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Kidney transplantation has become the treatment of choice for patients with end stage renal disease since it offers an excellent quality of life. Moreover, the economic impact is considerable, particularly beyond the first year. Indeed, the annual cost of a successful renal transplantation is ten fold lower than haemodialysis. But surgical complications remain one of our main concerns. Surgical complications are various. They may be non-specific as haematomas, incision-induced hernias and wound infections. They may also be directly related to the procedure as vascular thrombosis and urinary fistula in the early postoperative period or arterial stenosis and ureteral obstruction in the late post-operative period. The accurate diagnosis and the appropriate management of these complications are the most important tasks for the surgical team. This review is based upon our experience in kidney transplantation and upon the medical published data.

Kidney transplantation has become the treatment of choice for patients with end stage renal disease since it offers an excellent quality of life. Moreover, the economic impact is considerable, particularly beyond the first year. Indeed, the annual cost of a successful renal transplantation is ten fold lower than haemodialysis. But surgical complications remain one of our main concerns. Surgical complications are various. They may be non-specific as haematomas, incision-induced hernias and wound infections. They may also be directly related to the procedure as vascular thrombosis and urinary fistula in the early postoperative period or arterial stenosis and ureteral obstruction in the late post-operative period. The accurate diagnosis and the appropriate management of these complications are the most important tasks for the surgical team. This review is based upon our experience in kidney transplantation and upon the medical published data.

With the rising epidemic of type 2 diabetes worldwide, including the United States, the death and disability due to the suboptimal control of cardiovascular disease associated with this epidemic has made prevention of type 2 diabetes emerge as a primary strategic intervention. Several modalities have been assessed in large randomized controlled trials for diabetes prevention such as lifestyle interventions and various pharmacologic agents. Included in these agents are metformin, thiazolidinediones, acarbose, angiotensin converting enzyme inhibitors, as well as angiotensin receptor blockers. Abrogation of oxidative stress appears to be a common soil hypothesis that explains the favorable effects of these agents on glucose metabolism, including the prevention of diabetes and its complications. This comprehensive review highlights the role of oxidative stress in the pathogenesis of diabetes, with emphasis on the major clinical trials conducted on prevention of type 2 diabetes.

BackgroundLittle is known about the epidemiology of adult attention-deficit hyperactivity disorder (ADHD).AimsTo estimate the prevalence and correlates of DSM-IV adult ADHD in the World Health Organization World Mental Health Survey Initiative.MethodAn ADHD screen was administered to respondents aged 18–44 years in ten countries in the Americas, Europe and the Middle East (n=11422). Masked clinical reappraisal interviews were administered to 154 US respondents to calibrate the screen. Multiple imputation was used to estimate prevalence and correlates based on the assumption of cross-national calibration comparability.ResultsEstimates of ADHD prevalence averaged 3.4% (range 1.2–7.3%), with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). Adult ADHD often co-occurs with other DSM-IV disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for comorbid disorders.ConclusionsAdult ADHD should be considered more seriously in future epidemiological and clinical studies than is currently the case.

Background The Temperament Evaluation of Memphis Pisa Paris and San Diego Auto-questionnaire (TEMPS-A) has been translated and validated into several languages, and used in different subgroups (e.g. clinical, students, company, employees and those with different educational levels). Methods Lebanon is the only country that has validated the TEMPS-A in a national cohort, as part of the Lebanese Evaluation of the Burden of Ailments and Needs Of the Nation (LEBANON). In this paper, we test the suitability of the TEMPS-A for large scale epidemiologic population-based studies. Results 82.1% of the respondents found the TEMPS-A to be easy to understand. The global reports of the Lebanese of their own temperaments paralleled those of the formal sub-scores on the five affective temperament subscales. The majority of respondents (90.3%) felt that their answers on the Lebanese–Arabic TEMPS-A scale represented them throughout their adulthood; the minority who did not were more likely to be older, and to have scored higher on the cyclothymic, and lower on the hyperthymic subscales. Limitation Although the TEMPS-A has been designed for self-administration (auto-questionnaire), this was not practical in all subjects. We nonetheless feel that the interview format is viable as it introduces flexibility with certain subjects in population studies. Conclusions The TEMPS-A appears to be suitable for use in epidemiologic surveys and research.

Objectives: In accordance with consolidated clinical practice, Diagnostic and Statistical Manual of Mental Disorders, 5th edition suggests a key role of collateral information in the evaluation of retrospective childhood attention-deficit/hyperactivity disorder symptoms in adults despite poor evidence supporting its use. This study aims to assess the incremental value of collateral information on the presence of childhood attention-deficit/hyperactivity disorder symptoms when evaluating adults with attention-deficit/hyperactivity disorder. Methods: Adult patients with attention-deficit/hyperactivity disorder ( n = 449) and non-attention-deficit/hyperactivity disorder subjects ( n = 143) underwent an extensive clinical assessment based on Diagnostic and Statistical Manual of Mental Disorders, 4th edition criteria. For patients, retrospective collateral information regarding childhood attention-deficit/hyperactivity disorder was obtained and used to sort them into two groups: agreement ( n = 277) and disagreement ( n = 172) between self- and collateral reports. We compared demographic, clinical and response to treatment profiles among groups to test the relevance of collateral information on the specific issue of childhood attention-deficit/hyperactivity disorder symptoms. Results: Both attention-deficit/hyperactivity disorder groups had higher rates of several comorbidities (oppositional defiant, conduct, substance use and bipolar disorders; all p 2 Conclusion: Although collateral report has an important role for diagnosing attention-deficit/hyperactivity disorder in children, it has no incremental value in the evaluation of childhood attention-deficit/hyperactivity disorder symptoms in adults with a self-reported history of attention-deficit/hyperactivity disorder assessed in clinical settings.

