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Pedro Santos-Moreno,1 Guillermo Sánchez-Vanegas,2 Angélica Monterrosa-Blanco,3 Gabriel-Santiago Rodríguez-Vargas,1 Manuel Rivero,1 Pedro Rodriguez,1 Omar-Javier Calixto,4 Adriana Rojas-Villarraga,5 Carlos Alberto Castro3 1Rheumatology Department, Biomab IPS, Bogotá, Colombia; 2Scientific Direction Department, Hospital Universitario Mayor Mederi, Universidad del Rosario, Bogotá, Colombia; 3Research and Health Education Department, Comprehensive Solutions for Health Research and Education-SIIES, Bogotá, Colombia; 4Rheumatology and Immunology Department, Hospital Militar Central, Bogotá, Colombia; 5Research Institute, Fundación Universitaria de Ciencias de la Salud–FUCS, Bogotá, ColombiaCorrespondence: Pedro Santos-Moreno, Rheumatology Department, Biomab IPS, Calle 48 # 13-86, Bogotá, Colombia, Tel +57 320 8094232, Email pedrosantosmoreno@hotmail.comPurpose: To assess, in a cohort of patients with rheumatoid arthritis (RA) treated with subcutaneous antitumor necrosis factor drugs (anti-TNFs), the levels of treatment adherence before and after implementing a comprehensive care model (CCM).Patients and Methods: An observational study including RA patients under treatment with subcutaneous anti-TNFs (adalimumab, etanercept, and golimumab) selected at convenience was performed; a sample size of 125 patients was calculated. The outcome variable was adherence assessed with the Compliance Questionnaire on Rheumatology (CQR19), measured before and after implementing a CCM. Descriptive and bivariate analyses were performed comparing adherence before and after applying the model (Wilcoxon and McNemar’s Chi2 test). For multivariate analysis, a generalized linear model adjusted for covariates was performed, where the difference in the proportion of adherence was the outcome measure.Results: A total of 131 RA patients were followed-up for 24 months; average age was 62 years, and 83.9% were women. The median of DAS28 at the beginning of the follow-up was 2.32, and the HAQ was 0.25. At baseline, 87.8% were adherent; after 24 months, 96.2% were adherent according to CQR19. At the end of follow-up, adherence increased with the three types of anti-TNFs treatment. In a matched model adjusted for clinical variables, the CCM was estimated to produce a 9.4% increase in the total percentage of adherent patients. Additionally, a statistically significant increase of 4.5% in the percentage of adherent patients treated with golimumab compared with etanercept and adalimumab was found.Conclusion: A CCM produced an important increase in the percentage of patients with rheumatoid arthritis adherent to treatment after 24 months of follow-up. It is noteworthy that Golimumab patients were more adherent when compared with other current anti-TNFs treatments.Keywords: rheumatoid arthritis, treatment adherence, comprehensive health care, antirheumatic agents, controlled before–after studies

Las interferencias analíticas en el laboratorio clínico pueden causar errores en la interpretación de los resultados de diversas magnitudes biológicas por parte del médico peticionario. Las interferencias analíticas más frecuentemente observadas en el laboratorio clínico son la hemólisis, ictericia y lipemia. La lipemia se define como la turbidez de la muestra causada por la acumulación de lipoproteínas, principalmente lipoproteínas de muy baja densidad (VLDL) y quilomicrones. Existen diversos métodos de detección de muestras lipémicas, como por ejemplo, el índice lipémico o la determinación de triglicéridos en muestras de suero o plasma o la Concentración de Hemoglobina Corpuscular Media (CHCM) en muestras de sangre. Las empresas de diagnóstico in vitro son las responsables, según la Directiva Europea 98/79/CE, de realizar el estudio de las sustancias interferentes que pueden afectar a la medición de una magnitud. Existe una necesidad urgente de estandarizar la forma en que se realizan y se reportan los estudios de interferencia por parte de los fabricantes. La interferencia por lipemia puede ser eliminada por diferentes métodos permitiendo la determinación de magnitudes biológicas de manera exacta. El laboratorio clínico debe decidir los protocolos de actuación ante muestras lipémicas dependiendo de la magnitud biológica que se quiere analizar.

