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Malnutrition is associated with a high risk of morbidity and mortality in patients with critical illness. The nutrition status of patients in the intensive care unit (ICU) is challenging to assess. The Global Leadership Initiative on Malnutrition (GLIM) is a novel framework used for the diagnosis of malnutrition. However, its efficacy in patients with critical illness in the ICU has not been validated.To investigate the use and validity of the GLIM criteria in adult patients admitted to the ICU.A systematic review and meta-analysis were performed, and seven databases were searched for relevant studies. The selection criteria included studies that used the GLIM in adult patients admitted to the ICU. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.Five studies were included in the analysis. Approximately 15%-68% of patients were diagnosed with malnutrition using the GLIM criteria. Meanwhile, 48%-75% of patients with malnutrition were identified with the Subjective Global Assessment (SGA). The inflammation criterion was easily adjudicated due to critical status, and three studies compared the GLIM and the SGA. According to the QUADAS-2 tool, the nutritional assessment process was not explicit in the studies. The meta-analysis had an overall sensitivity of 65.3% (95% CI: 34.9%-86.9%) and an overall specificity of 88.8% (95% CI: 58.1%-97.8%). In the prospective validation, malnutrition assessed by the GLIM criteria, and the SGA was associated with mortality. However, the association between length of hospital stay and mechanical ventilation was unclear.The use and validity of the GLIM criteria among patients admitted to the ICU is still limited. Moreover, some concurrent and predictive validation studies have methodological limitations. Further studies must be performed to validate the use of the GLIM criteria in the ICU.

This research has been partially supported by the Spanish Ministry of Science and Innovation through the grant PID2019-110742RB-I00.

Introduction: Medical schools are responsible for breaking bad news training, which should be focused on the students; therefore, the purpose of this study is to identify undergraduate medical students’ perceptions regarding the best way to train them. Methods: Cross-sectional anonymous survey applied between 438 >18-years-old Colombian medicine students. Results: The students feel unprepared to breaking bad news; even without formal training, they believe they are better at breaking bad news as they advance in their training due to their observation of other clinicians and their personal experiences. A higher proportion of male students consider themselves empathetic than female students, but advanced male students report more frequently that their empathic capacity has decreased throughout their career more frequently than female students of the same academic level. Discussion: This information will allow the medical school to modify the curriculum to offer proper training to its students. Conclusion: Very few students have received formal training regarding this topic, and most of them are interested in training. Resumen: Introducción: Las escuelas de Medicina son las responsables del entrenamiento en dar malas noticias, el cual ha de estar enfocado en los estudiantes, por lo que el propósito de este estudio es identificar sus percepciones acerca de la mejor forma para entrenarles. Métodos: Estudio trasversal anónimo entre 438 estudiantes >18 años de un programa colombiano de Medicina. Resultados: Los estudiantes no se sienten preparados para dar malas noticias. Aun sin entrenamiento formal, ellos creen que su capacidad para dar malas noticias mejora a medida que avanza su entrenamiento médico. Hay una mayor proporción de estudiantes varones que mujeres que se consideran empáticos, pero también ellos reconocen con más frecuencia que ellas que su capacidad empática disminuye con el avance de sus estudios. Discusión: La información recolectada puede permitir a las escuelas de Medicina modificar su currículo para ofrecer entrenamiento más adecuado a sus estudiantes en dar malas noticias. Conclusión: Muy pocos estudiantes han recibido capacitación formal sobre este tema y la mayoría de ellos están interesados ??en capacitarse.

espanolLas comunidades de practica son modelos que enlazan la ensenanza clinica con el aprendizaje en el sitio de trabajo; esto facilita la construccion de la identidad profesional de los estudiantes, optimiza la atencion al paciente y genera oportunidades de aprendizaje para los miembros de la comunidad hospitalaria; fomentan el cambio de modelos educativos en los que el aprendizaje memoristico es reemplazado por experiencias de aprendizaje basadas en la construccion colectiva de saberes y en la coparticipacion de los miembros de la comunidad hospitalaria, con lo que se puede impulsar una practica profesional mas segura para los pacientes. Se presentan los fundamentos pedagogicos que permiten comprender la participacion que los estudiantes asumen dentro de una comunidad de practica clinica y se plantean reflexiones para que el quehacer docente de los profesores clinicos cambie a modelos innovadores que produzcan mayor impacto en el aprendizaje y que los transforme en verdaderos educadores en las profesiones de la salud. EnglishCommunities of practice are models that link clinical teaching to learning in the workplace; This facilitates the construction of the professional identity of the students, optimizes patient care and generates learning opportunities for members of the hospital community; They promote the change of educational models in which rote learning is replaced by learning experiences based on the collective construction of knowledge and the co-participation of members of the hospital community, thus promoting safer professional practice for patients. patients. The pedagogical foundations that allow understanding the participation that students assume within a community of clinical practice are presented and reflections are made so that the teaching tasks of clinical teachers change to innovative models that have a greater impact on learning and transform them into true educators in the health professions.

