Search

Dry Needling is gaining wide popularity as a technique to relieve musculoskeletal pain. It has rarely been used to treat Supraspinatus Calcific tendinopathy. Most treatment techniques focus around Subacromial Corticosteroid needle decompression to improve the outcomes of Supraspinatus Calcification. Our study observed the Elastographic changes along with the Radiographic changes in the Calcification before and after the Dry Needling sessions.

In this investigation, the coal fires in different Colombian coal mines were studied using advanced electron beam and X-ray diffraction techniques. The results were compared with information from high-resolution transmission electron microscopy (HR-TEM) equipped with a dispersive X-ray detector (EDS). Amorphous phases, salammoniac, anatase, muscovite, goethite, jarosite, calcite, gypsum, kaolinite, illite, and quartz are the dominant mineral matter constituents in almost all of the coal fires, with minute quantities of native sulfur, magnetite, siderite, pyrite, pickeringite, epsomite, hexahydrite, halotrichite being present in around half of the investigated coal fire samples. Other minerals that are present in some particular samples are chlorite, ankerite, and dolomite. Fe-sulfides were also detected particularly in the pyrite-bearing coal fires, possibly indicating oxidation of the Fe-sulfides occurring with coal fires. Exhaust discharge data indicate an overall trend of reducing carbon dioxide (CO2) and carbon monoxide (CO) releases (between 1.5 and 34%) from the coal fires. This is the first report on Colombian coal fires, which would be important for different perspectives of the research in the area.

The demand for the valorization and reuse of by-products is stronger than ever and is considered a serious challenge to the worldwide economy and society. In the field of food, processing by-products represents a major environmental issue that urgently needs to be solved. A panoply of studies has been carried out on food residues, particularly on fruit and vegetable wastes, in order to identify and quantify the phytochemicals present and evaluate its biological safety and efficacy for humans. The bioactive compounds present are mainly polyphenols, fatty acids, minerals, and vitamins. Especially, the cosmetic field may benefit from high-added value ingredients. This chapter aims to revise the potential applications of bioactive compounds extracted from fruit, vegetable, and cereal by-products as active ingredients for skincare products. Their potential emollient, antiwrinkle, or antioxidant activity is critically reviewed and discussed.

a preprint version, For many riders, the motorcycle is much more than a transportation mode. Riding a motorcycle can be a pleasurable experience in itself, and the mo-torcycle is frequently a tool of socialization. An evidence for that can be found in the numerous motorcycling communities around the world. However, those communities may not be accessible to everyone, or they may not satisfy every-one. We believe that a social application for motorcyclists could reach more rid-ers and has the potential of more easily fitting their needs. To explore this idea, we conducted focus groups with motorcyclists, exploring their current practices in digital tools as well as their needs and desires that could possibly be integrated in a social application. The results hinted on several aspects that need to be con-sidered in the design of a social application for motorcyclists. Generally, motor-cyclists are willing to receive and share information with others, and referred several needs in terms of communication and trip planning. However, they also showed concerns regarding a digital tool associated with riding, both for safety reasons and because it could disrupt the riding experience. We conclude that not only the needs but also the concerns must be considered in the design of this new digital tool., This work is supported by: European Structural and Investment Funds in the FEDER component, through the Operational Competitiveness and Internationalization Programme (COMPETE 2020) [Project nº 039334; Funding Reference: POCI-01-0247-FEDER-039334].

This is a preprint version of an accepted manuscript in WorldCist'21 -9th World Conference on Information Systems and Technologies, As cycling becomes increasingly important in sustainable mobility policies, there is also an urge for new digital applications and services for urban cycling. This new generation of cycling applications should be able to connect cyclists with their local cycling ecosystem, promote cycling, and empower cyclists to become active agents of urban mobility. In this work, we aim to explore the new opportunity space of digital tools and applications designed specifically for urban cycling. We pursue this goal by trying to uncover current practices associated with digital tools that are already available and also by trying to uncover new information needs, even those that cyclists are not yet able to fully express. To explore these topics, we conducted 2 focus group sessions and 10 interviews with cyclists. The result is a set of design opportunities for the development of new applications, tools and methods for improving the cycling experience in the context of urban mobility. We expect this contribution might help to better define the design space of innovative digital tools for urban cyclists., This work is supported by: European Structural and Investment Funds in the FEDER component, through the Operational Competitiveness and Internationalization Programme (COMPETE 2020) [Project nº 039334; Funding Reference: POCI-01-0247- FEDER-039334]

