Cuadro depresivo con conductas autolesivas agravado por la situación de pérdida en pandemia en una adolescente de 17 años

Ana (nombre figurado) es una adolescente de 17 años que ya se encontraba en seguimiento psicológico antes del mes de marzo del año 2020, cuando comenzó la pandemia mundial por la COVID-19 que ha roto el delicado equilibro de la salud mental de muchos jóvenes. Consultó por primera vez con 14 años por presentar un bajo rendimiento escolar y un pobre autoconcepto académico. Recibió un apoyo psicopedagógico y tratamiento psicológico, evidenciándose ya una conflictividad familiar, con un hermano mayor que ella que presentaba un cuadro depresivo cuando Ana contaba con 14 años, lo cual generaba una dinámica familiar disfuncional. Pero Ana no generaba problemas, según refería su madre, lo único que ocurría era que no aprobaba. Desde aquel momento, Ana ya no era vista ni contaba para nada. Solo era una mera espectadora de toda la conflictividad familiar, sin ser tenida en cuenta ni escuchada, porque no era disruptiva ni presentaba un patrón desajustado. En diciembre de 2019 vuelve a realizar una consulta, en este caso con psiquiatría. El motivo de la consulta en esta ocasión estaba relacionado con un bajo estado de ánimo, aunque su madre vuelve a poner el foco en el rendimiento escolar.

Age Does Not Affect Metoprolol's Effect on Perioperative Outcomes (From the POISE Database)

BACKGROUND:

Perioperative β-blockade reduces the incidence of myocardial infarction but increases that of death, stroke, and hypotension. The elderly may experience few benefits but more harms associated with β-blockade due to a normal effect of aging, that of a reduced resting heart rate. The tested hypothesis was that the effect of perioperative β-blockade is more significant with increasing age.

METHODS:

To determine whether the effect of perioperative β-blockade on the primary composite event, clinically significant hypotension, myocardial infarction, stroke, and death varies with age, we interrogated data from the perioperative ischemia evaluation (POISE) study. The POISE study randomly assigned 8351 patients, aged ≥45 years, in 23 countries, undergoing major noncardiac surgery to either 200 mg metoprolol CR daily or placebo for 30 days. Odds ratios or hazard ratios for time to events, when available, for each of the adverse effects were measured according to decile of age, and interaction term between age and treatment was calculated. No adjustment was made for multiple outcomes.

RESULTS:

Age was associated with higher incidences of the major outcomes of clinically significant hypotension, myocardial infarction, and death. Age was associated with a minimal reduction in resting heart rate from 84.2 (standard error, 0.63; ages 45–54 years) to 80.9 (standard error, 0.70; ages >85 years; P < .0001). We found no evidence of any interaction between age and study group regarding any of the major outcomes, although the limited sample size does not exclude any but large interactions.

CONCLUSIONS:

The effect of perioperative β-blockade on the major outcomes studied did not vary with age. Resting heart rate decreases slightly with age. Our data do not support a recommendation for the use of perioperative β-blockade in any age subgroup to achieve benefits but avoid harms. Therefore, current recommendations against the use of β-blockers in high-risk patients undergoing noncardiac surgery apply across all age groups.

Search for γ-Ray Line Signals from Dark Matter Annihilations in the Inner Galactic Halo from 10 Years of Observations with H.E.S.S