Objective To design and validate a scale to evaluate the quality of life in children and adolescents with epilepsy. Methods Scale validation, multicentered, three-phase study. We did a literature review for the construction of the instrument, and a validation of appearance, construct, criterion, and reproducibility. We evaluated the scale among the patients that consulted at the Liga Central contra la Epilepsia and the Fundacion Hospital de La Misericordia (Bogota, Colombia) between 2014 and 2015. Results The resulting questionnaire has 4 domains, with 18–26 items according to age groups (0−3, 4−10 and 11−17 years old) and a Likert scale score from 1 to 5. The comparison with CAVE and QOLIE AD 48 was adequate (Pearson correlation coefficient between 0.713 and 0.837 according to age groups: intraclass correlation coefficient between 0.664 and 0.817.) Internal consistency was adequate (Cronbach’s alpha between 0.791 and 0.809). Test-retest assessment was good, with Spearman’s coefficient between 0.99 and 1.00. The time to fill out the scale ranged between 3.5 and 6.8 min. Significance We designed and validated a quality-of-life scale in Spanish for children and adolescents with epilepsy, which is easy and quick to fill and has excellent reliability and validity parameters.

Metabolic syndrome (MetS) is a public health problem and a risk of developing cardiometabolic and neurodegenerative diseases. The biochemical-inflammatory impairment in brain areas related to learning and memory has not been differentiated between MetS models. We aimed to compare the effect of the MetS generated by consuming high-fat (HFD) or -carbohydrate diets (HCD) on the hippocampus and frontal cortex, related to astrocyte-neuron metabolism and neuroinflammation origin. Sixty male Wistar rats were separated into three groups: 1) control group, 2) HCD group, and 3) HFD group. After 3 months, we evaluated zoometry, a serum bioclinical profile, and in the hippocampus and frontal cortex, we performed biochemical assays (concentration of lactate, glutamate, fatty acids, and ASAT, ALAT, and LDH activity), immunoreactivity tests (GFAP, COX2, CD36, and BDNF), and immunoassays (TNF-α, IL-1β, IL-6, and PGE2). The bioclinical parameters showed that both diets induce MetS. At the brain level, it is noteworthy that the HCD group had an increase in lactate and glutamate concentration, reactive astrogliosis, immunoreactive COX2 neurons in the CA1 subfield hippocampus and frontal cortex, and high levels of PGE2, TNF-α, IL-1β, and IL-6, and low BDNF immunoreactivity. Meanwhile, the HFD is highlighted by increased fatty acid levels and CD36 expression in the hippocampus and frontal cortex, strong reactive astrogliosis and COX2 immunoreactivity, and the greatest inflammation with the lowest BDNF immunoreactivity. In conclusion, MetS induction by an HFD or HCD generates different biochemical, cellular, and inflammatory patterns in the hippocampus and frontal cortex.

Aging induces cognitive decline, reduces of synaptic plasticity and increases oxidative reactive species (ROS) in the central nervous system. Traditional medicine has long benefitted from naturally occurring molecules such as curcumin (diferuloymethane). Curcumin is extracted from the plant Curcuma longa and is known for its synaptic and antioxidant-related benefits. In this study, we tested the hypothesis that chronic curcumin treatment reduces cognitive and cellular effects of aging. Curcumin-treated mice showed improved learning and memory using the Morris Water Maze and novel object recognition task. In addition, using the Golgi-Cox stain, curcumin treatment increased spine density in all evaluated regions and increased dendritic arborization in the prefrontal cortex (PFC) layer 3 and CA3 subregion of the hippocampus. Moreover, chronic curcumin exposure increased synaptophysin and actin expression and reduced glial fibrillary acidic protein expression, a marker of astrocytes, in the hippocampus (CA1 and CA3 subregions), while simultaneously reducing the ROS-related molecule, metallothionein 3 expression in the PFC and hippocampus. Collectively, these novel findings suggest that curcumin reduces cognitive, neuronal and astrocytic signs of aging in mice.

Background: In October of 2015, an epidemic of Zika began in Colombia's geographic areas with a high population of mosquitoes of the genus Aedes. Our aim was to describe the outcome of fetuses of symptomatic pregnant women who were tested with RT-PCR for ZIKV according to trimester of infection. Methods: Symptomatic women were tested with RT-PCR for ZIKV and followed prospectively by obstetricians and high-risk maternal-fetal medicine specialists, using detailed anatomic ultrasound and neurosonography to detect fetal structural anomalies of the central nervous system (CNS) according to trimester of infection. Findings: 115 symptomatic women with a positive RT-PCR and 56 with a negative RT-PCR were enrolled in the study; CNS compromise of the fetus occurred in 24% and 20%, respectively (p=0.398). When symptomatic ZIKV positive women were categorized by trimester of infection, CNS anomalies were present in 38% of first-trimester infections, compared to 21% and 10% in second and third-trimester infections (p=0.012). Including all trimesters, neuronal migration disorders were the most frequent anomaly of the CNS (15%), followed by microcephaly (13%). Interpretation: Prevalence of CNS anomalies were similar between symptomatic RT-PCR ZIKV positive and negative pregnant women suggesting a high rate of false-negative results with RT-PCR. First-trimester infections were more frequent and severe compared to second and third-trimester infections in exposed fetuses. The prevalence of CNS anomalies was higher than previously reported in the literature, possibly due to fetal-ultrasound assessments' quality and expertise. Migrational disorders were the most frequently observed anomaly of the CNS, followed by microcephaly. Funding: Grants from the Universidad Industrial de Santander (UIS), and the Epidemiology Research Center at UIS, supported this study. Conflict of Interest: We declare no competing interests. Ethical Approval: The Committee on Ethics and Research from the Universidad Industrial de Santander and participating centers approved the study. All pregnant women signed informed consent for participation in this study.