This work was funded by ERDF (European Regional Development Fund) through the operations: POCI- -01-0145-FEDER-029130 (“mINSPIRERS—mHealth to measure and improve adherence to medication in chronic obstructive respiratory diseases - generalisation and evaluation of gamification, peer support and advanced image processing technologies”) co-funded by the COMPETE2020 (Programa Operacional Competitividade e Internacionalização), Portugal 2020 and by Portuguese Funds through FCT (Fundação para a Ciência e a Tecnologia). © 2020, Sociedade Portuguesa de Alergologia e Imunologia Clinica. All rights reserved. Aims: To identify distinct asthma control clusters based on Control of Allergic Rhinitis and Asthma Test (CARAT) and to compare patients’ characteristics among these clusters. Methods: Adults and adolescents (≥13 years) with persistent asthma were recruited at 29 Portuguese hospital outpatient clinics, in the context of two observational studies of the INSPIRERS project. Demographic and clinical characteristics, adherence to inhaled medication, beliefs about inhaled medication, anxiety and depression, quality of life, and asthma control (CARAT, >24 good control) were collected. Hierarchical cluster analysis was performed using CARAT total score (CARAT-T). Results: 410 patients (68% adults), with a median (percentile 25–percentile 75) age of 28 (16-46) years, were analysed. Three clusters were identified [mean CARAT-T (min-max)]: cluster 1 [27(24-30)], cluster 2 [19(14-23)] and cluster 3 [10(2-13)]. Patients in cluster 1 (34%) were characterised by better asthma control, better quality of life, higher inhaler adherence and use of a single inhaler. Patients in clusters 2 (50%) and 3 (16%) had uncontrolled asthma, lower inhaler adherence, more symptoms of anxiety and depression and more than half had at least one exacerbation in the previous year. Further-more, patients in cluster 3 were predominantly female, had more unscheduled medical visits and more anxiety symp-toms, perceived a higher necessity of their prescribed inhalers but also higher levels of concern about taking these inhalers. There were no differences in age, body mass index, lung function, smoking status, hospital admissions or specialist physician follow-up time among the three clusters. Conclusion: An unsupervised method based on CARAT--T, identified 3 clusters of patients with distinct, clinically meaningful characteristics. The cluster with better asthma control had a cut-off similar to the established in the validation study of CARAT and an additional cut-off seems to distinguish more severe disease. Further research is necessary to validate the asthma control clusters identified. publishersversion published

The present study is focused on the chemical and nano-mineralogical characterization of sludge from gold mine activities, in order to put forward diverse solution alternatives, where lack of knowledge has been found. The sample was collected from “La Estrella” mine of Suarez, located in Department of Cauca, south-west Colombia. The sludge micro-structure and chemical composition were analyzed using a high resolution transmission electron microscopy (HR-TEM) equipped with a dispersive X-ray detector (EDS). X-ray diffraction technique was employed to identify the mineralogical phases present in the sludge. Additional mineralogical characterization was done by using RAMAN spectroscopy. Main findings points to its potential to be used as a fertilizer, this is why, mine sludge contains macronutrients such as P, Ca and S, together with micronutrients like Cu. However, the presence of goethite could decrease the mobilization of nutrients to soils, thus additional alternatives, for instance, a mixture with humus or another material containing Humic Acids should be done, in order to minimizing its retention effect. Additionally, another possible uses to explore could be as construction and ceramic material or in the wastewater treatment for nutrient retention and organic material removal. Rutile (TiO2 nanoparticles) particles have been also detected, what could cause health concern due to its nanoparticle toxic character, mainly during gold extraction process.

Pollution generated by hazardous elements and persistent organic compounds that affect coal fire is a major environmental concern because of its toxic nature, persistence, and potential risk to human health. The coal mining activities are growing in the state of Santa Catarina in Brazil, thus the collateral impacts on the health and economy are yet to be analyzed. In addition, the environment is also enduring the collateral damage as the waste materials directly influence the coal by-products applied in civil constructions. This study was aimed to establish the relationships between the composition, morphology, and structural characteristics of ultrafine particles emitted by coal mine fires. In Brazil, the self-combustions produced by Al–Ca–Fe–Mg–Si coal spheres are rich in chalcophile elements (As, Cd, Cu, Hg, Pb, Sb, Se, Sn, and Zn), lithophile elements (Ce, Hf, In, La, Th, and U), and siderophile elements (Co, Cr, Mo, Fe, Ni, and V). The relationship between nanomineralogy and the production of hazardous elements as analyzed by advanced methods for the geochemical analysis of different materials were also delineated. The information obtained by the mineral substance analysis may provide a better idea for the understanding of coal-fire development and assessing the response of particular coal in different combustion processes.