Interferences in the clinical laboratory may lead physicians misinterpret results for some biological analytes. The most common analytical interferences in the clinical laboratory include hemolysis, icterus and lipemia. Lipemia is defined as turbidity in a sample caused by the accumulation of lipoproteins, mainly very-low density lipoproteins (VLDL) and chylomicrons. Several methods are available for the detection of lipemic samples, including the lipemic index, or triglyceride quantification in serum or plasma samples, or mean corpuscular hemoglobin (MCHC) concentration in blood samples. According to the European Directive 98/79/CE, it is the responsibility of clinical laboratories to monitor the presence of interfering substances that may affect the measurement of an analyte. There is an urgent need to standardize interference studies and the way interferences are reported by manufacturers. Several methods are currently available to remove interference from lipemia and enable accurate measurement of biological quantities. The clinical laboratory should establish a protocol for the handling of lipemic samples according to the biological quantity to be tested.

German Devia Jaramillo,1 Jenny Castro Canoa,1 Emiro Valverde Galván2 1Emergency Medicine Department, Hospital Universitario Mayor Méderi Universidad del Rosario, Bogotá, Colombia; 2Emergency Medicine, Universidad del Rosario, Bogotá, Colombia Abstract: Sepsis and septic shock constitute a complex disease condition that requires the engagement of several medical specialties. A great number of patients with this disease are constantly admitted to the emergency department, which warrants the need for emergency physicians to lead in the recognition and early management of septic patients. Timely and appropriate interventions may help reduce mortality in a disease with an unacceptably high mortality rate. Poor control of cellular hypoperfusion is one of the most influential mechanisms contributing to the high mortality rate in these patients. This article aims to make an evidence-based approach and an algorithm for the active identification of hypoperfusion in patients with suspicion of severe infection, based on both clinical variables (capillary refill, mottling index, left ventricular function by ultrasound, temperature gradient, etc.) and laboratory-measured variables (lactate, central venous oxygen saturation [ScvO2], and venous-to-arterial carbon dioxide tension difference [P (v−a) CO2]). Such variables are feasible to use in the emergency department and would help to explain the cause behind the inadequate oxygen use by cells, thereby guiding treatment at the macrovascular, microvascular, or cellular level. Keywords: sepsis, septic shock, cellular perfusion, microcirculation, emergency medicine

Previous studies have illustrated that different bioactive legume fodders containing condensed tannins might represent one of the options for integrated sustainable control of gastrointestinal nematodes (GIN) in ruminants, which may help address the worldwide development of resistance to synthetic anthelmintics. More recently, impetus has been given to assess the potential antiparasitic activity of less conventional resources, represented by different agro-industrial by-products (AIBPs). This review presents in vitro and in vivo results obtained with a range of tannin-containing AIBPs of various geographical and botanical origins, namely AIBP of nuts, temperate and tropical barks, carob, coffee and cocoa. They tend to confirm the “proof of concept” for their antiparasitic effects and also for other aspects of ruminant production in an agro-ecological context. Socio-economic aspects of the exploitation of such non-conventional resources are also discussed as potential models of the circular economy, by using waste. The different modes of use of these resources are presented in this review, as well as strengths, weaknesses, opportunities, and threats (SWOT) analyses to illustrate the advantages and limitations of on-farm use.