OBJECTIVE: The age-at-onset criterion for separation anxiety disorder was removed in DSM-5, making it timely to examine the epidemiology of separation anxiety disorder as a disorder with onsets spanning the life course, using cross-country data. METHOD: The sample included 38,993 adults in 18 countries in the World Health Organization (WHO) World Mental Health Surveys. The WHO Composite International Diagnostic Interview was used to assess a range of DSM-IV disorders that included an expanded definition of separation anxiety disorder allowing onsets in adulthood. Analyses focused on prevalence, age at onset, comorbidity, predictors of onset and persistence, and separation anxiety-related role impairment. RESULTS: Lifetime separation anxiety disorder prevalence averaged 4.8% across countries (interquartile range [25th-75th percentiles]=1.4%-6.4%), with 43.1% of lifetime onsets occurring after age 18. Significant time-lagged associations were found between earlier separation anxiety disorder and subsequent onset of internalizing and externalizing DSM-IV disorders and conversely between these disorders and subsequent onset of separation anxiety disorder. Other consistently significant predictors of lifetime separation anxiety disorder included female gender, retrospectively reported childhood adversities, and lifetime traumatic events. These predictors were largely comparable for separation anxiety disorder onsets in childhood, adolescence, and adulthood and across country income groups. Twelve-month separation anxiety disorder prevalence was considerably lower than lifetime prevalence (1.0% of the total sample; interquartile range=0.2%-1.2%). Severe separation anxiety-related 12-month role impairment was significantly more common in the presence (42.4%) than absence (18.3%) of 12-month comorbidity. CONCLUSIONS: Separation anxiety disorder is a common and highly comorbid disorder that can have onset across the lifespan. Childhood adversity and lifetime trauma are important antecedents, and adverse effects on role function make it a significant target for treatment. The World Health Organization (WHO) World Mental Health Survey Initiative is supported by NIMH (R01 MH070884, R13 MH066849, and R01 MH069864), the National Institute on Drug Abuse (R01 DA016558), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation and the Fogarty International Center (FIRCA R03-TW006481). The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation Thematic Project (grant 03/00204-3). The ESEMeD project is funded by the European Commission (contracts QLG5-1999-01042, SANCO 2004123, and EAHC 20081308), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP). The Lebanese National Mental Health Survey (L.E.B.A.N.O.N.) is supported by the Lebanese Ministry of Public Health, WHO (Lebanon), National Institutes of Health/Fogarty International Center (R03 TW006481-01). The U.S. National Comorbidity Survey Replication is supported by NIMH (U01-MH60220), with supplemental support from the National Institute of Drug Abuse, the Substance Abuse and Mental Health Services Administration, the Robert Wood Johnson Foundation (grant 044708)

Several investigations documented that Attention-Deficit/Hyperactivity Disorder (ADHD) is better conceptualized as a dimensional disorder. At the same time, the disorder seems to have different neurobiological underpinnings and phenotypic presentation in children compared to adults. Neurodevelopmental genes could explain, at least partly these differences. The aim of the present study was to examine possible associations between polymorphisms in SNAP25, MAP1B and NOS1 genes and ADHD symptoms in Brazilian samples of children/adolescents and adults with ADHD. The youth sample consisted of 301 patients whereas the adult sample comprises 485 individuals with ADHD. Diagnoses of ADHD and comorbidities were based on the Diagnostic and Statistical Manual of Mental Disorders-4th edition criteria. The Swanson, Nolan and Pelham Scale-Version IV (SNAP-IV) was applied by psychiatrists blinded to genotype. The total SNAP-IV scores were compared between genotypes. Impulsivity SNAP-IV scores were also compared according to NOS1 genotypes. Adult patients homozygous for the C allele at SNAP25 rs8636 showed significantly higher total SNAP-IV scores (F = 11.215; adjusted P-value = 0.004). Impulsivity SNAP-IV scores were also significantly different according to NOS1 rs478597 polymorphisms in adults with ADHD (F = 6.282; adjusted P-value = 0.026). These associations were not observed in children and adolescents with ADHD. These results suggest that SNAP25 and NOS1 genotypes influence ADHD symptoms only in adults with ADHD. Our study corroborates previous evidences for differences in the genetic contribution to adult ADHD compared with childhood ADHD.

Objectives Data on the mental health of older adults in the Middle East is lacking. Prevalence of mental disorders in Lebanese older adults (age: 60+ years) as well as accounts of their attitude towards seeking professional help for mental disorders were investigated. The results of older adults were compared to a younger age group (18–59 years). Design Cross-sectional nationally representative study, using data from the Lebanese Evaluation of the Burden of Ailments and Needs of the Nation. Setting Community-based epidemiologic survey. Participants Community-dwelling adults (N = 2,857) in Lebanon. Measurements Mental disorders were evaluated using the World Health Organization Composite International Diagnostic Interview. Results The lifetime and 12-month prevalences of having "any mental disorder" in older adults (N = 593) were 17.4% and 10.6%, respectively, and were significantly lower than the prevalence in younger adults (25.7% and 18.5%, respectively). Female sex, low household income, social disability, and exposure to war trauma were significant correlates of 12-month mental disorders in older adults. Of those with a 12-month mental disorder, 16.0% sought professional help for their condition in the past year. Conclusions As shown in other epidemiologic studies, the prevalence of mental disorders in Lebanon was lower in older adults as compared to younger adults. Several factors in epidemiologic studies, however, may contribute to the underdiagnosis of mental disorders in older adults. No significant differences in attitude towards mental health services were found between older and younger age groups. The importance of interventions that improve the social relationships of older adults is highlighted.

BackgroundPrevious research suggests that many people receiving mental health treatment do not meet criteria for a mental disorder but are rather ‘the worried well’.AimsTo examine the association of past-year mental health treatment with DSM-IV disorders.MethodThe World Health Organization's World Mental Health (WMH) Surveys interviewed community samples of adults in 23 countries (n = 62 305) about DSM-IV disorders and treatment in the past 12 months for problems with emotions, alcohol or drugs.ResultsRoughly half (52%) of people who received treatment met criteria for a past-year DSM-IV disorder, an additional 18% for a lifetime disorder and an additional 13% for other indicators of need (multiple subthreshold disorders, recent stressors or suicidal behaviours). Dose–response associations were found between number of indicators of need and treatment.ConclusionsThe vast majority of treatment in the WMH countries goes to patients with mental disorders or other problems expected to benefit from treatment.