Efflorescent nanophases (NPs) are found as a transitory accumulation of potentially hazardous elements (PHEs), particularly in tropical climates. The central objective of this study was to investigate the distribution of PHEs with NPs through the evaporative formation structures (EFS) of enormously PHEs-rich coal-mine drainages (CMD). The EFS were studied in natural coal mine drainage for five months in order to determine their geochemical and ecological structures and to assess their position in the reduction of PHEs in nature. The largest coal-fired power plant in South America, located in south Brazil, is used as an example of such a problem. In this work, a novel methodology for the analysis of PHEs in CMD precipitates is proposed for this affected coal area. The analytical method, combining X-Ray Diffraction (XRD) and advanced electron microscopies, shows the importance of nanomineralogy in understanding different circumstances of coal contamination. Several ultrafine-nanoparticles (UNPs) were identified in the sampled soils and river sediments together with the PHEs. A decrease in PHEs was identified in association with UNPs. However, further investigations are required with regard to the mobility of PHEs in water, atmosphere, soils, and sediments. The EPS was thoroughly studied, acquiring suitable understanding with investigational facts for Ca and Fe-sulphates, pickeringite, and several amorphous phases.

The opinions and experiences of the public regarding health services are valuable insights into identifying opportunities to improve healthcare systems. We analyzed the 2012-2013 Public Opinion Health Policy Survey carried out in Brazil (n = 1486), Colombia (n = 1485), El Salvador (n = 1460), Jamaica (n = 1480), México (n = 1492) and Panama (n = 1475). In these countries between 82 and 96% of participants perceived that their health systems needed fundamental changes. The most frequent barrier to access to healthcare was lack of the primary medical home, difficulties in obtaining medical care during the weekends and financial barriers. Type of health insurance and challenges in obtaining medical care during the weekends were associated with an increased opinion for the need for fundamental changes in healthcare systems, whereas having a primary medical home showed a protective effect. Focusing on tackling organizational and financial barriers and ensuring access to a primary medical home should be placed on the agenda of Latin American countries.

Background The study aimed to assess the performance of a multidisciplinary-team diabetes care program called DIABETIMSS on glycemic control of type 2 diabetes (T2D) patients, by using available observational patient data and machine-learning-based targeted learning methods. Methods We analyzed electronic health records and laboratory databases from the year 2012 to 2016 of T2D patients from six family medicine clinics (FMCs) delivering the DIABETIMSS program, and five FMCs providing routine care. All FMCs belong to the Mexican Institute of Social Security and are in Mexico City and the State of Mexico. The primary outcome was glycemic control. The study covariates included: patient sex, age, anthropometric data, history of glycemic control, diabetic complications and comorbidity. We measured the effects of DIABETIMSS program through 1) simple unadjusted mean differences; 2) adjusted via standard logistic regression and 3) adjusted via targeted machine learning. We treated the data as a serial cross-sectional study, conducted a standard principal components analysis to explore the distribution of covariates among clinics, and performed regression tree on data transformed to use the prediction model to identify patient sub-groups in whom the program was most successful. To explore the robustness of the machine learning approaches, we conducted a set of simulations and the sensitivity analysis with process-of-care indicators as possible confounders. Results The study included 78,894 T2D patients, from which 37,767patients received care through DIABETIMSS. The impact of DIABETIMSS ranged, among clinics, from 2 to 8% improvement in glycemic control, with an overall (pooled) estimate of 5% improvement. T2D patients with fewer complications have more significant benefit from DIABETIMSS than those with more complications. At the FMC’s delivering the conventional model the predicted impacts were like what was observed empirically in the DIABETIMSS clinics. The sensitivity analysis did not change the overall estimate average across clinics. Conclusions DIABETIMSS program had a small, but significant increase in glycemic control. The use of machine learning methods yields both population-level effects and pinpoints the sub-groups of patients the program benefits the most. These methods exploit the potential of routine observational patient data within complex healthcare systems to inform decision-makers.