Objective: The Evaluation of Risks (EVAR) scale has been used to assess risk-taking propensity in military samples. This report provides preliminary reliability, validity, and normative data on a modified version of the instrument designed to facilitate data entry with optical scanners, the Evaluation of Risks-Bubble Sheet version (EVAR-B).Methods: 2,015 U.S. Army soldiers completed the EVAR-B and a survey assessing risk-related behaviors 3 months after returning home from combat deployment in Iraq.Results: EVAR-B demonstrated acceptable internal consistency and reliability and correlated significantly with independent measures of self-reported risk-taking behavior, including alcohol use and aggressive behavior, in the weeks preceding the survey. Tentative cut-offs significantly differentiated heavy drinkers, dangerous drivers, and soldiers reporting recent aggressive outbursts. Normative data are provided for comparison with future studies.Conclusions: The EVAR-B is a reliable and valid measure of risk-taking propensity, which provides enhanced flexibility for administration and scoring in large surveys and field environments. [ABSTRACT FROM AUTHOR]

Objective: The U.S. military conducts health screenings of service members three to six months after they return from combat deployments. This population health program includes a modified version of the Two-Item Conjoint Screen (TICS), which is widely used in primary care to screen for alcohol misuse. Rates of referral in the military for alcohol treatment are very low, and the utility of these screening questions in predicting serious alcohol-related behaviors is unknown.Methods: Anonymous surveys were collected from 6,527 U.S. Army soldiers who were screened three to four months after returning from deployment to Iraq. Positive responses on the TICS alcohol screen were correlated with alcohol-related behaviors. Odds ratios (ORs) were calculated using logistic regression, after adjusting for gender, rank, race, and military component (active or reserve).Results: Twenty-seven percent of soldiers screened positive for alcohol misuse. Compared with soldiers who screened negative, those who screened positive were more likely to have recently engaged in the following behaviors: drinking and driving (OR=4.99, 95% confidence interval [CI]=4.31-5.76), riding with a driver who had been drinking (OR=5.87, CI=4.99-6.91), reporting late or missing work because of a hangover (OR=9.24, CI=6.73-12.68), using illicit drugs (OR=4.97, CI=3.68-6.71), being referred to alcohol rehabilitation (OR=7.15, CI=4.84-10.58), and being convicted of driving under the influence (OR=4.84, CI=3.04-7.67).Conclusions: Positive responses to a two-item alcohol screening tool were strongly associated with serious alcohol-related behaviors. This study highlights the need to improve screening and access to care for alcohol-related problems among service members returning from combat deployments. [ABSTRACT FROM AUTHOR]

Objective: This study examined rates of utilization of mental health care among active duty and National Guard soldiers with mental health problems three and 12 months after they returned from combat in Iraq. Stigma and barriers to care were also reported for each component (active duty and National Guard).Methods: Cross-sectional, anonymous surveys were administered to 10,386 soldiers across both time points and components. Mean scores from 11 items measuring stigma and barriers to care were computed. Service utilization was assessed by asking soldiers whether they had received services for a mental health problem from a mental health professional, a medical doctor, or the Department of Veterans Affairs in the past month. Risk of mental problems was measured using the Patient Health Questionnaire, the PTSD Checklist, and items asking about aggressive behaviors and "stress, emotional, alcohol, or family" problems within the past month.Results: A higher proportion of active duty soldiers than National Guard soldiers reported at least one type of mental health problem at both three months (45% versus 33%) and 12 months (44% versus 35%) postdeployment. Among soldiers with mental health problems, National Guard soldiers reported significantly higher rates of mental health care utilization 12 months after deployment, compared with active duty soldiers (27% versus 13%). Mean stigma scores were higher among active duty soldiers than among National Guard soldiers.Conclusions: Active duty soldiers with a mental health problem had significantly lower rates of service utilization than National Guard soldiers and significantly higher endorsements of stigma. Current and future efforts to improve care for veterans should work toward reducing the stigma of receiving mental health care. [ABSTRACT FROM AUTHOR]

Research examining the influence of nonwork issues on work-related outcomes has flourished. Often, however, the breadth of the interrole conflict construct varies widely between studies. To determine if the breadth of the interrole conflict measure makes a difference, the current study compares the criterion-related validity of scores yielded by a work--nonwork conflict scale and those yielded by a work--family conflict scale using active-duty U.S. Army soldiers stationed in Germany and Italy with spouses and/or children and without spouses or children. Results demonstrated that the two constructs are related but distinct. In addition, work--family conflict had a stronger relationship with job satisfaction and turnover intentions for employees with a spouse and/or children than for single, childless employees, whereas work--nonwork conflict had a stronger relationship with these outcomes for single, childless employees than for employees with a spouse and/or children [ABSTRACT FROM AUTHOR]

