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We present an assessment of the Southern Paraguayan Grasslands using Important Bird Areas (IBAs) located in a grassland landscape mosaic. Eleven IBAs in southern Paraguay were evaluated 10 years after their designation, using the BirdLife International method to assess the state, pressure, and response of these areas, during 2017 and 2018. Overall, the Pressure from ecosystem modifications led by fire, and fire suppression, agricultural expansion, and intensification due to farming and grazing have been identified as the major threats to IBAs. Regarding the State, 64% of the IBAs presented Very poor habitat quality to support grassland bird communities. The level of conservation Response was mostly negligible when considering conservation designation, management planning and conservation actions for the trigger species. Our results provide useful information to partners to reconsider these areas as IBAs as most of them no longer fulfill international requirements, we also highlight the importance of strengthening national policies to adequately protect natural grasslands.
The metacestode of Echinococcus multilocularis is the etiological agent of alveolar echinococcosis. The metacestode stage used for research is maintained in rodents by serial passages. In order to determine whether cryopreservation of E. multilocularis metacestodes would be suitable for long-term maintenance and replace serial passages, isolates of different geographic origin were cryopreserved in 1984–1986. The aim of the current study was to test the viability of cryopreserved isolates following long-term cryopreservation (up to 35 years) and to determine the phylogenetic clades these isolates belonged to. Cryopreserved isolates were tested for viability in vitro and in vivo in gerbils. In vitro results of 5 isolates indicated protoscolex survival in 13 of 17 experiments (76%) and metacestode survival in 5 of 12 (42%) in vivo experiments. In vivo results showed ‘abortive lesions’ in 13 of the 36 animals, 15 were negative and 8 harboured proliferating metacestode tissue containing protoscoleces. Genetic analysis confirmed the isolates belonged to European, Asian and North-American clades. In conclusion, the results of the current study indicate that metacestodes of E. multilocularis are able to survive long-term cryopreservation. Therefore, cryopreservation is a suitable method for long-term storage of E. multilocularis metacestode isolates and reduces the number of experimental animals.
Site-selectivity analysis of drilling predation traces may provide useful behavioral information concerning a predator interacting with its prey. However, traditional approaches exclude some spatial information (i.e., oversimplified trace position) and are dependent on the scale of analysis (e.g., arbitrary grid system used to divide the prey skeleton into sectors). Here we introduce the spatial point pattern analysis of traces (SPPAT), an approach for visualizing and quantifying the distribution of traces on shelled invertebrate prey, which includes improved collection of spatial information inherent to drillhole location (morphometric-based estimation), improved visualization of spatial trends (kernel density and hotspot mapping), and distance-based statistics for hypothesis testing (K-, L-, and pair correlation functions). We illustrate the SPPAT approach through case studies of fossil samples, modern beach-collected samples, and laboratory feeding trials of naticid gastropod predation on bivalve prey. Overall results show that kernel density and hotspot maps enable visualization of subtle variations in regions of the shell with higher density of predation traces, which can be combined with the maximum clustering distance metric to generate hypotheses on predatory behavior and anti-predatory responses of prey across time and geographic space. Distance-based statistics also capture the major features in the distribution of traces across the prey skeleton, including aggregated and segregated clusters, likely associated with different combinations of two modes of drilling predation, edge and wall drilling. The SPPAT approach is transferable to other paleoecologic and taphonomic data such as encrustation and bioerosion, allowing for standardized investigation of a wide range of biotic interactions.
Introduction: Women experiencing early pregnancy loss or threatened loss frequently seek care in emergency departments (ED) or early pregnancy clinics (EPC). The dearth of existing qualitative studies has left understudied questions about how these women perceive their healthcare and which strategies best meet their supportive care needs, particularly in the Canadian context. The objective of this study was to deepen our understanding of these women's experiences and gain insight into how clinicians and healthcare services can lessen the impact of this traumatic event on patients and their families. Methods: We conducted a descriptive qualitative study of women who presented to the ED or EPC at an urban tertiary care hospital and an urban community hospital for early pregnancy loss or threatened loss. Purposive sampling was used to recruit patients for in-depth, one-on-one telephone interviews conducted 4-6 weeks after the index visit. Data collection and analysis were concurrent and continued until thematic saturation had occurred. Data analysis was led by two qualitative researchers with support from a multi-disciplinary research team following standard thematic analysis techniques. Results: Interviews were completed with 59 women between July 2018 and August 2019. Participants ranged in age from 22 to 47 years and reflect the diversity of the multicultural city where the study occurred. Our analysis revealed that the medicalization and normalization of early pregnancy complications among ED and EPC clinicians is at odds with women's general lack of knowledge about the frequency, personal risk, causation, duration, and physical intensity of the miscarriage experience. Women identified the value of rapid access to appointments, point of care ultrasound, detailed care plans, and knowledgeable advice as key to lessening the physical and emotional trauma related to early pregnancy loss. Conclusion: This research highlights the physical, emotional, and psychological complexity of a medical situation frequently minimized within the current healthcare system. The results impart important knowledge about which aspects of ED and EPC care are most valued by women experiencing early pregnancy loss or threatened loss and demonstrate the clear need for women and their families to be provided with more education about the totality of the early pregnancy experience, including the possibility of pregnancy complications and loss.
