Neurocognitive reorganization of emotional processing following a socio-cognitive intervention in Colombian ex-combatants

Ex-combatants often exhibit atypical Emotional Processing (EP) such as reduced emphatic levels and higher aggressive attitudes. Social Cognitive Training (SCT) addressing socio-emotional components powerfully improve social interaction among Colombian ex-combatants. However, with narrow neural evidence, this study offers a new testimony. A sample of 28 ex-combatants from Colombian illegal armed groups took part in this study, split into 15 for SCT and 13 for the conventional program offered by the Governmental Reintegration Route. All of them were assessed before and after the intervention with a protocol that included an EP task synchronized with electroencephalographic recordings. We drew behavioral scores and brain connectivity (Coherency) metrics from task performance. Behavioral scores yielded no significant effects. Increased post-intervention connectivity in the delta band was observed during negative emotional processing only SCT group. Positive emotions exposed distinctive gamma band connectivity that differentiate groups. These results suggest that SCT can trigger covert neurofunctional reorganization in ex-combatants embarked on the reintegration process even when overt behavioral improvements are not yet apparent. Such covert functional changes may be the neural signature of compensatory mechanisms necessary to reshape behaviors adaptively. This novel framework may inspire cutting-edge translational research at the crossing of neuroscience, sociology, and public policy-making.

Suicidal Ideation Persists Among Individuals Engaged in HIV Care in the Era of Antiretroviral Therapy

Little research has focused on suicidality in the era of successful antiretroviral therapy among those engaged in HIV care. We performed a study of 648 clinic patients who completed a psychological and behavioral annual assessment in 2012. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9), suicidal ideation was measured by the last item of the scale. Anxiety symptoms were measured using the Generalized Anxiety Disorder-7 questionnaire (GAD-7). HIV biomedical markers were abstracted from medical records. Suicidal ideation was reported among 13% (n = 81) of the sample. Individuals endorsing suicidality were more likely to have unsuppressed viral loads, moderate to severe anxiety symptoms and consider themselves to be homeless (p < 0.01 for all). After adjusting for confounders, homeless individuals and those endorsing moderate to severe anxiety symptoms had higher odds of reporting suicidality. Results suggest basic needs must be met to complement HIV management efforts. Furthermore, better understanding of how psychological distress symptoms are expressed and how to manage them may better inform barriers to HIV management.

Reconstructing anatomy from electro-physiological data

Here we show how it is possible to make estimates of brain structure based on MEG data. We do this by reconstructing functional estimates onto distorted cortical manifolds parameterised in terms of their spherical harmonics. We demonstrate that both empirical and simulated MEG data give rise to consistent and plausible anatomical estimates. Importantly, the estimation of structure from MEG data can be quantified in terms of millimetres from the true brain structure. We show, for simulated data, that the functional assumptions which are closer to the functional ground-truth give rise to anatomical estimates that are closer to the true anatomy.

Opportunities to improve antimicrobial use in paediatric intensive care units: a nationwide survey in Spain

Improving antimicrobial use is a complex process that requires an accurate assessment of ongoing problems and barriers. Paediatric intensive care units (PICU) have seldom been assessed from this perspective. Two Internet-based, self-administered surveys were conducted nationwide in Spain between January and February 2014. The first survey aimed to assess those characteristics of Spanish PICUs that could influence antimicrobial prescribing or antimicrobial stewardship. The second survey targeted Spanish PICU physicians and pursued to assess their attitudes and perceptions regarding antimicrobial resistance and antimicrobial use. Information about 29/39 contacted PICUs was obtained. A total of 114/206 (55.3%) paediatric intensivists responded. PICUs were heterogeneous regarding years since foundation, number of beds, type of patients admitted and staffing. Only 11 (37.9%) PICUs had available e-prescribing systems. Procalcitonin was available in 24 (89.1%) PICUs, but there were no procalcitonin-based protocols in 14 (60.9%) of them. Half of surveyed PICUs had implemented antimicrobial stewardship activities. Ninety-eight of the 114 PICU physicians (86%) who participated considered that antimicrobial resistance was a significantly relevant problem for their daily and that improving antimicrobial use in their PICU should be a priority (103; 90.4%). The main perceived problems regarding antimicrobial use were the excessive use of antimicrobials in patients with nonconfirmed infections and excessive use of broad-spectrum antimicrobials. The most valued antimicrobial stewardship interventions were the implementation of protocols to guide antimicrobial therapy. Spanish PICU doctors are aware of the relevance of the problem of antimicrobial resistance and the need to improve antimicrobial use. Targeted interventions should take into account their difficulties and preferences when feasible.