X-ray crystallography is an experimental technique used in material analysis that allows to measure the atomic positions of the elements present in a crystal. This technique is based on the X-ray diffraction patterns that provide electronic and elastic properties of the crystal of interest. Thus, the crystal can be uniquely identified by means of the phase of its diffraction patterns that are also used to analyze the material of interest. The phase of the X-ray cannot be directly measured; however, it can be recovered from the intensity of diffraction patterns. A recent work has shown that the phase signal can be recovered more efficiently when the acquisition architecture includes an optical element, known as coded aperture, such that the underlying signal is recovered from coded diffraction patterns. A coded aperture is an element that modulates the X-ray diffraction patterns by blocking some X-ray beams. The structure and the number of coded projections are crucial inasmuch they determine the quality and the acquisition time of the X-ray signal. This paper presents the analysis of a coded X-ray Crystallography system, and the design of the spatial structure of the coded aperture, such that the images are recovered with high PSNR (Peak Signal to Noise Ratio) using the minimum number of coded projections. The simulations indicate that the designed coded apertures obtain a reduction of up to 50% in the number of coded projections and an increase in the PSNR of up to 2 dB when the results are compared with the reconstructed images by using random non-designed coded aperture structures. All simulations were carried out on a set of diffraction pattern images, obtained by using the SAXS/WAXS X-ray crystallography software to simulated the diffraction patterns of a real crystal structure, called Rhombic Dodecahedron.

Aggregation of the amyloid beta (Aβ) peptide and hyperphosphorylation of tau protein, which are markers of Alzheimer's disease (AD), have been reported also in diabetes mellitus (DM). One regulator of tau phosphorylation is O-GlcNAcylation, whereas for hyperphosphorylation it could be GSK3beta, which is activated in hyperglycemic conditions. With this in mind, both O-GlcNAcylation and phosphorylation of tau protein were evaluated in the brain of rats with streptozotocin (STZ)-induced hyperglycemia and hyperinsulinemia and treated with the As25-35 peptide in the hippocampal region CA1. Weight, glycated hemoglobin, glucose, and insulin were determined. Male Wistar rats were divided in groups (N=20): a) control, b) treated only with the Aβ25-35 peptide, c) treated with Aβ25-35 and STZ, and d) treated only with STZ. Results showed statistically significant differences in the mean weight, glucose levels, insulin concentration, and HbA1c percentage, between C- and D-treated groups and not STZ-treated A and B (P

Amphetamines (AMPH) are psychostimulants widely used for therapy as well as for recreational purposes. Previous results of our group showed that AMPH exposure in pregnant rats induces physiological and behavioral changes in the offspring at prepubertal and postpubertal ages. In addition, several reports have shown that AMPH are capable of modifying the morphology of neurons in some regions of the limbic system. These modifications can cause some psychiatric conditions. However, it is still unclear if there are changes to behavioral and morphological levels when low doses of AMPH are administered at a juvenile age. The aim of this study was to assess the effect of AMPH administration (1mg/kg) in Sprague-Dawley rats (postnatal day, PD21-PD35) on locomotor activity in a novel environment and compare the neuronal morphology of limbic system areas at three different ages: prepubertal (PD 36), pubertal (PD50) and postpubertal (PD 62). We found that AMPH altered locomotor activity in the prepubertal group, but did not have an effect on the other two age groups. The Golgi-Cox staining method was used to describe the neural morphology of five limbic regions: (Layers 3 and 5) the medial prefrontal cortex (mPFC), the dorsal and ventral hippocampus, the nucleus accumbens and the amygdala, showing that AMPH induced changes at pubertal ages in arborization and spine density of these neurons, but interestingly these changes did not persist at postpubertal ages. Our findings suggest that even early-life AMPH exposure does not induce long-term behavioral and morphological changes, however it causes alterations at pubertal ages in the limbic system networks, a stage of life strongly associated with the development of substance abuse behaviors.

Alzheimer's disease (AD) is a neurodegenerative disorder caused by the aggregation of the amyloid-beta peptide (Aβ) in senile plaques and cerebral vasculature. The Aβ25-35 fraction has shown the most toxicity; its neurotoxic mechanisms are associated with the generation of oxidative stress and reactive astrogliosis that induce neuronal death and memory impairment. Studies indicate that pharmacological treatment with flavonoids reduces the rate of AD, in particular, it has been shown that antioxidants are compounds that could interact with this peptide due to their antioxidant proprieties. In this study, experimental and computational tools were used to calculate the molecular electrostatic potential and the Fukui function with the Gaussian 09 computational program, to predict the most reactive parts of these molecules and make the complex between Aβ25-35 and two flavonoids (catechin and epicatechin) in the absolute gas-phase, where a possible interaction between them was observed. This is important for understanding the Aβ25-35-Flavonoid (A-F) interaction as a therapeutic strategy to inhibit the neurotoxic effects that this peptide causes in AD, which currently is still considered an ambiguous process.