Costa Rica is near malaria elimination. This achievement has followed shifts in malaria health policy. Here, we evaluate the impacts that different health policies have had on malaria transmission in Costa Rica from 1913 to 2018. We identified regime shifts and used regression models to measure the impact of different health policies on malaria transmission in Costa Rica using annual case records. We found that vector control and prophylactic treatments were associated with a 50% malaria case reduction in 1929–1931 compared with 1913–1928. DDT introduction in 1946 was associated with an increase in annual malaria case reduction from 7.6% (1942–1946) to 26.4% (1947–1952). The 2006 introduction of 7-day supervised chloroquine and primaquine treatments was the most effective health policy between 1957 and 2018, reducing annual malaria cases by 98% (2009–2018) when compared with 1957–1968. We also found that effective malaria reduction policies have been sensitive to natural catastrophes and extreme climatic events, both of which have increased malaria transmission in Costa Rica. Currently, outbreaks follow malaria importation into vulnerable areas of Costa Rica. This highlights the need to timely diagnose and treat malaria, while improving living standards, in the affected areas.
To assess empathic and aversive emotional responses of excessive players of violent video games, both 20 male gamers and 20 controls, age and education matched were examined with functional MRI.
The examinations focused on resting state activity, voxelbased morphometry and the functional scanning of diverse aspects of emotional processing. The actual fMRI-scans were performed under presentation of pictures taken from the IAPS. To put the obtained fMRI-results in a broader context, the participants were examined with psychometrically.
The first-person-shooter players, half of whom fulfilled the criteria of computer game dependency, scored significantly higher (p ≤ .05) in 4 out of 6 factors of aggressiveness as measured by the FAF. The general aggression scale of the FAF correlates significantly positively (p≤ .05; r=−.515) with the Perspective Taking Scale of the Interpersonality Reactivity Index (IRI), while a couple of the FAF-Subscales correlate likewise with the Empathic Response Scale.
Within the measurement of resting state activity, differences in the Default Mode-network between players and controls could be shown. The excessive gamers exhibited significant differences within the ACC as compared to controls. This cluster significantly correlates with the FAF-Subscale for self aggression/depression. The calculation of ANOVA design of the functional experiment with picture presentation did not reveal differences in terms of group level. Yet, the analysis of the singular conditions has shown differences in the fusiform gyrus. This may point to unbalanced material for stimulation in terms of visual procession of facial presentations.
The fMRI-results are discussed against the background of the psychometric findings.
Serotonin Syndrome (SS) is an adverse drug reaction that drives mental-status changes, autonomic hyperactivity and neuromuscular abnormalities.
Neuroleptic Malignant Syndrome (NMS) is an idiopathic reaction to dopamine-antagonist that consists of extra-pyramidal symptoms, autonomic dysfunction, hyperthermia, diaphoresis and fluctuating consciousness.
Differential diagnosis is sometimes difficult for their overlapping clinical features. Potentially lethal, both require heightened clinical awareness for prevention, recognition and prompt treatment.
Caucasian 59 years-old woman with Catatonic profile (Scored: severity-17points/ 5 screening in Bush-Francis Catatonia-Rating-Scale).
Past Medical History
- Bipolar Disorder type-2 (25 years of evolution)
15 days before hospitalization, anafranil and fluoxetine treatment was replaced by Trazodone 200 mg/day and venlafaxine 150mg/day. She was also on valpromida and lorazepam 15 mg/day.
Mutism, negativism. No reaction to painful stimuli, stuporous. Diaphoresis, pallor, tremor, axial rigidity without pyramidalism (>lower limbs), high fever (40°C), tachycardia (>100lpm), rhabdomyolysis (CPK reached 17.000, 48 hours after the admission), leukocytosis, upper transaminasas, hiponatremia with hiperpotasemia.
