vessels were small and inconspicuous in the resting testis. The lymphatic vessels were not identified in both groups studied.

RESUMEN: Se estudió la morfología del tejido conectivo intersticial en testículos sexualmente activos y en reposo de la gallina de Guinea (Numida meleagris). Se utilizaron seis gallinas de Guinea machos adultos sanos, en fase activa y de reposo del ciclo reproductivo. El tejido conectivo intersticial estaba formado por tejido conectivo laxo, células endocrinas intersticiales, pocas células conectivas, vasos sanguíneos y fibras nerviosas adrenérgicas, tanto en testículos activos como en reposo. El espacio intertubular en los testículos sexualmente activos era menor en comparación a los del testículos en reposo. El tejido conectivo laxo estaba compuesto principalmente de fibras colágenas y en menor cantidad de fibras reticulares. Las fibras elásticas estaban ausentes en ambos grupos. Las células endocrinas intersticiales se organizaban en racimos de pocas células y se observaban con menor frecuencia en los testículos sexualmente activos. Las células endocrinas intersticiales de los testículos activos presentaban forma poligonal, citoplasma levemente eosinofílico con algunas gotas lipídicas de gran tamaño en su interior y nucleos redondos con cromatina laxa. Las células intersticiales de los testículos en reposo eran planas y altamente heterocromáticas, con numerosas gotas lipídicas pequeñas en su citoplasma. Las células intersticiales mostraron una reacción negativa a las fosfatasas ácidas, alcalinas y PAS en ambos grupos, Sin embargo presentaron reacción positivas para los lípidos. El tejido conectivo intersticial estaba bien vascularizado con vasos sanguíneos situados centralmente en el testículo activo y vasos sanguíneos pequeños y discretos en el testículo en reposo. Los vasos linfáticos no fueron identificados en los dos grupos estudiados.Los macrófagos fueron observados solo en los testículos en reposo, aunque en escasa cantidad.

Efectos del reposo prolongado en adultos mayores hospitalizados / Effects of prolonged rest in hospitalized older adults

Introducción: El reposo prolongado en cama y la disminución de la actividad física en los adultos mayores representan un factor predisponente al desarrollo o al agravamiento de ciertas condiciones patológicas relacionadas en mayor medida con los sistemas cardiovascular, respiratorio y musculoesquelético, en donde hasta el 33% de los adultos mayores hospitalizados presentarán deterioro funcional en al menos una de las actividades de la vida diaria y se incrementa a acerca del 50% cuando superan los 80 años de edad. Objetivo: Describir los principales efectos del reposo en cama sobre los principales sistemas que pudiesen generar un decline funcional en el adulto mayor hospitalizado. Metodología: Se realizó una revisión bibliográfica en las bases de datos Pubmed, Scielo y Pedro. Resultados: La información obtenida se organizó de acuerdo a los sistemas corporales principalmente involucrados en el reposo prolongado. Se encontró que la falta de movilidad en adultos mayores provoca un desacondicionamiento físico, además de un agravamiento de la enfermedad que lo llevo a la residencias hospitalarias conllevando a un aumento de los días de hospitalización. Conclusiones: el reposo en cama puede ser minimizado tanto como sea posible y puede ser prescrita una recuperación ambulatoria y actividad física para limitar los efectos de desacondicionamiento del reposo en cama.

Introduction: Prolonged bed rest and decreased physical activity in the elderly represent a predisposing factor to the development or worsening of certain pathological conditions most closely related to the cardiovascular, respiratory and musculoskeletal systems. Functional impairment in less than the activities of daily living and increase by about 50% when they are over 80 years of age. Objective: To describe the main effects of bed rest on the main systems that could generate a functional decrease in the elderly hospitalized. Methodology: A bibliographic review was performed in Pubmed, Scielo and Pedro databases. Results: The information obtained was organized according to the body systems mainly involved in prolonged rest. It was found that the lack of mobility in older adults causes a physical deconditioning, in addition to an aggravation of the disease that leads to hospital residences with an increase in the days of hospitalization. Conclusions: bed rest can be minimized as much as possible and may prescribe an outpatient recovery and physical activity to limit the effects of deconditioning of bed rest.