Resumen Introduccion Los farmacos anticolinergicos reducen la eficacia de los inhibidores de la acetilcolinesterasa (IACE) y se consideran inapropiados en pacientes de edad avanzada. El objetivo fue conocer la prevalencia de prescripcion concomitante de IACE y anticolinergicos en un Area de Salud, identificar pacientes afectados e informar a los medicos responsables para que valorasen la idoneidad de los tratamientos. Material y metodos Estudio descriptivo transversal y observacional de prevalencia. Se selecciono a pacientes en tratamiento con IACE y algun farmaco anticolinergico en el primer trimestre de 2015. Para la identificacion de anticolinergicos, se utilizo como referencia la revision de Duran et al., asignando una puntuacion a cada farmaco en funcion de su potencia anticolinergica. Se proporciono a cada medico una nota informativa sobre la interaccion, relacion de pacientes afectados y recomendaciones. Resultados Se incluyo a 486 pacientes, lo que supone el 59,0% sobre el total de pacientes con enfermedad de Alzheimer del area. El 66,0% eran mujeres, el 86,8% mayores de 75 anos, con una media de 9,2 farmacos/paciente. El numero medio de farmacos anticolinergicos fue 1,6; el 38,3% de los pacientes tenian prescritos varios farmacos anticolinergicos y el 23,9% algun farmaco de alta potencia anticolinergica. Se encontro asociacion estadisticamente significativa entre tomar IACE y anticolinergicos de forma concomitante (p = 0,000; OR: 3,9). Conclusiones La prevalencia de interaccion entre IACE y anticolinergicos es relevante, considerando que ademas afecta a poblacion vulnerable. Proporcionar a los medicos informacion sobre la interaccion podria ayudar a la toma de decisiones clinicas, mejorar la seguridad y los resultados en salud de los pacientes.

ResumenIntroducciónLa presencia de tronco arterioso representa únicamente del 1,2% al 3% de las cardiopatías congénitas complejas, y de no ser corregida, menos del 20% sobreviven después del año de vida. Si la enfermedad progresa usualmente desarrollan hipertensión arterial pulmonar severa y pueden manifestarse incluso como un síndrome de Eisenmenger. Se presenta un caso de un escolar con diagnóstico de tronco arterioso tipo i no corregido e hipertensión arterial pulmonar severa llevado a cirugía no cardiaca.Presentación del casoEscolar de 9 años de edad con cardiopatía compleja y presión arterial pulmonar similar a la presión arterial sistémica, sometido a cirugía ortopédica electiva bajo anestesia regional con bloqueo de plexo lumbar y bloqueo ciático posterior. Esta técnica anestésica nos proporcionó una adecuada anestesia con estabilidad hemodinámica sin repercusión en las resistencias vasculares.ConclusiónLa elección de la técnica anestésica debe ser planeada en función de la fisiopatología cardiovascular del tronco arterioso, del grado de hipertensión pulmonar y del procedimiento quirúrgico a realizarse. Los pacientes con hipertensión pulmonar severa tienen mayor riesgo de manifestar presiones pulmonares suprasistémicas con compromiso hemodinámico importante, por lo que la técnica anestésica elegida será aquella que produzca una adecuada anestesia y menor repercusión hemodinámica. Es importante considerar, de ser posible, el bloqueo de los nervios periféricos como primera elección en cirugía ortopédica.AbstractIntroductionThe presence of truncus arteriosus represents just 1.2 to 3% of all complex congenital heart pathologies and if not corrected, less than 20% survive beyond one year of life. When the disease progresses patients usually develop severe pulmonary hypertension and may even develop into Eisenmenger's syndrome. The paper discusses a case of a schoolboy with a diagnosis of uncorrected truncus arteriosus type I, and severe pulmonary arterial hypertension undergoing non-cardiac surgery.Case discussionThis is a 9-year old schoolboy with complex heart disease and similar pulmonary and systemic blood pressures, undergoing elective orthopedic surgery under regional anesthesia, with lumbar plexus block and posterior sciatic block. This anesthetic approach provided adequate anesthesia with hemodynamic stability and no impact on vascular resistance.ConclusionThe choice of the anesthetic technique should be a planned decision based on the cardiovascular pathophysiology of the truncus arteriosus, the level of pulmonary hypertension, and the surgical procedure to be performed. Patients with severe pulmonary hypertension are at increased risk of developing suprasystemic pulmonary pressures with considerable hemodynamic involvement. Consequently, the anesthetic technique chosen shall provide adequate anesthesia and ensure the least hemodynamic impact. Whenever possible, it is important to consider the peripheral nerve block as the first line approach for orthopedic surgery.

Schizophrenia, a severe and debilitating disorder with a high social burden, affects 1% of the adult world population. Available therapies are unable to treat all the symptoms, and result in strong side effects. For this reason, numerous animal models have been generated to elucidate the pathophysiology of this disorder. All these models present neuronal remodeling and abnormalities in spine stability. It is well known that the complexity in dendritic arborization determines the number of receptive synaptic contacts. Also the loss of dendritic spines and arbor stability are strongly associated with schizophrenia. This review evaluates changes in spine density and dendritic arborization in animal models of schizophrenia. By understanding these changes, pharmacological treatments can be designed to target specific neural systems to attenuate neuronal remodeling and associated behavioral deficits.