Chronic diseases are one of the main causes of death worldwide mainly due to lifestyle factors, such as the high consumption of processed foods, low consumption of plants, and lack of exercise. In the last decade, different studies suggest the use of dietary supplements to attenuate many of the pathophysiological processes involved in the development of some of these diseases. Cross-sectional and prospective cohorts and other studies have shown in some situations an association between nutritional supplements diet and a lower prevalence and incidence of chronic diseases, such as cardiovascular disease, cancer, metabolic syndrome, diabetes, and neurodegenerative diseases as well as a reduced overall mortality. However, the number of clinical studies is very limited and in some cases controversial. The present chapter aims to review the role of a variety of dietary supplements in treating some of these chronic diseases through evaluation of the evidence-based effects of nutritional supplements on human health, from cohort studies to clinical trials and meta-analysis.

Congenital nasal pyriform aperture stenosis (CNPAS) is a rare cause of upper airway (UA) obstruction in newborn. Although commonly described as arising from overgrowth of the nasal process of the maxilla, some authors defend that it results from medialisation of normally shaped maxilla.[1][1] It is

Recently, an increased interest in nanoscience applications can be observed in various fields. Soils around coal power plants may contain potentially hazardous elements (PHEs) and nanoparticles (NPs), which can be neo-produced pollutants or can be a product of industrial coal utilization. While titanium (Ti)-NPs contact is a worldwide concern, transference of Ti-NPs to infants as well as their human health impact is still imprecise. In general, the toxicity and the human health risk assessment associated with the presence of some Ti-NPs, needs to be determined with a robust and fast analytical methodology. The mode of occurrences of Ti-NPs in children’s playgrounds were evaluated by advanced electron microscopy techniques (field emission scanning electron microscope-FE-SEM and high resolution transmission electron microscope-HR-TEM) coupled with an energy dispersive X-ray microanalysis system (EDS); Raman Spectroscopy (RS); and X-Ray Diffractions (XRD). The reported data showed that when the size of the NPs reduced, the ability of sedimented dust aggregates to transport PHEs increased. Carbonaceous matter and amorphous silica were the main factors that influenced the distribution of PHEs among the studied Ti-NPs aggregates. Together, the data indicate that the proportions of PHEs in sedimented urban dust in the urban area around coal power plants are mainly due to emissions related to vehicle traffic and the coal industry, representing immediate environmental risks and long-term health risks. Therefore, actions are required to monitor and mitigate the impact of Ti-NPs aggregates in the urban area and nearby ecosystems. Such pollutants are necessary to be observed as children represent a susceptible cluster likened to adults. The currently estimated risk can be influenced by factors such as absorption, form of Ti-NPs, particle fraction, particle size, and physico-geochemical properties in relation to toxicity, among others. Analysis of actual particle concentrations in human organs, as well as organ concentrations and effects in liver and the reproductive system after chronic exposure to well-characterized Ti-NPs in animals are recommended to refine this assessment.

Pollution caused by hazardous and carcinogenic inorganic elements and organic compounds from coal may be more severe when coupled by other sources of pollution. In addition, the modes of occurrence of potential hazardous elements (PHEs) in coal cleaning rejects (CCRs) have been widely investigated using different methods, including statistical methods, which, however, in some cases resulted in misleading interpretations. In order to verify this potential problem and find an effective solution, we selected a data set, which contained comprehensive analyses of CCRs. The secondary products in sulphides-bearing coal mine rejects were studied in demand to determine their geochemical and ecological structures and to assess their position in the reduction of PHEs in the nature. A zone located in south Brazil, which is the major coal power plant in South America, can be given as an example of such a problem. In this work, a novel methodology for the analysis of PHEs in soils and sediments is proposed for this affected coal area. The analytical method combining X-Ray Diffraction (XRD) and advanced electron microscopies shows the importance of nanomineralogy in understanding different circumstances of coal contamination. Several ultrafine-nanoparticles (UNPs) were identified in the sampled soils and river sediments together with the PHEs. A decrease in PHEs was identified in association with UNPs. However, still further investigations are required with regard to the mobility of PHEs in water, atmosphere, soils, and sediments. The site studied around the coal power plant showed the highest sorption capacity possibly due to the high retention ability of components of soil and sediments such as carbon and clay. These observations of the coal-derived nanoparticles confirm their capability of regulating the mobility of hazardous elements, implying the need for restoring complex abandoned coal areas.