-NMS: Intensity, duration and high CPK are suggestive (Sternbach). This syndrome has been described due to Venlafaxine.
-SS: Combination of Venlafaxine and Trazodone favors but she doesn't have acatisia, hiperreflexia, diarrhea and it wasn't resolved after 96 hours.
Drugs were removed and Lorazepam on high doses (5mg/day) was prescribed. One month later the patient was totally recovered of the episode.
If unsure diagnoses it's priority to remove the causing drugs and supportive care. Afterwards, it can be used benzodiacepines, also dantroleno in SNM.
Brain volume abnormalities and oxidative cell damage have been reported to be pathological characteristics of schizophrenia patients. This study aims to assess a potential relationship between these two characteristics in child and adolescent patients with first-episode psychosis.
26 child and adolescent patients with first-episode early-onset schizophrenia, and 78 age- and gender-matched healthy controls were assessed. Magnetic resonance imaging (MRI) scans were used for volumetric measurements of five cerebral regions: gray matter of the frontal, parietal, and temporal lobes, sulcal cerebrospinal fluid (CSF), and lateral ventricles. Oxidative cell damage was traced by means of a systemic increase in lipid hydroperoxides (LOOH).
Lateral ventricle volumes were significantly higher in schizophrenia patients than in controls. In schizophrenia patients, a significant positive relationship was found between oxidative cell damage (LOOH levels) and the abnormal enlargement of the lateral ventricles, after controlling for total intracranial volume, age, gender, daily smoking status, intelligence quotient (IQ), psychopathology, and time since onset of psychotic symptoms. No association was found between brain volumes and oxidative cell damage in control subjects.
Our results suggest that, in patients with first-episode early-onset schizophrenia, enlargement of the lateral ventricles is associated with chronic oxidative cell damage.
Calcineurin inhibitors can cause neurological and psychiatric side effects. Mild symptoms to severe complications can be found.
We report a 49 year old man who received an orthotopic liver transplantation in May 2010. He received tacrolimus. Ten days later, while he was still in Hospital, he suffered behavioural disorders, being psychotic with delusions of persecution; he called the police thinking that he was being poisened by the staff of the Hospital. Although his Tacrolimus blood concentration had been kept in the normal range, his symptoms improved dramatically when the Tacrolimus was changed into Cyclosporine and Haloperidol was introduced at high doses (7 mg/day) for 10 days when the dose was reduced to 4 mg/day.
Chronic hepatitis VHC 1a in 1994. Received treatment with Interferon alfa in 1997 with no antiviral answer. In 2001 new treatment with pegylated Interferon and Ribavirine with positive virological answer but had to be stopped because of psychoses secondary to treatment. New treatment in March 2006 to March 2007 with Pegasys+Ribavirine with rapid virologycal answer with prophylactic Olanzapine 5 mg during a year with no psychotic symptons. In May 2009, Child Pugh C10, in list for liver transplantation.
We discuss the implications of these findings and the relevance for future clinical care in these patients.
We compared the effectiveness of a multi-component intervention with usual care to treat postnatal depression among low-income mothers in primary care clinics in Santiago, Chile.
Randomised controlled trial. Two hundred and thirty mothers with major depression attending primary care clinics were randomly allocated to either a multi-component intervention or usual care. The multi-component intervention involved a psychoeducational group, systematic monitoring and treatment compliance support, and pharmacotherapy if needed. Data were analysed on an intention-to-treat basis. The main outcome measure was the Edinburgh Postnatal Depression Scale (EPDS) at 3 and 6 months post randomisation.
Approximately 90% of randomised women completed assessments. There was a marked difference in all outcome measures at 3 months, in favour of the multi-component intervention. However, these differences between groups decreased after 3 months. In our primary analysis, the adjusted difference in mean EPDS between the two groups at 3 months was -4.5, 95% C.I. -6.3 to -2.7, p<0.001. There was a sharp decline in the proportion of women on antidepressants after 3 months in both groups.
This intervention considerably improved the outcome of depressed low-income mothers compared to usual care for the first 3 months. However, some of these clinical gains were not maintained thereafter, most likely because a large proportion stopped taking medication. Further refinements to this intervention are needed to ensure treatment compliance after the acute phase.