BackgroundCourse and predictors of persistence of attention deficit hyperactivity disorder (ADHD) in adults are still largely unknown. Neurobiological and clinical differences between child and adult ADHD raise the need for follow-up studies of patients diagnosed during adulthood. This study investigates predictors of ADHD persistence and the possibility of full remission 7 years after baseline assessment.MethodA 7-year follow-up study of adults with ADHD (n = 344, mean age 34.1 years, 49.9% males) was conducted. Variables from different domains (social demographics, co-morbidities, temperament, medication status, ADHD measures) were explored with the aim of finding potential predictors of ADHD persistence.ResultsRetention rate was 66% (n = 227). Approximately a third of the sample (n = 70, 30.2%) did not maintain ADHD criteria and 28 (12.4%) presented full remission (p p = 0.01), oppositional defiant disorder (OR 3.12, 95% CI 1.20–8.11, p = 0.02), and social phobia (OR 3.59, 95% CI 1.12–11.47, p = 0.03).ConclusionsDespite the stage of brain maturation in adults suggests stability, approximately one third of the sample did not keep full DSM-IV diagnosis at follow-up, regardless if at early, middle or older adulthood. Although full remission is less common than in childhood, it should be considered as a possible outcome among adults.

Resume En transplantation, le greffon est le nerf de la guerre. Sans lui, point de greffe. Et quand il est disponible, il doit etre anatomiquement et fonctionnellement parfait. La vie du receveur en depend. C'est dire la minutie avec laquelle il doit etre preleve et conserve. Neuf fois sur dix, les greffons sont preleves sur un donneur en etat de mort encephalique et deux fois sur trois la procedure est multiorganes. Cœur, poumons, foie, reins, pancreas, intestin, os, cornees et parfois peau ! Prendre le maximum, quand cela est possible, pour reduire l'attente cruelle parce que mortelle des malades inscrits en liste de greffe. L'operation est complexe. Elle reunit plusieurs equipes et il faut faire tres vite. Elle est heureusement parfaitement reglee. Tout bon chirurgien doit en connaitre le detail parce qu'il y sera necessairement confronte un jour, quel que soit le lieu de son exercice. Un chapitre de techniques chirurgicales se lit en essayant de vivre l'atmosphere qui entoure la procedure. Alors imaginez que votre geste a une dimension inhabituelle. Une famille est en deuil, un homme a accepte de donner et votre implication, qui certes concerne un « mort », va donner la vie. Dernier conseil. Comme vous etes surement un chirurgien chevronne de votre specialite, attachez-vous particulierement a comprendre le prelevement de l'organe qui ne vous concerne pas. C'est la que se reconnaissent les « bons preleveurs ».

Resume Objectif Evaluer l’impact de recommandations locales de prise en charge de la pathologie infectieuse urinaire, diffusees au sein d’un hopital universitaire. Methodes Etude de type avant/apres, dans 2 services du CHU de Nantes. La qualite des prescriptions etait jugee par 2 criteres : conformite par rapport aux recommandations diffusees et justification ou attitude therapeutique indiquee dans la situation clinique rencontree, fondees sur le jugement conjoint du choix de la molecule, de la posologie et de la duree prescrite. Les ecarts aux recommandations ont ete identifies et evalues. Resultats Mille quatre-vingt-six infections urinaires (prostatites, pyelonephrites aigues, autres infections hautes sans cadre nosocomial defini, infections sur sonde) ont ete repertoriees sur 2 periodes de 12 mois, avant et apres la diffusion des recommandations. Les recommandations etaient applicables dans 313 cas (soit 30 %). Globalement, apres la diffusion des recommandations, le taux de prescriptions justifiees n’etait pas modifie (passant de 41,8 a 38,7 %, p = 0,299), mais la proportion de prescriptions strictement conformes a diminue (de 30,4 a 15,7 %, p = 0,0022). Les proportions de prescriptions conformes et justifiees etaient differentes en medecine (respectivement 45,0 et 46,6 %,) et en urologie (respectivement 13,1 et 36,5 %). Conclusion La diffusion de recommandations per se ne semble pas ameliorer systematiquement la qualite du traitement antibiotique des infections urinaires a l’hopital.

Several measures have been proposed to evaluate temperament traits and their connection to psychopathology. One recent development in this area is the TEMPS-A (Temperament Evaluation of Memphis, Pisa, Paris and San Diego Auto-questionnaire). The purpose of this study is to psychometrically validate the Lebanese-Arabic version of TEMPS-A.The TEMPS-A was adapted to Lebanese-Arabic and administered to 1320 Lebanese (593 males, 727 females, mean age of 43+/-16 years) representing the adult population of Lebanon (total population: 4.2 million). This section was added by the Institute for Development Research and Applied Care (IDRAC) to the cross-national World Mental Health (WMH) initiative Lebanese chapter. Chronbach-alpha and Pearson's correlation were used to test the internal consistency and correlation among the subscales. Factor loadings were calculated using the principal component analysis with varimax rotation.Internal consistency varied between 0.66 (depressive) and 0.88 (anxious). As formulated by the originators of the instrument, five main factors emerged from the factor analysis, with some overlap between the depressive, the cyclothymic and the anxious temperaments, but almost none for the hyperthymic and irritable temperaments. The strongest correlation was observed between the anxious and the cyclothymic temperament subscales. Women had higher mean scores on the depressive, cyclothymic, and anxious subscales, whereas men scored higher on the hyperthymic subscale. There was a trend of increase by age in scores of the depressive subscale, and a trend of decrease in the cyclothymic and irritable subscales.The Lebanese-Arabic TEMPS-A has a good internal consistency, is easy to use, and opens new and interesting research avenues in large epidemiologic national studies on temperament.