Atmosphere, water, and soil contamination with toxic compounds is a recurrent issue due to environmental disasters, coal burning, urbanization, and industrialization, allf of which have contributed to soil contamination over the decades. Consequently, understanding of the nanomineralogy and potential hazardous elements (PHEs) in coal area soil are always a vital topic since contaminated soil can affect the environment, agricultural safety, and human health. Colombian coal mining in the La Guajira zone has been usually been related with important health and ecological effects. Coalmine rejects from active and/or abandoned operations are causes of high intensities of potential hazardous elements (PHEs) and nanoparticles (NPs, minerals and/or amorphous compounds). Although these pollutants can be reduced by sorption to NPs, in this study was recognized an analytical procedure for understand distribution of PHEs and their relationship to iron NPs(Fe-NPs) was recognized. Non and poorrly crystalline Fe-NPs performances as the major PHEs association. This complex interaction is constant and efficient in resolving PHEs in proportions above monitoring quantities. The indefinite basis of PHEs in Colombian (La Guajira area) coalmine rejects sources results in years-long leaching of PHEs into rivers and drainages. The iron-clays and their great geomobility interfere the mitigating character that Fe hydr/oxides alone show through adsorption of PHEs and their control in spontaneous coal combustion (SCC) zones. This can have significant consequences to the probable availability of several pollutants (e.g. drinking water). The new results presented in this study add novel viewpoints into the description of Fe-NPs and its incidence in SCC areas. The methodology utilized in this work can be applied as a supplementary technique to evaluate the influence of coalmining actions on ecological and human health.

A fibrodisplasia óssea é uma patologia congénita rara com predileção pelos ossos craniofaciais, envolvendo frequentemente os seios perinasais, órbita e base do crânio. Os autores apresentam 2 casos de fibrodisplasia óssea monostótica craniofacial e realizam uma breve revisão da literatura sobre o tema. O primeiro trata-se de um caso de fibrodisplasia óssea do frontal, num homem de 20 anos, e o segundo de um caso de fibrodisplasia óssea do esfenoide, num homem de 65 anos. O primeiro caso, dada a idade jovem, crescimento e repercussão estética da lesão, foi submetido a cirurgia, não evidenciando sinais de recidiva após um ano de seguimento. O segundo caso, tratou-se de um achado imagiológico sem sinais de crescimento, num homem mais velho e assintomático, pelo que se optou pelo tratamento conservador e vigilância. Ambos foram orientados de forma multidisciplinar e ilustram a diversidade de apresentação, orientação e evolução que a mesma patologia pode assumir.

INTRODUÇÃO: As complicações intracranianas de otite média representam uma situação relacionada com alta taxa de mortalidade, manifestando-se de forma aguda e constituindo urgências médicas e cirúrgicas. São definidas como disseminação do processo inflamatório/infecioso para além dos espaços pneumatizados do ouvido médio, tendo variadas formas de apresentação.MATERIAL E MÉTODOS: Consulta dos processos clínicos dos doentes com patologia otológica e patologia intracraniana entre 2008 e 2014 admitidos no Hospital de Braga. Características dos pacientes, diagnósticos otológicos e neurológicos, resultados microbiológicos, abordagem terapêutica e evolução clínica foram os parâmetros analisados.RESULTADOS: Obteve-se um total de 19 doentes, com uma idade média de 40,4 anos. Febre persistente e cefaleias foram os principais sintomas encontrados. Otite média aguda foi o diagnóstico otológico mais associado a complicação intracraniana. Seis pacientes apresentavam mais do que uma complicação, resultando num total de 28, quase metade das quais correspondendo a meningite.DISCUSSÃO: Após comparação com estudos semelhantes da literatura, verificamos que os nossos resultados são semelhantes aos já encontrados, exceto no que diz respeito à principal etiologia das complicações intracranianas.CONCLUSÃO: As complicações intracranianas de otite média devem ser consideradas situações de alto risco que requerem intervenção médica imediata.