Algorithmic procedures for Bayesian MEG/EEG source reconstruction in SPM

The MEG/EEG inverse problem is ill-posed, giving different source reconstructions depending on the initial assumption sets. Parametric Empirical Bayes allows one to implement most popular MEG/EEG inversion schemes (Minimum Norm, LORETA, etc.) within the same generic Bayesian framework. It also provides a cost-function in terms of the variational Free energy-an approximation to the marginal likelihood or evidence of the solution. In this manuscript, we revisit the algorithm for MEG/EEG source reconstruction with a view to providing a didactic and practical guide. The aim is to promote and help standardise the development and consolidation of other schemes within the same framework. We describe the implementation in the Statistical Parametric Mapping (SPM) software package, carefully explaining each of its stages with the help of a simple simulated data example. We focus on the Multiple Sparse Priors (MSP) model, which we compare with the well-known Minimum Norm and LORETA models, using the negative variational Free energy for model comparison. The manuscript is accompanied by Matlab scripts to allow the reader to test and explore the underlying algorithm.

[Late-onset bipolar disorder following right thalamic injury]

Bipolar disorder occurs in the elderly ages and is frequently associated to a brain injury -cerebrovascular disease. Its diagnosis is based on the finding of an ischemic injury in specific regions of the brain. The case of a 63-year-old male with cardiovascular risk factors, who was admitted due to maniform picture during a two-year long bipolar affective syndrome is presented. The neuroimaging tests showed lacunar infarction in the right thalamus and diffuse foci of ischemia in subcortical white matter having right predominance. Due to the refractoriness to psychodrugs of an endogenomorphic depressive episode, electroconvulsive therapy was prescribed, with normalization of motor component, although without mood stabilization. The therapeutic strategies and the evolution of this form of bipolarity are discussed.

Encapsulation of bovine serum albumin in poly(lactide-co-glycolide) microspheres by the solid-in-oil-in-water technique

Non-aqueous protocols to encapsulate pharmaceutical proteins into biocompatible polymers have gained much attention because they allow for the minimization of procedure-induced protein structural perturbations. The aim of this study was to determine if these advantages could be extended to a semi-aqueous encapsulation procedure, namely the solid-in-oil-in-water (s/o/w) technique. The model protein bovine serum albumin (BSA) was encapsulated into poly(lactide-co-glycolide) (PLG) microspheres by first suspending lyophilized BSA in methylene chloride containing PLG, followed by emulsification in a 1% aqueous solution of poly(vinyl alcohol). By variation of critical encapsulation parameters (homogenization intensity, BSA:PLG ratio, emulsifier concentration, ratio of organic to aqueous phase) an encapsulation efficiency of > 90% was achieved. The microspheres obtained showed an initial burst release of < 20%, a sustained release over a period of about 19 days, and a cumulative release of at least 90% of the encapsulated BSA. Different release profiles were observed when using different encapsulation protocols. These differences were related to differences in the microsphere erosion observed using scanning electron microscopy. Release of BSA was mainly due to simple diffusion or to both diffusion and microsphere erosion. Fourier-transform infrared studies were conducted to investigate the secondary structure of BSA during the encapsulation. Quantification of the alpha-helix and beta-sheet content as well as of overall structural changes showed that the secondary structure of encapsulated BSA was not more perturbed than in the lyophilized powder used initially. Thus, the encapsulation procedure did not cause detrimental structural perturbations in BSA. In summary, the results demonstrate that the s/o/w technique is an excellent alternative to the water-in-oil-in-water technique, which is still mainly used in the encapsulation of proteins in PLG microspheres.