Spectral lines are among the most powerful signatures for dark matter (DM) annihilation searches in very-high-energy γ rays. The central region of the Milky Way halo is one of the most promising targets given its large amount of DM and proximity to Earth. We report on a search for a monoenergetic spectral line from self-annihilations of DM particles in the energy range from 300 GeV to 70 TeV using a two-dimensional maximum likelihood method taking advantage of both the spectral and spatial features of the signal versus background. The analysis makes use of Galactic center observations accumulated over ten years (2004-2014) with the H.E.S.S. array of ground-based Cherenkov telescopes. No significant γ-ray excess above the background is found. We derive upper limits on the annihilation cross section ⟨σv⟩ for monoenergetic DM lines at the level of 4×10^{-28}  cm^{3} s^{-1} at 1 TeV, assuming an Einasto DM profile for the Milky Way halo. For a DM mass of 1 TeV, they improve over the previous ones by a factor of 6. The present constraints are the strongest obtained so far for DM particles in the mass range 300 GeV-70 TeV. Ground-based γ-ray observations have reached sufficient sensitivity to explore relevant velocity-averaged cross sections for DM annihilation into two γ-ray photons at the level expected from the thermal relic density for TeV DM particles.

Are we using mass media to raise awareness about psychiatric disorders?

Introduction

The global burden of mental disorders is large and continues to grow. Depression is the leading cause of disability worldwide. Every 40 seconds somebody dies from suicide. People with mental disorders are amongst the most marginalized in society. The stigma they experience puts them at an increased risk of poverty, discrimination and human right violations.

Objectives

To study the presence of psychiatric disorders in the media.

Methods

We selected and analyzed the top media Twitter accounts of general news outlets, based on their number of followers. Our research strategy focused on the search of several psychiatric terms of interest (ex: “insomnia”) on each Twitter account. The search includes tweets from the beginnings of Twitter in 2007 up to May 2016, and yielded a database of more than 10,000 news.

Results

The terms with the highest impact in mass media referred to suicide, depression, addictions and gender dysphoria. Disorders related to anxiety (Generalized anxiety, phobias, panic disorder, obsessive-compulsive disorder), dysthymia and bipolar disorder were the psychiatric disorders with the lowest impact. We noticed that the presence of psychiatric disorders in the media is increasing. However, it does not accurately reflect the actual impact it has on society.

Conclusions

The media can be a useful tool for the implementation of strategies for the promotion and prevention of mental disorders. However, we are not fully taking advantage of the benefits that mass media has to offer in order to educate and raise awareness about said disorders.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

H.E.S.S. Limits on Linelike Dark Matter Signatures in the 100 GeV to 2 TeV Energy Range Close to the Galactic Center

A search for dark matter linelike signals iss performed in the vicinity of the Galactic Center by the H.E.S.S. experiment on observational data taken in 2014. An unbinned likelihood analysis iss developed to improve the sensitivity to linelike signals. The upgraded analysis along with newer data extend the energy coverage of the previous measurement down to 100 GeV. The 18 h of data collected with the H.E.S.S. array allow one to rule out at 95% C.L. the presence of a 130 GeV line (at l=-1.5°, b=0° and for a dark matter profile centered at this location) previously reported in Fermi-LAT data. This new analysis overlaps significantly in energy with previous Fermi-LAT and H.E.S.S.

RESULTS

No significant excess associated with dark matter annihilations was found in the energy range of 100 GeV to 2 TeV and upper limits on the gamma-ray flux and the velocity weighted annihilation cross section are derived adopting an Einasto dark matter halo profile. Expected limits for present and future large statistics H.E.S.S. observations are also given.

Search for Dark Matter Annihilations towards the Inner Galactic Halo from 10 Years of Observations with H.E.S.S

The inner region of the Milky Way halo harbors a large amount of dark matter (DM). Given its proximity, it is one of the most promising targets to look for DM. We report on a search for the annihilations of DM particles using γ-ray observations towards the inner 300 pc of the Milky Way, with the H.E.S.S. array of ground-based Cherenkov telescopes. The analysis is based on a 2D maximum likelihood method using Galactic Center (GC) data accumulated by H.E.S.S. over the last 10 years (2004-2014), and does not show any significant γ-ray signal above background. Assuming Einasto and Navarro-Frenk-White DM density profiles at the GC, we derive upper limits on the annihilation cross section ⟨σv⟩. These constraints are the strongest obtained so far in the TeV DM mass range and improve upon previous limits by a factor 5. For the Einasto profile, the constraints reach ⟨σv⟩ values of 6×10^{-26}  cm^{3} s^{-1} in the W^{+}W^{-} channel for a DM particle mass of 1.5 TeV, and 2×10^{-26}  cm^{3} s^{-1} in the τ^{+}τ^{-} channel for a 1 TeV mass. For the first time, ground-based γ-ray observations have reached sufficient sensitivity to probe ⟨σv⟩ values expected from the thermal relic density for TeV DM particles.