Since the 1970s, the biological role of vanadium compounds has been discussed as insulin-mimetic or insulin-enhancer agents. The action of vanadium compounds has been investigated to determine how they influence the insulin signaling pathway. Khan and coworkers proposed key proteins for the insulin pathway study, introducing the concept "critical nodes". In this review, we also considered critical kinases and phosphatases that participate in this pathway, which will permit a better comprehension of a critical node, where vanadium can act: a) insulin receptor, insulin receptor substrates, and protein tyrosine phosphatases; b) phosphatidylinositol 3'-kinase, 3-phosphoinositide-dependent protein kinase and mammalian target of rapamycin complex, protein kinase B, and phosphatase and tensin homolog; and c) insulin receptor substrates and mitogen-activated protein kinases, each node having specific negative modulators. Additionally, leptin signaling was considered because together with insulin, it modulates glucose and lipid homeostasis. Even in recent literature, the possibility of vanadium acting against metabolic diseases or cancer is confirmed although the mechanisms of action are not well understood because these critical nodes have not been systematically investigated. Through this review, we establish that vanadium compounds mainly act as phosphatase inhibitors and hypothesize on their capacity to affect kinases, which are critical to other hormones that also act on common parts of the insulin pathway.

The aged brain has biochemical and morphological alterations in the dendrites of the pyramidal neurons of the limbic system, which consequently trigger motor and cognitive deficits. Bexarotene 4-[1-(3,5,5,8,8-pentamethyl-6,7-dihydronaphthalen-2-yl)ethenyl]benzoic acid is a selective agonist of X-retinoid receptors which acts by binding to the intracellular retinoic acid receptors (RAR). It decreases oxidative and inflammatory activity, in addition to the transport of lipids, mechanisms that together could have a neuroprotective effect. Our objective was to evaluate the effect of bexarotene on the motor and cognitive processes, as well as its influence on the dendritic morphology of neurons in the limbic system of elderly mice. Dendritic morphology was evaluated with the Golgi-Cox staining procedure followed by the Sholl analysis. Bexarotene was administered at different doses: 0.0; 0.5; 2.5 and 5.0 mg/kg for 60 days in 18-month-old mice. After the treatment, locomotor activity in a novel environment and spatial memory in the water labyrinth were evaluated. Mice treated with bexarotene did not show significant changes in their behavior. Moreover, bexarotene-treated mice only showed a significant increase in the density of the dendritic spines and the dendritic length in the nucleus accumbens (NAcc) neurons. In conclusion, the administration of bexarotene improves the plasticity of the NAcc of aged mice, and therefore could be a pharmacological alternative to prevent or delay neuroplasticity disruptions in brain aging.

Resumen Objetivos Estimar la prevalencia del trastorno obsesivo compulsivo (TOC) en ninos y adolescentes escolarizados y determinar los factores sociodemograficos asociados. Metodo Se desarrollo un estudio transversal con una muestra de 501 ninos y ninas de 10 a 17 anos de colegios de Bucaramanga. Se tomaron los datos sociodemograficos y se les realizo la entrevista clinica estructurada para los trastornos del eje I del DSM-IV, version clinica. Se examinaron los factores sociodemograficos con un analisis bivariado. Se realizo analisis estratificado y una regresion logistica no condicional, tomando el trabajo por dinero como una variable explicatoria de riesgo para el desarrollo de TOC. Resultados La prevalencia del TOC fue de 7,4% (IC 95%: 5,3–10,0). Los estudiantes con TOC presentan una prevalencia de trabajo por dinero mayor que en los que no tienen (OR: 2,23; IC 95%: 1,0–4,4). Al controlar variables confusoras, las ninas que trabajaban por dinero mostraron un mayor riesgo en la presencia de TOC (OR: 5,4; IC 95%: 1,7–17,4). Conclusion El estudio sugiere que la prevalencia del TOC en ninos escolarizados de Bucaramanga es alta. La doble condicion de trabajar y estudiar en las ninas podria ser un factor de riesgo asociado con TOC

Objective: To explore the prevalence of common mental disorders and their association with health-related behaviors in Colombian women. Method: A cross-sectional study was carried out with a multi-stage probability sample of women from the general population. Common mental disorders were explored with the General Health Questionnaire (GHQ-12) with a cut-off point of eleven or more. Non conditional logistic regression was computed to adjust associated variables. Results: A total of 1,740 women participated in this research. The mean age of participants was 38.3 years (SD=13.3), mean years of education were 8.8 years (SD=3.9), 59.5% were married, 37.0% were employed, 1.4% reported abusive alcohol consumption, 6.3% daily cigarette smoking, 44.5% daily coffee intake, 17.5% a medical condition, and 15.7% (95% CI 14.0-17.4) scored for a common mental disorder. Abusive alcohol consumption (OR=6.4, 95% CI 2.7-15.2), daily cigarette smoking (OR=3.3, 95% CI 2.1-5.0), medical condition (OR=2.0, 95% CI 1.4-2.8), and daily coffee intake (OR=1.3, 95% CI 1.0-1.8) were associated with common mental disorders, adjusted for age and education. Conclusions: Common mental disorders are frequent in Colombian women. Health risk behaviors and stressful events are strongly related to common mental disorders. It is necessary to identify and treat these mental disorders early on to reduce health risk behaviors in women.