Resume Objectifs. – Presenter les donnees actuelles sur l'anesthesie pour la chirurgie prostatique en insistant sur l'analyse et la prevention des risques specifiques a cette chirurgie, le choix d'un schema anesthesique adapte au geste chirurgical et au patient, la reconnaissance et le traitement des complications perioperatoires specifiques a la chirurgie prostatique. Source des donnees. – Recherche informatisee a partir de Pubmed® des articles sur le theme (1990–2004) et analyse des bibliographies. Synthese des donnees. – Il existe un consensus sur la necessite d'urines verifiees steriles en preoperatoire de toute intervention chirurgicale portant sur la prostate. Le risque thromboembolique de la prostatectomie radicale pour cancer est comparable a celui de la chirurgie pelvienne carcinologique et ce risque est prolonge. En raison de leur âge, les patients presentent les tares cardiovasculaires, respiratoires, neurologiques et metaboliques du sujet âge ou du vieillard. Les postures utilisees dans la chirurgie de la prostate ont des retentissements hemodynamiques et respiratoires et sont a l'origine de lesions neurologiques et musculaires. L'hemodilution normovolemique aigue est une technique d'epargne transfusionnelle adaptee a la prostatectomie radicale retropubienne. La prostatectomie radicale laparoscopique est en plein developpement. Dans la chirurgie de l'adenome benin, le volume a resequer conditionne le choix de la technique chirurgicale : endoscopique jusqu'a 80 g, transvesicale au-dessus. L'anesthesie rachidienne est adaptee a la resection transurethrale de la prostate, et doit procurer un niveau analgesique atteignant T9–T10. Elle presente l'avantage de permettre le depistage precoce des complications liees a la resorption du liquide d'irrigation vesicale. Les bacteriemies sont frequentes lors des resections, malgre l'antibioprophylaxie recommandee.

Resume Objectif. – Evaluer la qualite des prescriptions d'antibiotiques pour le traitement des infections urinaires : prostatites, pyelonephrites aigues, infections du tractus urinaire sur sonde, autres infections hautes. Patients et methodes. – La conformite des prescriptions vis-a-vis de recommandations locales a ete evaluee retrospectivement dans deux services (medecine et chirurgie urologique) du CHU de Nantes, considerant simultanement : choix de la molecule, posologie et duree du traitement. Les ecarts etaient majeurs (non conformite du choix de la molecule, prescription de molecules inactives d'apres l'antibiogramme, abstention de traitement a tort) ou mineurs (prescription d'un traitement a tort, d'une bitherapie inappropriee, non association en bitherapie lorsque necessaire, absence de desescalade, duree du traitement, trop longue, ou trop courte, prescriptions decalee, erreur de posologie). Resultats. – Mille quatre-vingt-six cas ont ete analyses sur 24 mois. La proportion de prescriptions conformes etait de 40,1 % (46,6 % en medecine et de 36,5 % en urologie). En medecine (226 ecarts sur 389 prescriptions), la proportion d'ecarts majeurs etait de 9,8 %, dont 44,7 % d'abstentions de traitement a tort. En urologie (539 ecarts sur 695 prescriptions), les ecarts concernant les durees etaient parmi les plus frequents. La proportion d'ecarts majeurs etait de 19,9 %, dont 60,7 % de non conformites de la molecule. Traitements a tort et bitherapies inappropriees etaient fortement representes. Conclusions. – Pour les deux services, ITU/sonde et ITU diverses representaient plus de la moitie des infections rencontrees, bien que les moins detaillees dans les recommandations fournies.

The goal of multiple organ procurement is to retrieve intact organs fully. This goal can only be reached if the organ dissection and preservation are optimal.

This is the first published study from an Arab Near Eastern country to examine the comorbidity of substance abuse with other psychiatric disorders. All inpatients with substance abuse/dependence (present or past) admitted to the psychiatry unit at St. George Hospital (Lebanon) between 1979 and 1992 (N = 222) constituted the study sample. Of these, 64.9% were found to have comorbid psychiatric disorders with specific relations between individual substances and psychiatric diagnoses identified such as cocaine and bipolar disorder (42.1%), and cannabis and schizophrenia (44.8%). Patients with no axis I disorder were predominantly heroin users, most of them having antisocial personality disorder. Polydrug abuse was found among 44.9% of patients, and most of the benzodiazepine abusers belonged to this category. The pattern of comorbidity of psychiatric and substance use disorders in this Near East inpatient population compares well with findings from the Western hemisphere: cultural factors (including war) do not seem to have much of an effect on the different forms of dual diagnoses. This adds weight to the already existing literature on the need for careful psychiatric assessment in the treatment of substance abuse. Copyright 2002, Elsevier Science (USA). All rights reserved.

In the above article (Auerbach et al.2016) there was an omission in a funding source which should have been listed in the acknowledgements section of the article. ‘Liu’s work was supported in part by a training grant from the National Institute of Mental Health (T32MH017119)’ This has now been included in the original version of the article.

Importance The inverse social gradient in mental disorders is a well-established research finding with important implications for causal models and policy. This research has used traditional objective social status (OSS) measures, such as educational level, income, and occupation. Recently, subjective social status (SSS) measurement has been advocated to capture the perception of relative social status, but to our knowledge, there have been no studies of associations between SSS and mental disorders. Objectives To estimate associations of SSS with DSM-IV mental disorders in multiple countries and to investigate whether the associations persist after comprehensive adjustment of OSS. Design, Setting, and Participants Face-to-face cross-sectional household surveys of community-dwelling adults in 18 countries in Asia, South Pacific, the Americas, Europe, and the Middle East (N = 56 085). Subjective social status was assessed with a self-anchoring scale reflecting respondent evaluations of their place in the social hierarchies of their countries in terms of income, educational level, and occupation. Scores on the 1 to 10 SSS scale were categorized into 4 categories: low (scores 1-3), low-mid (scores 4-5), high-mid (scores 6-7), and high (scores 8-10). Objective social status was assessed with a wide range of fine-grained objective indicators of income, educational level, and occupation. Main Outcomes and Measures The Composite International Diagnostic Interview assessed the 12-month prevalence of 16 DSM-IV mood, anxiety, and impulse control disorders. Results The weighted mean survey response rate was 75.2% (range, 55.1%-97.2%). Graded inverse associations were found between SSS and all 16 mental disorders. Gross odds ratios (lowest vs highest SSS categories) in the range of 1.8 to 9.0 were attenuated but remained significant for all 16 disorders (odds ratio, 1.4-4.9) after adjusting for OSS indicators. This pattern of inverse association between SSS and mental disorders was significant in 14 of 18 individual countries, and in low-, middle-, and high-income country groups but was significantly stronger in high- vs lower-income countries. Conclusions and Relevance Significant inverse associations between SSS and numerous DSM-IV mental disorders exist across a wide range of countries even after comprehensive adjustment for OSS. Although it is unclear whether these associations are the result of social selection, social causation, or both, these results document clearly that research relying exclusively on standard OSS measures underestimates the steepness of the social gradient in mental disorders.