[Comparative study] of beclomethasone and budesonide, with same posology (400 micrograms every 12 hours), in the control of cortico-dependent intrinsic asthma]

Inhaled steroids have rendered an undoubtful benefit in the control of airway inflammation of the asthmatic patients. Our objective was to compare clinical efficacy between budesonide (BUD) and beclomethasona depropionate (BDP), when administered at equal doses (800 micrograms/24 hours). A two ways crossed open clinical trial was designed. Thirty-three steroid dependent chronic asthmatic patients (18 females, 15 males) were included. Ages ranged from 29 to 73 years (mean = 52.5 +/- 11.7). All subjects suffered a severe asthma, with several years of activity (mean = 11.7 +/- 7.8), insufficiently controlled by inhaled steroids and bronchodilators, who required regular systemic steroids supply. The parameters compared were: the patients subjective symptoms punctuation (cough, expectoration, thoracic noises, exercise induce dyspnea and dyspnea at rest), salbutamol needs (number of inhalations/day), additional prednisone needs, sputum eosinophil counts, FEV1 measurement and inespecific bronchial reactivity control (PD20 methacoline). After a baseline week patients received one of the drugs for 6 weeks and, after a lavage week, the other drug was administered for another 6 weeks. All patients improved with both therapies. We got the following conclusions: 1) a significative decrease in salbutamol (p < 0.05-0.001) and prednisone needs (p < 0.05-0.001); 2) this decrease has been more important during BUD therapy, although without significative differences; 3) no significant variations in sputum eosinophils, FEV1 or bronchial reactivity were observed; 4) both drugs, when administered at equal doses, have probed to be equally effective in severe steroid dependent asthma control.

[Comparative study between 10 and 20 mg of cetirizine in the symptomatic treatment of seasonal allergic rhinoconjunctivitis]

Our patients with seasonal allergic rhinoconjunctivitis usually present severe clinical symptoms. A single daily dose of cetirizine 10 mg might be insufficient for these patients. To investigate this hypothesis we compared clinical efficacy and adverse side effects between two daily doses of cetirizine, 10 and 20 mg. We designed a comparative open randomized study, including 38 patients, with hay fever sensitized to local pollens (grass, olive, parietaria judaica, chenopodium album, artemisia vulgaris and plantago lanceolata) diagnosed by clinical history and a positive skin prick test (wheal > 3 mm), 20 women and 18 men, aged 17 to 57 years (x: 31.32 +/- 9.73), living in the same geographic area. Randomly, after a week run in period, 21 subjects received a daily dose of cetirizine 10 mg during 2 weeks, and the other 17 received 10 mg twice a day. The symptomatic score used was based on: sneezes number, nasal itching, nasal secretion, nasal congestion, ocular itching, lacrimation, weight gain, sedation and additional methylprednisolone usage. All symptoms were scored on a 0-3 scale (0: absent; 1: mild; 2: moderate; 3: severe). A mean 8 points daily score during the previous week was required for recruitment. Nasal eosinophilia was determined at baseline and at the end of treatment. The study was conducted in may 1992. We did not find significant differences between the two groups, except in sneezes number and sedation. Both groups improved their symptoms, in comparison with the basal week (p < 0.01) and reduced their oral steroid use (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Cost-effectiveness of various methods of diagnosing hypersensitivity to Alternaria

This study was undertaken for two reasons: 1) It is more difficult to diagnose hypersensitivity to molds than to other allergens, so an evaluation of diagnostic tests was needed. 2) Alternaria is the principal cause of mold sensitization in our area. Sixty-six patients (20 +/- 4 years) were selected and divided into two groups. Group A was made up of patients with rhinitis and/or asthma due to Alternaria sensitization. Group B consisted of patients sensitized to other allergens and patients with nonrespiratory allergic disorders. Skin tests (prick and intradermal), challenge tests (conjunctival, nasal, and bronchial), and specific IgE determination were performed for all patients. A biologically standardized extract of Alternaria tenuis (Alergia e Inmunología Abelló, S. A., Madrid, Spain) obtained from a single batch was used for all tests. Our diagnostic criterion was a clinical history of rhinitis or asthma that coincided with the results of nasal/bronchial challenge. The diagnostic value of the other tests was compared to this criterion. In the group of rhinitic patients, skin tests and conjunctival challenge were more sensitive than specific IgE determination. In asthmatic patients, the most sensitive techniques were nasal and conjunctival challenges, followed by prick and intradermal skin tests, and, lastly, serum specific IgE determination. When rhinitis and asthma were considered jointly, the most sensitive test was conjunctival challenge, followed by skin-prick and intradermal tests. All tests had the same specificity, regardless of disorder. Nasal challenge was positive in all patients. Skin tests are easy to perform, cheap, non-traumatic for the patient, and sufficiently specific and sensitive for the diagnosis of Alternaria hypersensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Hemofiltration in children with renal failure

Hemofiltration is a relatively new and interesting form of treatment for patients with end-stage renal disease. This review considers this new modality for the pediatric patient and compares it with hemodialysis.