Neuraxial block, death and serious cardiovascular morbidity in the POISE trial

BACKGROUND

This post hoc analysis aimed to determine whether neuraxial block was associated with a composite of cardiovascular death, non-fatal myocardial infarction (MI) and non-fatal cardiac arrest within 30 days of randomization in POISE trial patients.

METHODS

A total of 8351 non-cardiac surgical patients at high risk of cardiovascular complications were randomized to β-blocker or placebo. Neuraxial block was defined as spinal, lumbar or thoracic epidural anaesthesia. Logistic regression, with weighting using estimated propensity scores, was used to determine the association between neuraxial block and primary and secondary outcomes.

RESULTS

Neuraxial block was associated with an increased risk of the primary outcome [287 (7.3%) vs 229 (5.7%); odds ratio (OR), 1.24; 95% confidence interval (CI), 1.02-1.49; P=0.03] and MI [230 (5.9%) vs 177 (4.4%); OR, 1.32; 95% CI, 1.07-1.64; P=0.009] but not stroke [23 (0.6%) vs 32 (0.8%); OR, 0.76; 95% CI, 0.44-1.33; P=0.34], death [96 (2.5%) vs 111 (2.8%); OR, 0.87; 95% CI, 0.65-1.17; P=0.37] or clinically significant hypotension [522 (13.4%) vs 484 (12.1%); OR, 1.13; 95% CI, 0.99-1.30; P=0.08]. Thoracic epidural with general anaesthesia was associated with a worse primary outcome than general anaesthesia alone [86 (12.1%) vs 119 (5.4%); OR, 2.95; 95% CI, 2.00-4.35; P<0.001].

CONCLUSIONS

In patients at high risk of cardiovascular morbidity, neuraxial block was associated with an increased risk of adverse cardiovascular outcomes, which could be causal or because of residual confounding.

Use of Barcelona Test for cognitive assessment of patients with schizophrenia

INTRODUCTION

In recent years different neuropsychological batteries have been developed to assess cognitive performance in schizophrenia. However, no test has been validated in Spanish for this purpose. The Barcelona Test has been one of the tests used. This present article has aimed to present a specific neurocognitive battery for schizophrenia by selecting specific subtests from the Barcelona Test. Normative data for patients with schizophrenia are presented and the influence of a number of variables is taken into account.

METHODS

The sample included 209 patients. The relationship between cognitive performance and gender, age, educational level, age of onset, duration of illness and symptomatology were assessed. Symptomatology was collected with the Positive and Negative Syndrome Scale for Schizophrenia.

RESULTS

More of the 50% of the sample had cognitive impairment when compared with standardized percentile scores of the Barcelona Test. No significant relationships between cognitive performance and variables assessed were found, except for in the educational level. Thus, percentile scores for the total sample and for the sample in terms of educational level were obtained.

CONCLUSIONS

The high percentage of patients with cognitive impairment when standardized percentile scores were used reinforces the need to use normative data appropriate for the schizophrenia group. The lack of relationship between cognitive performance and the variables assessed supports the hypothesis that cognitive impairment is a core feature in schizophrenia.

[Insight, neurocognition and psychopathology in schizophrenia]

INTRODUCTION

In recent years, research has been aimed at finding variables mediating between neurocognition and psychosocial functioning in schizophrenia, proposing insight as one of these variables. Some authors have found associations between insight and functional outcome, and between insight and symptomatology, although these associations remain unclear. These different findings could be explained by the insight definition used. The current study evaluates insight unidimensionally and multidimensionally and studies its relationship with cognitive and psychopathological variables.