Tesis de Maestría

Background: The goal of this paper is to map the total occurrence and evaluate the risk of co-occurrence of childhood adversities (CA) and a wide variety of childhood traumatic events (including war) in a national sample.Method:The nationally representative sample included 2,857 respondents and the instrument used was the Composite International Diagnostic Interview which screened for all CAs and traumatic events.Results:27.9% experienced CAs; the most common were parental death and parental mental/substance use disorder. 70.6% experienced a war-related traumatic event during their lifetime, and around half of them (38.1%) experienced it below the age of 18 years. 51.3% of the subjects experienced a traumatic event not related to war during their lifetime, and 19.2% experienced it before the age of 18 years. Sexual abuse, being a refugee during war, and experiencing a natural disaster were associated with female gender. Having any CA was associated with active war exposure (OR: 4.2, CI: 2.0-8.6); war-related direct personal trauma (OR: 3.9, CI: 1.5-10.0); war-related trauma to others (OR: 2.4, CI: 1.3-4.4); non-war direct personal trauma (OR: 3.8, CI: 2.0-7.4); and any non-war childhood traumatic event (OR: 1.9, CI: 1.1-3.1).Conclusion:Childhood is awash with adversities and traumatic events that co-occur and should be measured simultaneously; otherwise, the effects of a subset of traumata or adversities could be wrongly thought to be the contributor to negative outcomes under study.

ObjectiveThis study aimed to study the comorbidity of common mental disorders (CMDs) and cancer, and the mental health treatment gap among community residents with active cancer, cancer survivors and cancer-free respondents in 13 high-income and 11 low-middle-income countries. MethodsData were derived from the World Mental Health Surveys (N=66,387; n=357 active cancer, n=1373 cancer survivors, n=64,657 cancer-free respondents). The World Health Organization/Composite International Diagnostic Interview was used in all surveys to estimate CMDs prevalence rates. Respondents were also asked about mental health service utilization in the preceding 12months. Cancer status was ascertained by self-report of physician's diagnosis. ResultsTwelve-month prevalence rates of CMDs were higher among active cancer (18.4%, SE=2.1) than cancer-free respondents (13.3%, SE=0.2) adjusted for sociodemographic confounders and other lifetime chronic conditions (adjusted odds ratio (AOR)=1.44, 95% CI 1.05-1.97). CMD rates among cancer survivors (14.6%, SE=0.9) compared with cancer-free respondents did not differ significantly (AOR=0.95, 95% CI 0.82-1.11). Similar patterns characterized high-income and low-middle-income countries. Of respondents with active cancer who had CMD in the preceding 12months, 59% sought services for mental health problems (SE=5.3). The pattern of service utilization among people with CMDs by cancer status (highest among persons with active cancer, lower among survivors and lowest among cancer-free respondents) was similar in high-income (64.0%, SE=6.0; 41.2%, SE=3.0; 35.6%, SE=0.6) and low-middle-income countries (46.4%, SE=11.0; 22.5%, SE=9.1; 17.4%, SE=0.7). ConclusionsCommunity respondents with active cancer have higher CMD rates and high treatment gap. Comprehensive cancer care should consider both factors. Copyright (c) 2013 John Wiley & Sons, Ltd.

Post-traumatic stress disorder (PTSD) should be one of the most preventable mental disorders, since many people exposed to traumatic experiences (TEs) could be targeted in first response settings in the immediate aftermath of exposure for preventive intervention. However, these interventions are costly and the proportion of TE-exposed people who develop PTSD is small. To be cost-effective, risk prediction rules are needed to target high-risk people in the immediate aftermath of a TE. Although a number of studies have been carried out to examine prospective predictors of PTSD among people recently exposed to TEs, most were either small or focused on a narrow sample, making it unclear how well PTSD can be predicted in the total population of people exposed to TEs. The current report investigates this issue in a large sample based on the World Health Organization (WHO)'s World Mental Health Surveys. Retrospective reports were obtained on the predictors of PTSD associated with 47,466 TE exposures in representative community surveys carried out in 24 countries. Machine learning methods (random forests, penalized regression, super learner) were used to develop a model predicting PTSD from information about TE type, socio-demographics, and prior histories of cumulative TE exposure and DSM-IV disorders. DSM-IV PTSD prevalence was 4.0% across the 47,466 TE exposures. 95.6% of these PTSD cases were associated with the 10.0% of exposures (i.e., 4,747) classified by machine learning algorithm as having highest predicted PTSD risk. The 47,466 exposures were divided into 20 ventiles (20 groups of equal size) ranked by predicted PTSD risk. PTSD occurred after 56.3% of the TEs in the highest-risk ventile, 20.0% of the TEs in the second highest ventile, and 0.0-1.3% of the TEs in the 18 remaining ventiles. These patterns of differential risk were quite stable across demographic-geographic sub-samples. These results demonstrate that a sensitive risk algorithm can be created using data collected in the immediate aftermath of TE exposure to target people at highest risk of PTSD. However, validation of the algorithm is needed in prospective samples, and additional work is warranted to refine the algorithm both in terms of determining a minimum required predictor set and developing a practical administration and scoring protocol that can be used in routine clinical practice.