It is necessary to explore the possibilities of brief intervention of smoking cessation in bipolar disorder (BD) that may act on the level of motivation for change.
Assess the effectiveness of the 3 A's intervention (Ask, Advise and Assess) in a sample of euthymic BD patients.
260 patients diagnosed with BD that were in the euthymic phase and attended the Community care centers of Spain that have been evaluated for their history of smoking habits and current use.
Patients who consumed in the last month qualified for the level of motivation for change (measured by URICA scale); before and after conducting a brief intervention of no more than 30 minutes in total, divided in three contacts during a month, two face to face and one phone contact.
The 49% of the evaluated patients showed an actual use of cigarettes with an average of 28.73 (SD 11.82) years of consumption, with a mean consumption of 21.00 (SD 10.40) cigarettes per day and a level of nicotine dependency of 5.72 (SD 3.03). The 67% of patients were in the Contemplation stage of change, after the intervention 18% progressed to the stage of motivation and 14% ended up in the Stage of Ready for Change. In the third appointment the 21.4% of the smokers reported a reduction of the consumption.
The results seem to confirm its effectiveness, although it should be considered the possibility of carrying out specific tools of brief intervention for this sort of patients.
From 2004, the prescription of Atypical Antipsychotics has increased (Cascade et al.2009), being the third psychotropic drug most prescribed in children. There has been also an increase in the combined use of psychostimulants and antidepressants especially in children with behavioural disorders or anxiety (Comer et al. 2010). the severity of the side effects found in adults with these treatments bring us to the question of the risks of the long-term use of these drugs in child population.
Material and methods:
A bibliographical research is done in Pubmed of clinical essays and studies published between 2000 and 2010. Key words used: risperidone, olanzapine, quetiapine, aripiprazole, sertindole, ziclopentixol, ziprasidone, clotiapine. within the results found, 24 articles are selected being the only ones that show monitoring details of patients in treatment during a period of six months or more.
The aim of this work is to point the safety information published about the use of antipsychotics in children. Safety details were obtained for extrapyramidal, cognitive, endocrine, cardiovascular problems, metabolic syndrome, weight and BMI and liver function.
The results shows the lack of scientific evidence and highlights the need to initiate evaluation projects of efficacy and security of these drug as well as the development of new strategies of safety control of antipsychotic drugs in children.
There are few studies about assessment interventions in the quality of live area and rare are those using the evaluation research design indicated by the methodological scientific literature. The objectives of this research are to test a quality life intervention plan, and to promote mental health at the university. The Yoga formed the basis of the intervention plan developed.
to identify the relationship among the yoga practice, the health status (HS) and the quality of life (QL) experienced by students.
it was used a base line before the intervention and repeated measures at the end of the program intervention (pre-and post-test). Participants were a 67 students enrolled in the university program. Measures: a) A questionnaire to identify the participants' health status and their quality of life; b) The Yoga Intervention (YI) developed once a week, lasting one hour during two months at the students' place. Statistical results indicated the positive impact of YI over the students' health and their quality of life (QL). In general, there was an important difference in the degree of health status experienced by students at the end of the program. Even if some health problems remain the students have a better control over them. The QL measure also showed an important difference by the end of the intervention. In addition participants reported the importance of the Yoga in their lives, including better school performance.
The quality life intervention plan was tested. We encourage YI for promoting mental health in the university setting.
Major depressive disorder is a serious mental disorder with high prevalence and recurrence rate. Once depression is diagnosed, effective pharmacological treatments must be rapidly initiated. Depression etiology and responsiveness to antidepressants have been related to the activity of the hypothalamic-pituitary-adrenal (HPA) axis. Depressed subjects do not respond equally to the same drug. This variability could be explained by interindividual genetic differences related to HPA axis, including CRHR1 receptor.
To associate the salivary cortisol levels, prior to antidepressant treatment, and the CRHR1 rs242939 polymorphism with the response to therapy with fluoxetine.
We performed a pharmacogenetic prospective longitudinal study including clinic follow-up, endocrine and genetic evaluations. After diagnosis, patients started the pharmacotherapy. the severity of the disease and clinical response were evaluated by the Hamilton Depression Rating Scale (HAM-D). Rapid and slow responses were considered as reductions in the HAM-D scores of at least 50% at the third and eight weeks respectively.
157 patients were recruited. Salivary cortisol levels at 8:00AM were lower in rapid responders than in not responders (p-value = 0.0122). No differences were observed after eight weeks of treatment. the rs242939 polymorphism was in Hardy Weinberg equilibrium (p = 0,24) and was significantly associated with early response (p = 0.019). there was no association after two month of therapy.