Introduction: An assessment of morbidity and mortality caused by transfusion dependent thalassemia in India has never really been done despite thalassemia being the most prevalent life threatening non-communicable disorder of childhood. There is little structured understanding identifying the key risk factors feeding into research and policy making for effective management of thalassemia. With an estimated 10,000-12,000 children born with thalassemia each year in India, in addition to increasing focus on early pregnancy targeted screening, it seems critical to increase our understanding of risk factors associated with early mortality and morbidity. This is also relevant to family counselling about management options. Methodology: A retrospective analysis of mortality key risk factors in patients suffering from thalassemia major from 5 thalassemia day care centres in India was carried out. This included a total of 1,087 patients (656 males and 431 females with a median age of 8.6 years) enrolled for care between 1 Jan 2010 - 31 Oct 2018 at these centres. These centres were set up by a non-profit organization in collaboration with blood banks and /hospital facilities with the objective to provide comprehensive thalassemia care; A common web-based application was employed (ThalCare™). This system was used to track information associated with treatment including disease history at enrolment, demographic data and follow-up information. All analyses were performed with R Statistical software (3.5.2). Survival analysis was done from the age at presentation to the centre till October 2018. The reasons for mortality were categorized. Overall survival was also separately analyzed for patients in their 1st,2nd, 3rd or subsequent decades of life. The Cnaan and Ryan approach was used as patients entered and left the study cohort (left censored and right truncated data) and observation began only at enrolment and not at disease onset Results: The median age at enrolment was 5.4 years and the median follow up at the centre was 2.5 years. A total of 86 patients were cured by bone marrow transplantation (BMT), 13 of them moved to other centres for care and 41 patients died during the study period (28 males and 13 females). The median age at death was 15.4 years. Actuarial survival at 26.9 years of age was 50% (Figure 1) and under-five mortality was 7 times higher than the general population. Patients with transfusion-transmitted infections (TTI) had 3.4 times higher risk of death (p=0.031). Serum ferritin >4,000 ng/dL was associated with 4.6 times higher risk of mortality compared to ferritin 2 gm/dL/week had 7.7 times higher mortality risk compared to 2 gm/week (hazard ratio 5.58 ,p=0.0007) and lack of attention towards care for possible prevention from TTI (hazard ratio 2.86, p=0.0004) are factors independently associated with high mortality. Table 2 shows that in patients born after the year 2,000 overall survival is 85.2% compared to 29.4% for patients born earlier. Main causes of death were infection, iron overload, TTIs, and alloimmunization; In a quarter of patients the cause of death was unknown (Figure 2). Patients who received more than 4 years of adequate care had more than 66% mortality risk reduction (p Conclusion: Comprehensive care right from an early age at dedicated management centres is key to improving life expectancy of thalassemia patients in India. Optimizing blood transfusion, intensifying chelation and preventing TTIs seem particularly important. Sustained efforts in these areas coupled with increased prevention and access to safe BMT will ease the burden for both families and public healthcare. Disclosures No relevant conflicts of interest to declare.

Resumen Introduccion La ideacion suicida es un factor de mal pronostico en depresion por el riesgo de intento de suicidio y suicidio consumado; sin embargo, es un aspecto que no ha sido estudiado lo suficiente en la poblacion colombiana. Es importante conocer factores asociados para desarrollar estrategias adecuadas de tratamiento. Objetivo Identificar factores de riesgo para la ideacion suicida en pacientes con diagnostico de trastorno depresivo mayor entre los 18 y 65 anos, en 5 ciudades de Colombia. Metodo Se empleo la informacion de 295 pacientes con diagnostico de trastorno depresivo mayor que participaron en el Estudio de Carga Economica de la Depresion en Colombia. La asociacion de variables clinicas y psicosociales con la ideacion suicida se evaluo por medio de modelos multinivel. Resultados El sexo femenino fue un factor asociado con un menor riesgo de ideacion suicida. Los factores asociados con ideacion suicida incluyen desempleo, consumo de cigarrillo y de alcohol en los ultimos 30 dias, percepcion de la salud mental como regular o mala, diagnostico de depresion doble, tratamiento intrahospitalario, bajos ingresos y haber sufrido una gran crisis financiera en los ultimos 2 anos. Conclusiones La ideacion suicida es altamente prevalente en pacientes con trastorno depresivo mayor. Dentro de los factores de riesgo para ideacion suicida se identifican elementos de dominio tanto clinico como psicosocial que deben ser abordados con especial cuidado en pacientes con este diagnostico al momento de hacer una evaluacion de riesgo.