Sialic acid in glycoconjugates participates in important cellular functions associated with normal development, growth, and communication. Therefore we evaluated the sialylation pattern and memory deficits caused by the injection of Aβ((25-35)) into the hippocampus (Hp) of rats. The eight-arm maze spatial-learning and memory test indicated that the injection of Aβ((25-35)) into subfield CA1 of the Hp impaired both learning and memory. The sialylation pattern was examined using sialic acid-specific lectins. Our results showed that Maackia amurensis agglutinin (MAA, specific for Neu5Acα2,3Gal) showed reactivity in the CA1 and dentate gyrus (DG) subfields of the Hp mainly in the group injected with vehicle, whereas Macrobrachium rosenbergii lectin (MRL, specific for Neu5,9,7Ac) and Sambucus nigra agglutinin (SNA, specific for Neu5Acα2,6Gal-GalNAc) had increased reactivity in the CA1 and DG subfields of the Hp in the Aβ((25-35))-injected group. The staining pattern of the antibody specific for polysialic acid (a linear homopolymer of α-2,8-linked sialic acid) increased in the CA1 and DG subfields of the Hp of the Aβ((25-35)) group compared to the control group. Our results suggest that injection of Aβ((25-35)) causes impairment in spatial memory and alters the sialylation pattern in response to compensatory reorganization and-or sprouting of dendrites and axons of the surviving neurons.

The Aβ(25-35) fraction mimics the toxic effects of the complete peptide Aβ(1-42) because this decapeptide is able to cause memory impairment and neurodegenerative events. Recent evidence has shown that the injection of Aβ(25-35) into the temporal cortex (TCx) of the rat increases the nitric oxide (NO) pathways with several consequences, such as neuronal loss in rats. Our aim was to investigate the effects of each NOS isoform by the prior injection of NOS inhibitors before the injection of the Aβ(25-35). One month after the treatment, the animals were tested for their spatial memory in the radial maze. The hippocampus (Hp) and TCx were assessed for NO production, nitration of proteins (3-NT), astrocytosis (GFAP), and neuronal loss. Our findings show a significant impairment in the memory caused by Aβ25-35 injection. In contrast NOS inhibitors plus Aβ25-35 cause a protection yielding a high performance in the memory test and reduction of cell damage in the TCx and the Hp. Particularly, iNOS is the major source of NO and related to the inflammatory response leading to the memory deficits. The inhibition of iNOS is an important target for neuronal protection against the toxicity of the Aβ25-35 over the long term.

ResumenObjetivoEvaluar la relación entre la lactancia materna (LM) y el desarrollo de enfermedades alérgicas (EA).DiseñoEstudio de casos y controles.EmplazamientoHospital Universitario de Santander, Bucaramanga, Colombia, América del Sur. Nivel II de atención.ParticipantesMil cuatrocientos sesenta niños entre 3 y 7 años asistentes a la consulta externa. Las mediciones principales fueron la proporción de LM y LM exclusiva (LME), la asociación entre la presencia de enfermedades alérgicas y la LM y la LME ajustando, mediante regresión logística, la confusión dada por otras exposiciones.ResultadosDe 1.460 pacientes, recibieron LME el 41,6% (intervalo de confianza [IC] del 95%: 39,0 a 44,2), mientras que al 44,4% (IC del 95%: 41,9 a 47,0) se les suministró LM no exclusiva. Entre quienes presentaron alergia, el 34,8% (IC del 95%: 32,4 a 37,3) refería rinitis, el 27,8% (IC del 95%: 25,6 a 30,2) refería asma y el 11,6% (IC del 95%: 10,0 a 13,4) refería dermatitis atópica; el 7,0% (IC del 95%: 5,1 a 9,3) presentaba las 3 condiciones. El lactar de manera exclusiva por 3 o más meses es factor protector para las EA (odds ratio [OR] de 0,70; IC del 95%: 0,48 a 1,03). El lactar menos de 3 meses, independientemente de si es de manera exclusiva o no, es factor de riesgo para las EA (OR de 2,05; IC del 95%: 1,47 a 2,86).ConclusionesLa recomendación de lactar exclusivamente el mayor tiempo posible sigue siendo válida al encontrarse un significativo impacto preventivo del tiempo de duración de la LM en el desarrollo de las EA. Es necesario realizar estudios prospectivos que incluyan pruebas de función pulmonar y análisis inmunológicos para confirmar estos hallazgos.AbstractObjectiveTo evaluate the relationship between breastfeeding and the development of allergic diseases (AD).DesignA cases-controls study.SettingSantander University Hospital, Bucaramanga, Colombia, South America. Level II health care.ParticipantsA total of 1460 boys and girls between 3 and 7 years old attending an outpatient clinic.Main measurementsPartial (BF) and exclusive breastfeeding (EBF); relationship between the presence of allergic diseases and BF and EBF, adjusting for the confounding factors due to other exposures using logistic regression.ResultsOut of a total of 1460 patients, 41.6% (95%CI 39.0–44.2) received EBF, while 44.4% (95%CI 41.9–47.0) were partially breastfed. Among those who had an allergy, 34.8% (95%CI 32.4–37.3) had rhinitis, 27.8% (95%CI 25.6–30.2) asthma and 11.6% (95%CI 10.0–13.4) atopic dermatitis; 7.0% (95%CI 5.1–9.3) had the three conditions. To breastfeed exclusively for ⩾3 months is a protective factor for AD (OR 0.70, 95%CI 0.48–1.03). Breastfeeding for 3 months, regardless of whether or not it is exclusive, is a risk factor for AD (OR 2.05, 95%CI 1.47–2.86).ConclusionsThe recommendation to exclusively breastfeed for as long as possible continues to be valid, as there was a significant preventive impact on the development of AD with the length of time breastfed. Prospective studies including lung function tests and immunological analyses need to be performed to confirm these findings.