METHODS

The sample consisted of 94 subjects admitted to an outpatient Psychosocial Rehabilitation Program, all diagnosed of schizophrenia according to ICD-10 diagnostic criteria. A brief version of the Neuropsychology Battery Test Barcelona and the Wisconsin Card Sorting Test were used to evaluate cognitive variables. The Positive and Negative Syndrome Scale (PANSS) was used to evaluate psychopathology. Insight was assessed with the PANSS item ((lack of judgment and insight)), and with a semi-structured interview.

RESULTS

Two insight factors were found, one including more specific knowledge about the disease and its consequences (cognitive factor), that is related to executive functions, and another referring to unspecific knowledge about suffering from an illness and the need for treatment (psychotic factor). Each factor was statistically related to positive symptoms and superior cognitive functions.

CONCLUSIONS

These findings support a relationship between insight and low cognitive performance.

Post-surgical nasal cellulitis outbreak due to Mycobacterium chelonae

An outbreak of post-rhinoplasty nasal cellulitis due to Mycobacterium chelonae in a secondary care centre is described. A case-control study demonstrated that the use of inadequately sterilized surgical equipment in the Otorhinolaryngology Department was a risk factor. The causal organism was cultured from the equipment, from the surface of the operating theatre lamp, adhesive tape and from two of the hospital's general water tanks. Introduction of effective instrument sterilization methods, monitored with biological controls, the use of new air filters and cleansing and disinfection of hospital water tanks, were sufficient to control the outbreak. The antimicrobial susceptibilities of the causal organism were consistently different from those previously reported in M. chelonae.

[Evaluation of compliance with appointments and the control of blood pressure in a group of hypertensive patients]

The social and public health relevance of hypertension (HT) is well know. In the present study, 308 hypertensive patients were evaluated in two six month periods. An organized variation was carried out, consisting of the suppression of the scheduled visit with subsequent attention of the patient by visit on demand. The evaluated variables were the degree of compliance with the appointment and the control of the blood pressure levels in the two periods, depending on sex, age, and degree of hypertension. Better results were achieved during the first period (with scheduled visit), both regarding compliance and control. Therefore, it seems preferable to keep scheduled visits for the HT protocols.

Cerebral acidosis in focal ischemia: I. A method for the simultaneous measurement of local cerebral pH with cerebral glucose utilization or cerebral blood flow in the rat

We developed a technique for the simultaneous autoradiographic determination of local cerebral pH (LCpH) using [14C]dimethyloxazolidinedione ([14C]DMO) with either local cerebral glucose utilization (LCGU) using [14C]deoxyglucose ([14C]DG) or local CBF (LCBF) using [14C]iodoantipyrine ([14C]IAP). The method evolved from the observation that [14C]DMO is "unstable," which is shown here to be due to sublimation of the compound. Thus, the technique consists of administering to rats [14C]DMO followed by either [14C]DG or [14C]IAP. The first autoradiographic film that results contains both labeled compounds. The brain sections are then exposed in a fume hood until the complete disappearance of [14C]DMO, which usually required 10 days. The second film thus contains only the non-DMO isotope administered. Blood levels of the two isotopes are calculated from the total concentrations of isotope and the rate of decline of [14C]DMO in blood. This information is then used to determine cerebral pH and the other cerebral function of interest. Using this double-label technique in normal rats, LCpH, LCGU, and LCBF can be determined with the same accuracy as with single-label techniques. In rats with middle cerebral artery occlusion, this technique yielded LCpH and LCBF values 4 h after occlusion that were not statistically different from those obtained by separate determinations. Thus, interactions between LCpH and either LCBF or LCGU can be studied by this technique in normal and pathological conditions.