Constitutional epimutation of the two major mismatch repair genes, MLH1 and MSH2, has been identified as an alternative mechanism that predisposes to the development of Lynch syndrome. In the present work, we aimed to investigate the prevalence of MLH1 constitutional methylation in colorectal cancer (CRC) patients with abnormal expression of the MLH1 protein in their tumors. In a series of 38 patients who met clinical criteria for Lynch syndrome genetic testing, with loss of MLH1 expression in the tumor and with no germline mutations in the MLH1 gene (35/38) or with tumors presenting the BRAF p.Val600Glu mutation (3/38), we screened for constitutional methylation of the MLH1 gene promoter using methylation‐specific multiplex ligation‐dependent probe amplification (MS‐MLPA) in various biological samples. We found four (4/38; 10.5%) patients with constitutional methylation in the MLH1 gene promoter. RNA studies demonstrated decreased MLH1 expression in the cases with constitutional methylation when compared with controls. We could infer the mosaic nature of MLH1 constitutional hypermethylation in tissues originated from different embryonic germ layers, and in one family we could show that it occurred de novo. We conclude that constitutional MLH1 methylation occurs in a significant proportion of patients who have loss of MLH1 protein expression in their tumors and no MLH1 pathogenic germline mutation. Furthermore, we provide evidence that MLH1 constitutional hypermethylation is the molecular mechanism behind about 3% of Lynch syndrome families diagnosed in our institution, especially in patients with early onset or multiple primary tumors without significant family history.

An 80-year-old man presented with a 1-month history of frontal headache and pressure, irradiating to the nose. He did not have other complaints or relevant health issues besides high blood pressure and diabetes mellitus. The initial physical examination did not reveal any abnormality. Because of his severe complaints, he underwent a CT scan of the brain and paranasal sinuses, which showed an expansive solid mass in the right frontal sinus with erosion of its posterior wall and extension to the frontoethmoidal recess. These findings motivated a cranial MRI that revealed a giant mass (6.3×3.1×7.5 cm) in the frontoethmoidal area with both intracranial and extra-axial …

OBJETIVOS: Analizar la prevalencia del sindrome depresivo y los factores asociados con la depresion en Colombia entre los anos 2000 y 2001. METODOS: Para este estudio descriptivo de corte transversal se aplico una encuesta entre noviembre de 2000 y enero de 2001 a 1 116 adultos de 18 anos de edad o mas de uno u otro sexo que residian en viviendas particulares seleccionadas mediante un muestreo representativo nacional polietapico, estratificado segun el grado de urbanizacion del area incluida en el muestreo. La depresion se clasifico en breve, subclinica o clinica (leve, moderada o grave) en los 30 dias y los 12 meses previos a la entrevista. Se calcularon las frecuencias simples y estratificadas por la edad y el sexo, y los intervalos de confianza de 95% (IC95%) de mas de 500 variables. La asociacion de las variables seleccionadas con episodios depresivos se evaluo mediante un modelo de regresion logistica con multiples variables. RESULTADOS: De las personas estudiadas, 10,0% (IC95%: 9,2 a 10,7) presentaron algun episodio depresivo en los 12 meses previos a la encuesta y 8,5% (IC95%: 7,8 a 9,2) sufrieron alguno durante el ultimo mes. Hubo una mayor proporcion de mujeres con depresion en ambos periodos. Mas de 50% de los episodios fueron moderados, tanto en hombres como en mujeres, y las mayores prevalencias se encontraron en las personas mayores de 45 anos. Los factores asociados con la depresion en el ultimo mes fueron ser mujer, considerar el estado de salud propio como regular o malo, sufrir de dolores o molestias, tener dificultades en las relaciones interpersonales, consumir marihuana o sustancias adictivas, medicamentos estimulantes o calmantes, tener dependencia del alcohol, o estar desempleado con discapacidad. CONCLUSION: La depresion es una afeccion frecuente en Colombia. Se deben poner en marcha medidas dirigidas a reducir el riesgo de depresion, especialmente en mujeres y en personas mayores de 45 anos de edad.