Amyloid-beta is involved in neurodegeneration in Alzheimer's disease. The Amyloid-beta fraction 25-35 (Amyloid-beta 25-35) is believed to cause neurotoxicity through oxidative stress. We evaluated the antioxidant effects of Epicatechin on the Abeta25-35-caused hippocampal toxicity in vivo. Biochemical and histological evaluations, and learning and memory tasks, were assessed. Amyloid-beta 25-35 (100 microM/microL) or vehicle was injected into the CA1 hippocampal region of the rat 5 h after a single oral dose of Epicatechin (30 mg/kg). Lipid peroxidation and reactive oxygen species formation were measured in Amyloid-beta- and Amyloid-beta-Epicatechin-treated groups at 2 h and 24 h after dosing and formation of the lesion. There was an increase in lipid peroxidation and reactive oxygen species formation at 2-h and 24-h postlesion. Learning and memory tests were made 27-30 days after surgery in independent groups under the same experimental conditions. Immunohistochemical detection of glial-fibrilar acidic protein (GFAP) was evaluated in hippocampal tissues from the animals 30-days postsurgery. Amyloid-beta 25-35 caused a significant increase in lipid peroxidation and reactive oxygen species and a decrease in memory skills. In addition, hippocampal tissues from Amyloid-beta 25-35-treated animals showed an increased immunoreactivity against GFAP. In contrast, animals pretreated with Epicatechin had a significant decrease in lipid peroxidation and reactive oxygen species and an improvement in memory skills. GFAP immunoreactivity was also decreased. Our results showed that Amyloid-beta 25-35-caused oxidative damage of the hippocampus was blocked by the administration of Epicatechin.

The chemical alpha-asarone is an important active substance of the Acori graminei rhizome (AGR). It has pharmacological effects that include antihyperlipidemic, antiinflammatory, and antioxidant activity. Our aim was to study the effects alpha-asarone on nitric oxide (NO) levels in the hippocampus and temporal cortex of the rat after injection of the fraction 25-35 from amyloid-beta (Abeta((25-35))). In addition we examined the working spatial memory in an eight-arm radial maze. Our results showed a significant increase of nitrites in the hippocampus and temporal cortex of Abeta((25-35))-treated rats. Other evidence of neuronal damage was the expression of a glial-fibrillar-acid protein and a silver staining. There were impairments in the spatial memory evaluated in the eight-arm radial maze. We wanted to determine whether alpha-asarone improves the memory correlated with NO overproduction and neuronal damage caused by the injection of Abeta((25-35)) into rats. Then animals received a 16-day treatment of alpha-asarone before the Abeta((25-35)) injection. Our results show a significant decrease of nitrite levels in the hippocampus and temporal cortex, without astrocytosis and silver-staining cells, which correlates with memory improvement in the alpha-asarone-treated group. Our results suggest that alpha-asarone may protect neurons against Abeta((25-35))-caused neurotoxicity by inhibiting the effects of NO overproduction in the hippocampus and temporal cortex.

Resumen Objetivo describir las tendencias en la prescripcion de antibioticos y analizar su posible relacion con la evolucion de la sensibilidad a antimicrobianos de los patogenos respiratorios aislados en el area de salud. Material y metodos estudio descriptivo de la prescripcion de antimicrobianos y evolucion de las resistencias de Streptococcus pyogenes, Streptococcus pneumoniae y Haemophilus influenzae, desde 1996 hasta 2005. El consumo se expresa en dosis por 1.000 habitantes dia (DHD). Para analizar las tendencias se utilizan pruebas de la χ2, pruebas exactas, coeficientes de correlacion de Spearman y un analisis de series temporales. Resultados aislamos 1.301 cepas de S. pyogenes, todas sensibles a penicilina, con porcentajes de resistencia a eritromicina decreciente y a clindamicina creciente. Identificamos 579 cepas de neumococo, con descensos significativos de resistencia a penicilina, amoxicilina-clavulanico, cefotaxima y cefuroxima; las resistencias a eritromicina y azitromicina ascendieron los primeros anos, y luego descendieron, aunque no significativamente. Aislamos 769 cepas de H. influenzae, todas sensibles a cefotaxima, altamente sensibles a amoxicilina-clavulanico y cefuroxima, con resistencias mantenidas a ampicilina y un significativo descenso de resistencia a azitromicina. Simultaneamente hay un descenso progresivo del consumo general de antibioticos (20,45 DHD en 1996; 18,90 DHD en 2005); la prescripcion de penicilinas se mantiene, a expensas del aumento de la dosificacion de amoxicilina-clavulanico; la de cefalosporinas y macrolidos desciende (excepto azitromicina), y aumenta la de fluoroquinolonas. Observamos una correlacion significativa entre prescripcion y resistencias. Conclusiones encontramos una recuperacion de la sensibilidad a antimicrobianos de los patogenos respiratorios coincidente con un descenso progresivo de la prescripcion.