Discussion and conclusions:
Alterations in the CRHR1 receptor may significantly impact the regulation of stress response. the association observed in this study may be related with some refractoriness in the regulation of CRHR1 gene in non responders.
Normal Pressure Hydrocephalus(Hakim-Adams Syndrome)is a dilation of the ventricles without an increase of intracranial pressure.It corresponds to he classic triade of are gait disturbance, memory/cognitive problems,and urinary incontinence. Manic and depressive symptoms can be related to hydrocephalus occlusus even in the absence of neurological symptoms.These symptoms disappear after neurosurgery or pharmacological treatment.
A 26 year old-male,from Cabo Verde,is interviewed in the Emergency Department in June 2011 presenting disturbance of general behaviour.He is being aggressive and presents flight of ideas.The diagnosis: “Hypomanic state” treated with lorazepam 6 mg/day and Olanzapine 5 mg/day. August 2011, the patient is reevaluated because of his behaviour:soliloquies,laughs,expansive mood, abnormal irritability, easily excited to enthusiasm and irritable humor. He also presents psychomotor agitation associated to delusion of persecution.He has not been taking his medication. No other neurological symptoms are detected.
In Hospital he receives Risperidone 6 mg/day, Clorazepate Dipotassium45mg/day and Lormetazepam 2 mg /day disappearing most of the symptoms.
A MRI was done, presenting triventricular hydrocephalus with absence of intraparenchymal damage.After monitoring the intracranial pressure, Neurosurgery decides not to perform surgery.
In the case of not responding to Risperidone, studies have been published that Aripiprazole (atypical antipsychotic with a unique partial agonistic effect at D2receptors)is effective and safe in the treatment of manic episode. Some publications about the reduction of D2receptors demonstrated that the binding of striatal was reduced in NPH.
Sometimes imaging tests are needed in patients with behavioural disturbance as manic symptoms in order to avoid misdiagnosis and it is crucial for the correct medical and chirurgical treatment.
Respiratory failure is an uncommon complication of pregnancy, affecting only 0.1% of pregnant women; however, it is one of the main indications for intensive care unit (ICU) admission of pregnant and peri-partum women. Pregnancy is a unique physiologic state in women’s lives, and physicians should be familiar with it. Given the low incidence of respiratory failure during pregnancy, there is limited scientific evidence about the best strategies for this population.
Increasing clinical and experimental evidence accumulated during the past few decades supports an important role for dietary advanced glycation endproducts (AGE) in the pathogenesis of many chronic non-infectious diseases, such as type 2 diabetes, CVD and others, that are reaching epidemic proportions in the Western world. Although AGE are compounds widely recognised as generated in excess in the body in diabetic patients, the potential importance of exogenous AGE, mostly of dietary origin, has been largely ignored in the general nutrition audience. In the present review we aim to describe dietary AGE, their mechanisms of formation and absorption into the body as well as their main mechanisms of action. We will present in detail current evidence of their potential role in the development of several chronic non-infectious clinical conditions, some general suggestions on how to restrict them in the diet and evidence regarding the potential benefits of lowering their consumption.
Cystic echinococcosis (CE) is a zoonotic disease caused by a complex of species known as Echinococcus granulosus sensu lato. CE is endemic in Argentina, Chile, Peru, Uruguay and the South part of Brazil. In contrast, little is known regarding the presence of CE in Bolivia. In this study, 35 cysts isolated from livestock (mostly from the Department of La Paz) and 3 from humans (La Paz, Oruro and Potosi) were genetically characterized analysing the sequence of the cox1 gene (1609 bp). In total, 30 cysts (from La Paz, Cochabamba and Beni) were characterized as E. granulosus sensu stricto (3 fertile and 4 non-fertile cysts from sheep, 8 fertile and 12 non-fertile cysts from cattle and 3 fertile cysts from humans). A detailed analysis of the cox1 haplotypes of E. granulosus s.s. is included. Echinococcus ortleppi (G5) was found in 5 fertile cysts from cattle (from La Paz and Cochabamba). Echinococcus intermedius (G7) was identified in 3 fertile cysts from pigs (from Santa Cruz). Additionally, E. granulosus s.s. was detected in 4 dog faecal samples, while E. ortleppi was present in other two dog faecal samples. The implications of these preliminary results in the future implementation of control measures are discussed.