This article reviews recent findings in the epidemiology of childhood psychiatric disorders in the developing world and the relationship of epidemiology to system development. Examples of systems developed in the Third World are discussed. The experience with attention-deficit/hyperactivity disorder and the development of a comprehensive system of care around it in Lebanon are described. Cultural factors that affect special populations in childhood mental health are examined. The article concludes with recommendations for systems development in Third World countries.

Background: The measurement of exposure to war in large epidemiological studies necessitates the use of easily administered and reliable questionnaires that cover a range of war events. The War Event Questionnaire (WEQ) was designed by our group to address these issues and has proved to be quite easy to administer. The aim of this study is to establish the inter-rater reliability of the WEQ. Method: Two trained interviewers alternated in administering parts I and II of the WEQ. Results: The Kappa statistics used to calculate the degree of agreement between the two raters ranged from 0.281 to 0.774 for part I events and from 0.189 to 1.000 for part II events. Conclusion: The WEQ has proved to be a useful instrument that addresses both objective and the subjective war experiences; it is a fairly reliable instrument and has helped us avoid tautological assessment of the mental health effects of war.

Background. There are few cross-national comparisons of the rates of suicide ideation and attempts across diverse countries. Nine independently conducted epidemiological surveys using similar diagnostic assessment and criteria provided an opportunity to obtain that data.Methods. Suicide ideation and attempts were assessed on the Diagnostic Interview Schedule in over 40000 subjects drawn from the United States, Canada, Puerto Rico, France, West Germany, Lebanon, Taiwan, Korea and New Zealand.Results. The lifetime prevalence rates/100 for suicide ideation ranged from 2·09 (Beirut) to 18·51 (Christchurch, New Zealand). Lifetime prevalence rates/100 for suicide attempts ranged from 0·72 (Beirut) to 5·93 (Puerto Rico). Females as compared to males had only marginally higher rates of suicidal ideation in most countries, reaching a two-fold increase in Taiwan. Females as compared to males had more consistently higher rates for suicide attempts, reaching a two- to three-fold increase in most countries. Suicide ideation and attempts in most countries were associated with being currently divorced/separated as compared to currently married.Conclusions. While the rates of suicide ideation varied widely by country, the rates of suicide attempts were more consistent across most countries. The variations were only partly explained by variation in rates of psychiatric disorders, divorce or separation among countries and are probably due to cultural features that we do not, as yet, understand.

This article examines the effect of war events and pre-war depression on the prevalence of major depression during war. A total of 658 subjects aged 18-65 years were randomly selected from four Lebanese communities differentially exposed to the Lebanon Wars and were interviewed using the Diagnostic Interview Schedule (Arabic version). The individual levels of exposure to war events were assessed through a War Events Questionnaire. The lifetime prevalence of the DSM-III-R-defined major depression varied across the four communities from 16.3 to 41.9%; the final parameters predicting major depression since the onset of the wars were: depression before the wars and exposure to the wars. Both, individual levels of exposure to war and a history of pre-war depression, predict the development of depression during war.

The handgrip test has long been used as a test for investigating cardiac autonomic neuropathy in diabetic patients. However, the factors involved in the hemodynamic response to the handgrip test have not been thoroughly studied. The aim of this study was to investigate blood pressure (BP) and heart rate (HR) responses to an isometric test in non-insulin-dependent diabetics (NIDDs) and to correlate the results with vagal function evaluated by three standardized tests and with plasma insulin levels. Fifty-five NIDDs, 35 of whom had one to three abnormal parasympathetic tests (PS+), were compared with 10 healthy control subjects. Fasting and postprandial plasma insulin levels were significantly higher in the PS+ than in the PS- patients. Resting HR correlated significantly with log fasting and postprandial insulin. In PS+ NIDDs, resting HR was significantly higher than in PS- patients. Age-matched comparisons also showed that resting systolic BP was significantly higher in PS+ patients than in controls. In PS- patients, the mean acceleration of HR was significantly higher than in the control group from the second to the fifth minute, and the BP response was also higher than in controls. These data suggest that (1) sympathetic response to an isometric exercise is increased in PS- NIDDs; (2) cardiac parasympathetic dysfunction is associated with a more severe insulin resistance; and (3) the subsequent higher plasma insulin level may contribute to the increase in resting HR and BP through sympathetic activation while limiting the hemodynamic response to an isometric exercise through its vasodilative effect.