ObjetivoDeterminar la consistencia interna, la estructura factorial, la reproducibilidad y la validez de criterio del Inventario de Obsesiones de Leyton en niños y adolescents.DiseñoEstudio de validación.EmplazamientoColegios de secundaria de Bucaramanga, Colombia.ParticipantesSe incluyó a 581 estudiantes seleccionados al azar, de los cuales 38 no contestaron el inventario, 8 fueron excluidos por tener más de 17 años y 33 no acudieron a la entrevista clínica.Mediciones principalesAplicación independiente del Inventario de Obsesiones de Leyton y de la Entrevista Clínica Estructurada para los Trastornos del Eje I del DSM-IV (SCID-I), versión clínica. Se calculó el índice alfa de Cronbach y se realizó un análisis de los factores, la sensibilidad, la especificidad, la verosimilitud y el coeficiente de Lin.ResultadosLa prevalencia de trastorno obsesivo compulsivo fue del 11,8% (intervalo de confianza [IC] del 95%, 8,9-14,6). El alfa de Cronbach fue 0,803 y se halló un único factor con 3,60 de valor propio que explica el 74,8% de la varianza. El área bajo la curva ROC fue 0,799 (IC del 95%, 0,752-0,847) y el mejor punto de corte en esta población fue 12, a partir del cual la sensibilidad fue del 69,5% (IC del 95%, 56,0-80,5) y la especificidad del 77,7% (IC del 95%, 72,9-88,9). La reproducibilidad fue aceptable (coeficiente de Lin de 0,752; IC del 95%, 0,714-0,790).ConclusiónEl Inventario de Obsesiones de Leyton es un instrumento aceptable para cribar la presencia de trastorno obsesivos compulsivos en niños y adolescentes de Colombia.ObjectiveTo determine the internal consistency, factorial structure, reproducibility and validity of criterion of the Leyton Obsessional Inventory in children and adolescents.DesignStudy of validation with probabilistic sampling.SettingSecondary schools in Bucaramanga, Colombia.ParticipantsA total of 581 students selected at random, of whom 38 did not answer, 8 were excluded because they were over 17, and 33 did not attend the clinical interview.Main measurementsThe Inventory and the Structured Clinical Interview for axis I of the DSM-IV (SCID-I), clinical version, were used. Cronbach's alpha, factorial analysis, sensibility, specificity, probability, and Lin’ s coefficient were calculated.ResultsThe prevalence of obsessive-compulsive disorder was 11.8% (95% CI, 8.9-14.6). Cronbach's alpha was 0.803 and just one factor with 3.60 eigenvalue explained 74.8% of variance. The area under the ROC curve was 0.799 (95% CI, 0.752-0.847) and the best cut-off point was 12, with sensitivity at 69.5% (95% CI, 56.0-80.5) and specificity at 77.7% (95% CI, 72.9-88.9). Its reproducibility was acceptable (Lin's coefficient at 0.752; 95% CI, 0.714-0.790).ConclusionThe Leyton Obsessional Inventory is a fair screening tool for detecting obsessive-compulsive disorder in Colombian children and adolescents.

When comparing current smoking in schizophrenia patients versus the general population, the average odds ratio (OR) was 5.3 in a meta-analysis of 42 studies from 20 nations. Limited tobacco access can eliminate this strong association in some nations. Out of the 42 ORs, 37 were significantly higher than 1. Of the 5 non-significant ORs, three came from Colombian studies comparing current smoking prevalences in schizophrenia versus those in the general population (18%). However, the 3 ORs were not adjusted for confounders. We hypothesized that the association between schizophrenia and smoking is so strong that it can be detected in populations with limited access to smoking after carefully controlling for confounders. Of the three Colombian studies, one included 73 schizophrenia patients (DSM-IV schizophrenia or schizoaffective disorder) and 111 patients with mood disorders (DSM-IV bipolar or major depressive disorders). The current study matched each of these patients with 2 controls from the general population and performed more sophisticated statistical analyses. Prevalences of current smoking were 26% for schizophrenia patients and 10% for their matched controls (adjusted Mantel-Haenszel OR=3.1, 95% CI, 1.4-6.8), and 7% for patients with mood disorders and 12% for their matched controls (adjusted Mantel-Haenszel OR=0.62; CI, 0.28-1.4). The previously observed lack of association between schizophrenia and current smoking was due to lack of control of important confounding variables because of the absence of a control group. This re-analysis, which used a careful matching that controlled for confounders, suggests that the association between schizophrenia and smoking behaviors can stand in populations with low monetary income and low smoking rates. This study also suggests that the association between severe mood disorders (bipolar and major depression) and smoking is not as strong as that observed between schizophrenia and smoking, and may not be observable in countries where people have limited economic resources.

Objective To evaluate the effect of estrogen therapy (ET) on endothelial nitric oxide (NO) production and in flow-mediated vasodilation (FMV). Design Randomized, crossover, double-blind, placebo-controlled study. Setting Healthy postmenopausal women in an academic research environment. Patient(s) Forty postmenopausal women between 45 and 72 years of age. Intervention(s) Women received ET or placebo during two periods of 12 weeks that were separated by 2 weeks of washout. Main outcome measure(s) Flow-mediated vasodilation, nitrite and nitrate, lipid profile, creatinine, and glucose were measured at weeks 12 and 24. Student's t or Wilcoxon tests were used for comparative analyses, and κ test and limit analysis determined variability. Result(s) After placebo treatment, nitrate and nitrite mean concentration was 8.28 ± 1.17 mmol/L; it increased to 62.6 ± 12.82 mmol/L after ET. Percentage FMV was 18.8 ± 2.58 after the placebo period and did not change after ET (20.1 ± 1.92) in the whole sample, but in the subgroup (n = 15) of younger women (45–50 years of age), percentage FMV increased from 13.6 ± 3.6 after the placebo period to 22.2 ± 3.5 after ET. Conclusion(s) An increase in plasma concentrations of nitrite and nitrate after ET was observed in all the women studied, but the improvement in FMV was observed only in the younger ones. These age-related differences in FMV in response to ET must be further investigated.