Pain locations in the postoperative period after cardiac surgery: Chronology of pain and response to treatment. / Localizaciones del dolor en el postoperatorio de cirugía cardiaca: cronología del dolor y respuesta al tratamiento.

INTRODUCTION: Postoperative pain after cardiac surgery (CS) can be generated at several foci besides the sternotomy. METHODS: Prospective descriptive longitudinal study on the chronological evolution of pain in 11 sites after CS including consecutive patients submitted to elective CS through sternotomy. The primary endpoints were to establish the main origins of pain, and to describe its chronological evolution during the first postoperative week. Secondary endpoints were to describe pain characteristics in the sternotomy area and to correlate pain intensity with other variables. Numerical Pain Rating Scale from 0 to 10 at rest and at movement on postoperative days 1, 2, 4 and 6. Numerical Pain Rating Scale>3 was considered moderate pain. Statistical analysis consisted in Mann-Whitney U-test, a Chi-squared, a Fisher exact text and Pearson's correlations. RESULTS: Forty-seven patients were enrolled. In 4 of 11 locations pain was reported as Numerical Pain Rating Scale>3 (sternotomy, oropharynx, saphenectomy and musculoskeletal pain in the back and shoulders). Maximum intensity of pain on postoperative days 1 and 2 was reported in the sternotomy area, while on postoperative days 4 and 6 it was reported at the saphenectomy. Pain at rest and at movement differed considerably in the sternotomy, saphenectomy and oropharynx. Pain at back and shoulders and at central venous catheter entry were not influenced by movement. Pain in the sternotomy was mainly described as oppressive. Patients with arthrosis and younger patients presented higher intensity of pain (P=.004; P=.049, respectively). CONCLUSIONS: Four locations were identified as the main sources of pain after CS: sternotomy, oropharynx, saphenectomy, and back and shoulders. Pain in different focuses presented differences in chronologic evolution and was differently influenced by movement.

Espera, esperança e sonho: deixar a terra descansar / Expectation, hope, and dream: on lying fallow / Espera, esperanza y sueño: dejar a la tierra descansar

A importância da arte de esperar é uma das contribuições mais significativas de Winnicott para a clínica psicanalítica. Em trabalho anterior, propus que a capacidade de esperar implica a crença de que o objeto será encontrado; assim, a espera só é possível quando há esperança. Ora, a espera-esperança é também condição essencial para a capacidade de sonhar. O ato antissocial é um grito de socorro, e ele é, portanto, um sinal de esperança; em alguns casos, porém, quando a esperança se quebra, caímos no campo do “colapso do sonhar”. Em “On lying fallow”, M. Khan abordou com precisão e sensibilidade o lugar primordial do esperar e do silêncio na clínica psicanalítica e na vida em geral. Esse é o tema que retomarei aqui.

The art of expecting is one of Winnicott's most significant contributions to psychoanalytic practice. In a previous work, I proposed that the ability to expect implies to believe that the object will be found. Hence, expectation is only possible when there is hope. Well, the expectation-hope is also an essential condition for the ability to dream. The antisocial act is a cry for help and therefore a sign of hope. Nevertheless, when hope is broken we find ourselves in the field of the “dream breakdown (or collapse)”. In the work “On lying fallow”, M. Khan showed a sensitive and precise approach to the primary (or primordial) place of expectation and silence in the psychoanalytic practice and life in general. I hereby return to this theme.

La importancia del arte de esperar es una de las contribuciones más significativas de Winnicott a la clínica psicoanalítica. En un trabajo anterior, propuse que la capacidad de esperar implica la creencia de que el objeto será encontrado; así, la espera sólo es posible cuando hay esperanza. Ahora, la espera-esperanza es también esencial para la capacidad de soñar. El acto antisocial es un grito de ayuda, y es, por tanto, un signo de esperanza; en algunos casos, sin embargo, cuando la esperanza se rompe, se cae en el “colapso del soñar”. En “On lying fallow”, M. Khan trató con precisión y sensibilidad del rol fundamental del esperar y del silencio en la práctica psicoanalítica y en la vida en general. Este es el tema que abordaré aquí.