BACKGROUND: Although only a few people exposed to a traumatic event (TE) develop posttraumatic stress disorder (PTSD), symptoms that do not meet full PTSD criteria are common and often clinically significant. Individuals with these symptoms sometimes have been characterized as having subthreshold PTSD, but no consensus exists on the optimal definition of this term. Data from a large cross-national epidemiologic survey are used in this study to provide a principled basis for such a definition. METHODS: The World Health Organization World Mental Health Surveys administered fully structured psychiatric diagnostic interviews to community samples in 13 countries containing assessments of PTSD associated with randomly selected TEs. Focusing on the 23,936 respondents reporting lifetime TE exposure, associations of approximated DSM-5 PTSD symptom profiles with six outcomes (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate implications of different subthreshold definitions. RESULTS: Although consistently highest outcomes for distress-impairment, suicidality, comorbidity, and PTSD symptom duration were observed among the 3.0% of respondents with DSM-5 PTSD rather than other symptom profiles, the additional 3.6% of respondents meeting two or three of DSM-5 criteria B-E also had significantly elevated scores for most outcomes. The proportion of cases with threshold versus subthreshold PTSD varied depending on TE type, with threshold PTSD more common following interpersonal violence and subthreshold PTSD more common following events happening to loved ones. CONCLUSIONS: Subthreshold DSM-5 PTSD is most usefully defined as meeting two or three of DSM-5 criteria B-E. Use of a consistent definition is critical to advance understanding of the prevalence, predictors, and clinical significance of subthreshold PTSD. This work was supported by the National Institute of Mental Health (Grant Nos. R01 MH070884 and R01 MH093612-01), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the United States Public Health Service (Grant Nos. R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (Grant No. FIRCA R03-TW006481).The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation Thematic Project Grant No. 03/00204-3. The European Study of the Epidemiology of Mental Disorders (ESEMeD) project is funded by the European Commission (Contracts QLG5-1999-01042, Health and Consumer Affairs (SANCO) 2004123, and Executive Agency for Health and Consumers (EACH) 20081308); the Piedmont Region, Italy; Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (Grant No. Fund for Health of Spain (FIS) 00/0028); Ministerio de Ciencia y Tecnología, Spain (Grant No. SAF 2000-158-CE); Departament de Salut, Generalitat de Catalunya, Spain; Instituto de Salud Carlos III (Grant Nos. Networked Biomedical Research Centres (CIBER) CB06/02/0046 and Cooperative Health Research Thematic Networks (RETICS) RD06/0011 REM-TAP).The World Mental Health Japan Survey is supported by the Grant for Research on Psychiatric and Neurological Diseases and Mental Health (Grant Nos. H13-SHOGAI-023, H14-TOKUBETSU-026, and H16-KOKORO-013) from the Japan Ministry of Health, Labour and Welfare.The Mexican National Comorbidity Survey is supported by The National Institute of Psychiatry Ramon de la Fuente (Grant No. INPRFMDIES 4280) and by the National Council on Science and Technology (Grant No. CONACyT-G30544-H).The U.S. National Comorbidity Survey Replication is supported by the National Institute of Mental Health (Grant No. U01-MH60220) with supplemental support the Robert Wood Johnson Foundation (Grant No. 044708).

Hyperekplexia is a syndrome of readily provoked startle responses, alongside episodic and generalized hypertonia, that presents within the first month of life. Inhibitory glycine receptors are pentameric ligand-gated ion channels with a definitive and clinically well stratified linkage to hyperekplexia. Most hyperekplexia cases are caused by mutations in the α1 subunit of the human glycine receptor (hGlyR) gene (GLRA1). Here we analyzed 68 new unrelated hyperekplexia probands for GLRA1 mutations and identified 19 mutations, of which 9 were novel. Electrophysiological analysis demonstrated that the dominant mutations p.Q226E, p.V280M, and p.R414H induced spontaneous channel activity, indicating that this is a recurring mechanism in hGlyR pathophysiology. p.Q226E, at the top of TM1, most likely induced tonic activation via an enhanced electrostatic attraction to p.R271 at the top of TM2, suggesting a structural mechanism for channel activation. Receptors incorporating p.P230S (which is heterozygous with p.R65W) desensitized much faster than wild type receptors and represent a new TM1 site capable of modulating desensitization. The recessive mutations p.R72C, p.R218W, p.L291P, p.D388A, and p.E375X precluded cell surface expression unless co-expressed with α1 wild type subunits. The recessive p.E375X mutation resulted in subunit truncation upstream of the TM4 domain. Surprisingly, on the basis of three independent assays, we were able to infer that p.E375X truncated subunits are incorporated into functional hGlyRs together with unmutated α1 or α1 plus β subunits. These aberrant receptors exhibit significantly reduced glycine sensitivity. To our knowledge, this is the first suggestion that subunits lacking TM4 domains might be incorporated into functional pentameric ligand-gated ion channel receptors.

Pyoderma gangrenosum is an inflammatory disease of unknown etiology, commonly mistaken for an infection. Here, we report the case of a 55-year-old woman with an infectious process that was initially misdiagnosed as pyoderma gangrenosum and treated accordingly. We also discuss the criteria and the methods available to diagnose infections and pyoderma gangrenosum correctly.

BACKGROUND: Current trends in population aging affect both recipients and providers of informal family caregiving, as the pool of family caregivers is shrinking while demand is increasing. Epidemiological research has not yet examined the implications of these trends for burdens experienced by aging family caregivers. Method Cross-sectional community surveys in 20 countries asked 13 892 respondents aged 50+ years about the objective (time, financial) and subjective (distress, embarrassment) burdens they experience in providing care to first-degree relatives with 12 broadly defined serious physical and mental conditions. Differential burden was examined by country income category, kinship status and type of condition. RESULTS: Among the 26.9-42.5% respondents in high-, upper-middle-, and low-/lower-middle-income countries reporting serious relative health conditions, 35.7-42.5% reported burden. Of those, 25.2-29.0% spent time and 13.5-19.4% money, while 24.4-30.6% felt distress and 6.4-21.7% embarrassment. Mean caregiving hours per week in those giving any time were 16.6-23.6 (169.9-205.8 h/week per 100 people aged 50+ years). Burden in low-/lower-middle-income countries was 2- to 3-fold higher than in higher-income countries, with any financial burden averaging 14.3% of median family income in high-, 17.7% in upper-middle-, and 39.8% in low-/lower-middle-income countries. Higher burden was reported by women than men and for conditions of spouses and children than parents or siblings. CONCLUSIONS: Uncompensated family caregiving is an important societal asset that offsets rising formal healthcare costs. However, the substantial burdens experienced by aging caregivers across multiple family health conditions and geographic regions threaten the continued integrity of their caregiving capacity. Initiatives supporting older family caregivers are consequently needed, especially in low-/lower-middle-income countries. The World Health Organization World Mental Health (WMH) Survey Initiative is supported by the National Institute of Mental Health (NIMH; R01 MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R13-MH066849, R01-MH069864, and R01 DA016558), the Fogarty International Center (FIRCA R03-TW006481). The São Paulo Megacity Mental Health Survey is supported by the State of São Paulo Research Foundation (FAPESP) Thematic Project Grant 03/00204-3. The ESEMeD project is funded by the European Commission (Contracts QLG5-1999-01042; SANCO 2004123), the Piedmont Region (Italy), Fondo de Investigación Sanitaria, Instituto de Salud Carlos III, Spain (FIS 00/0028), Ministerio de Ciencia y Tecnología, Spain (SAF 2000-158-CE), Departament de Salut, Generalitat de Catalunya, Spain, Instituto de Salud Carlos III (CIBER CB06/02/0046, RETICS RD06/0011 REM-TAP). The Lebanese National Mental Health Survey (LEBANON) is supported by the Lebanese Ministry of Public Health, the WHO (Lebanon), National Institute of Health / Fogarty International Center (R03 TW006481-01). The Mexican National Comorbidity Survey (MNCS) is supported by The National Institute of Psychiatry Ramon de la Fuente (INPRFMDIES 4280) and by the National Council on Science and Technology (CONACyT-G30544-H). The US National Comorbidity Survey Replication (NCS-R) is supported by the National Institute of Mental Health (NIMH; U01-MH60220) with supplemental support from the Robert Wood Johnson Foundation (RWJF; Grant 044708)