OBJETIVO: A vacinação rotineira contra a rubéola foi implementada na Paraíba, nordeste brasileiro, através de uma campanha de catch-up direcionada a crianças com idades entre 1 e 11 anos em 1998. Uma campanha entre as mulheres em idade reprodutiva foi realizada em 2001. Descrevemos a epidemiologia da rubéola e da síndrome da rubéola congênita (SRC) no estado da Paraíba entre 1999 e 2005. MÉTODOS: Foram analisados os dados de vigilância da rubéola e da SRC entre 1999 e 2005. Os casos suspeitos de rubéola foram confirmados por exames laboratoriais, vínculo epidemiológico ou por critério clínico. Foram utilizadas as definições internacionais padrão de SRC. RESULTADOS: Dos 5.924 casos suspeitos de rubéola entre 1999 e 2005, 1.266 (21%) foram confirmados, 766 (61%) deles através dos exames laboratoriais. Durante uma epidemia de rubéola em 2000 (18,8/100.000), a incidência entre os indivíduos com idades entre 14 e 19 anos (42/100.000) quadruplicou em relação a crianças com idades entre 1 e 13 anos (intervalo de confiança de 95% = 3,2-5,1). A incidência geral da rubéola foi de 0,9/100.000 em 2005. Dos 177 casos suspeitos de SRC entre 1999 e 2005, 167 (94%) foram testados para a presença de IgM. Dos 14 (8%) casos de SRC confirmados laboratorialmente, 12 (86%) haviam nascido em 2001, com uma incidência de 0,2/100.000 crianças menores de 1 ano nesse ano. CONCLUSÕES: A campanha de vacinação contra a rubéola em 1998 não foi suficiente para prevenir um surto entre adultos jovens em 2000, com uma alta incidência de SRC em 2001. Entre 2002 e 2005, as incidências de rubéola e de SRC diminuíram; entretanto, a alta cobertura da vacina e a vigilância de alta qualidade são importantes para que se atinja a erradicação da SRC até 2010. OBJECTIVE: Routine rubella vaccination was introduced in Paraíba, northeastern Brazil, through a catch-up campaign targeting children aged 1-11 years, in 1998. A campaign among women of childbearing age was conducted in 2001. We describe the epidemiology of rubella and congenital rubella syndrome (CRS) in the state of Paraíba between 1999 and 2005. METHODS: Rubella and CRS surveillance data for the 1999-2005 period were analyzed. Suspected cases of rubella were confirmed by laboratory findings, epidemiological link, or clinical data. International standardized CRS definitions were used. RESULTS: Of 5,924 suspected cases of rubella between 1999 and 2005, 1,266 (21%) were confirmed, 766 (61%) by laboratory findings. During a rubella epidemic in 2000 (18.8/100,000), the incidence among individuals aged 14-19 years (42/100,000) had a fourfold increase relative to children aged 1-13 years (95% confidence interval = 3.2-5.1). The overall rubella incidence was 0.9/100,000 in 2005. Of 177 suspected cases of CRS between 1999 and 2005, 167 (94%) were tested for IgM. Of 14 (8%) laboratory confirmed cases of CRS, 12 (86%) were born in 2001, with an incidence of 0.2/100,000 children aged less than 1 year. CONCLUSIONS: The 1998 rubella vaccination campaign was insufficient to prevent an outbreak among young adults in 2000, with a high CRS incidence in 2001. Between 2002 and 2005 the incidence of rubella and CRS decreased; however, high routine vaccination coverage and high-quality surveillance remain critically important to achieve CRS elimination by 2010.

OBJECTIVE: Routine rubella vaccination was introduced in Paraiba, northeastern Brazil, through a catch-up campaign targeting children aged 1-11 years, in 1998. A campaign among women of childbearing age was conducted in 2001. We describe the epidemiology of rubella and congenital rubella syndrome (CRS) in the state of Paraiba between 1999 and 2005. METHODS: Rubella and CRS surveillance data for the 1999-2005 period were analyzed. Suspected cases of rubella were confirmed by laboratory findings, epidemiological link, or clinical data. International standardized CRS definitions were used. RESULTS: Of 5,924 suspected cases of rubella between 1999 and 2005, 1,266 (21%) were confirmed, 766 (61%) by laboratory findings. During a rubella epidemic in 2000 (18.8/100,000), the incidence among individuals aged 14-19 years (42/100,000) had a fourfold increase relative to children aged 1-13 years (95% confidence interval = 3.2-5.1). The overall rubella incidence was 0.9/100,000 in 2005. Of 177 suspected cases of CRS between 1999 and 2005, 167 (94%) were tested for IgM. Of 14 (8%) laboratory confirmed cases of CRS, 12 (86%) were born in 2001, with an incidence of 0.2/100,000 children aged less than 1 year. CONCLUSIONS: The 1998 rubella vaccination campaign was insufficient to prevent an outbreak among young adults in 2000, with a high CRS incidence in 2001. Between 2002 and 2005 the incidence of rubella and CRS decreased; however, high routine vaccination coverage and high-quality surveillance remain critically important to achieve CRS elimination by 2010.