Hyperglycemia is common in hospitalized patients and associated with adverse clinical outcomes. In hospitalized patients, multiple factors contribute to hyperglycemia, such as underlying medical conditions, pathophysiological stress, and medications. The development of transient insulin resistance is a known cause of hyperglycemia in both diabetic and nondiabetic patients. Though physicians are familiar with common diseases that are known to be associated with insulin resistance, the majority of us rarely come across a case of extreme insulin resistance. Here, we report a case of prolonged course of extreme insulin resistance in a patient admitted with diabetic ketoacidosis (DKA) and acute myocardial infarction (MI). The main purpose of this paper is to review the literature to identify the underlying mechanisms of extreme insulin resistance in a patient with DKA and MI. We will also briefly discuss the different clinical conditions that are associated with insulin resistance and a general approach to a patient with severe insulin resistance.

We present the design and the basic features of variable symbol-rate demodulators for digital TV broadcasting by cable and satellite. The demodulators are fully compliant with the DVB recommendations which were later published as ETSI standards. The satellite demodulator employs the QPSK signal constellation and can handle symbol rates up to 30 Mbaud. The cable demodulator is configurable to operate with all QAM signal formats from 16-QAM to 256-QAM, and handles symbol rates up to 7 Mbaud which is the maximum possible symbol rate in an 8 MHz channel. Both demodulators employ polyphase filtering for variable symbol rate operation and fully-digital carrier recovery loops with an extended frequency acquisition range. In addition, the cable demodulator includes a blind equalizer with smooth transition to a conventional adaptation algorithm after convergence.

Objectifs Evaluer les resultats oncologiques et fonctionnels de la prostatectomie robot assistee chez les patients ayant une transplantation renale. Methodes Nous avons analyse retrospectivement les parametres preoperatoires, peroperatoires et les resultats fonctionnels et carcinologiques de 12 patients operes entre 2009 et 2013. L’intervention a ete effectuee par voie transperitoneale sans modification de la position des trocarts. L’âge moyen etait de 61,92 ± 2,98 ans. Le delai entre la transplantation et la decouverte de l’adenocarcinome etait de 79,7 mois. La moyenne du PSA etait de 7,34 ng/mL (4,9–11) Resultats La duree operatoire etait de 241,3 ± 35,6 minutes, avec une seule conversion pour difficultes techniques (BMI 32 kg/m 2 ) et une seule transfusion. L’intervention a ete difficile en raison d’adherence du cote du transplant dans 50 % des cas. On constate un cas d’insuffisance renale aigue obstructive consecutive a un hematome du Retzius traitee par nephrostomie a j20. On note une majorite de Pt2c (72,7 %) dont 3 marges positives (27,3 %) mais 2 rechutes biochimiques traitees par hormonotherapie pour un patient et radiotherapie exclusive pour le deuxieme. Les PSA a distance sont tous indosables. Il n’y a pas de difference significative entre les creatinines en preoperatoire et a j7 ( p = 0,22). Conclusion La PTLRA est une technique realisable chez les transplantes renaux sans risque specifique majeur sur le plan oncologique et fonctionnel.

Objective: This study addresses if deficits in cognitive, attention, and inhibitory control performance in adults with ADHD are better explained by the disorder itself or by comorbid conditions. Method Adult patients with ADHD ( n = 352) and controls ( n = 94) were evaluated in the ADHD program of a tertiary hospital. The diagnostic process for ADHD and comorbidities was based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria. Stepwise regression analyses evaluated the effect of ADHD, demographics, and comorbidities on the scores from Wechsler Adult Intelligence Scale–Revised, Continuous Performance Test, and Stroop Color and Word Test. Results: Patients with ADHD of both genders had worse performance on neuropsychological domains, even after adjustment for comorbidities. The presence of comorbid bipolar disorder and specific phobia are associated with more Stroop errors, whereas patients with generalized anxiety disorder present a longer execution time in Stroop. Conclusion: Neuropsychological deficits in adults with ADHD go beyond comorbidity. Specific comorbid disorders may influence the neuropsychological functioning in adults with ADHD.

A retrospective evaluation of artificial urinary sphincter (AUS) implantation in women with previous pelvic radiotherapy (PR).From May 1987 to December 2009, on the 215 women implanted with AUS, nine (4.2%) had previous PR. We compared two groups of women, the first one without PR (group 1; n=206) and the other group with PR (group 2; n=9). Previous preop. urodynamics were realized. Patients using more than one pad per day at the end of follow-up were considered in failure.Mean follow-up for these two groups was 6 years (SD: 5.6 years), with a mean age of 62.8 years. Mean delay between PR and surgery was 14 years. PR was indicated for cervix cancer in 78% (7/9), endometrial cancer and ovarian cancer in 9% (1/9) each. PR was responsible of an increased rate of AUS erosion and explantation (P0.001). In group 2, more than half of women had AUS failure and 60% for AUS erosion, versus 22% and 26% respectively in group 1. In group 2, all the AUS eroded were explanted, one third of women, with a mean delay of 59.8 months (4-140) with AUS implantation.AUS implantation in a female population with previous PR is not necessary inconsistent, but the failure rate is high. This difficult surgery should be reserved for specialized centres.