This study assessed the impact of the activation of U.S. Army reservists after terrorists attacked the United States on September 11, 2001. A total of 263 soldiers completed a survey and participated in focus groups. The model's stressors were deactivation uncertainty, workload, and organizational constraints. The outcomes were well-being and turnover intentions. In general, most stressors did predict the proposed outcomes. That is, with high deactivation uncertainty, workload, or organizational constraints, reservists reported low psychological well-being and high turnover intentions. Commanders and policymakers can use our findings when addressing ways to improve reservists' psychological health and to decrease turnover intentions. Specifically, reservists need more predictability and the needed organizational conditions (i.e., proper workload levels and equipment) while activated and deployed to protect our country. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Studies of soldiers from prior wars conducted many years after combat have shown associations between combat-related posttraumatic stress disorder (PTSD) and physical health problems. The current Iraq war has posed a considerable PTSD risk, but the association with physical health has not been well studied. METHOD: The authors studied 2,863 soldiers using standardized self-administered screening instruments 1 year after their return from combat duty in Iraq. RESULTS: Among all participants, 16.6% met screening criteria for PTSD. PTSD was significantly associated with lower ratings of general health, more sick call visits, more missed workdays, more physical symptoms, and high somatic symptom severity. These results remained significant after control for being wounded or injured. CONCLUSIONS: The high prevalence of PTSD and its strong association with physical health problems among Iraq war veterans have important implications for delivery of medical services. The medical burden of PTSD includes physical health problems; combat veterans with serious somatic concerns should be evaluated for PTSD. [ABSTRACT FROM AUTHOR]

The province of Manabí occupies the first place in the meat production in Ecuador, the deficiency of food during the dry season is one of its main problems. The production of green hydroponic fodder (GHF) is proposed as an alternative solution, for which the following objectives were: i) determine the appropriate fertilizer for the hydroponic production of maize, ii) to establish the maize variety with the highest yield as GHF and iii) to define the appropriate harvest time in the exploitation of GHF. In order to develop this research, 2 mL/L of water of an inorganic fertilizer (IF) based on phosphorus was applied and 2 g/L of powdered mycorrhizal water were applied, which were tested in the varieties of white and yellow maize, With airing of 48 and 72 h respectively. The experimental design was completely randomized with factorial arrangement of 2x2x2 with eight treatments, generating 64 experimental units, considering as variables of response, weight, root size and leaf height of the GHF. The results determined higher weight of white maize with FI with 1.69 kg in trays of 40 x 50 cm and with 0.45 kg of maize per tray, at height level no statistical difference was determined and for root size, the best treatment was white corn with FI with 12.49 cm in length. It is concluded that white maize responds better to IF under hydroponic conditions, with an airing time of 48 h.

In the year 2016, seventeen cultivars of mango (Mangifera indica L.) were collected in local markets and farmers' field of Jipijapa Canton, Ecuador, with the aim of describing and analyzing mango fruits due to their morphological characteristics of sugars (°Brix) and total solids. Collections were carried out by stu-dents and teachers of the Research Methodologies course of the Agricultural Engineering Career, of the Southern State University of Manabí (UNESUM). The fruits were characterized by using 16 qualitative and quantitative variables for fruit and seed recommended by UPOV and IPGRI. The percentage of total solids and Brix grades of each harvested crop were also analyzed in the UNESUM bromatology laboratory. Results showed that in the Jipijapa Canton, Ecuador, there is a great biodiversity of native mangoes, which were not characterized. Fruit shapes, pulp color and variable fiber contents were observed. The length of fruit was 6.33 to 12.50 cm, and the width was 5.27 to 8.50 cm, with a length/width ratio between 0.77 and 1.83 cm. The fruit weight was 63.3 to 500 g. No significant differences were observed in the sugars content (°Brix). Finally, it was observed that the range of consumable pulp was 63 to 94% in native cultivars and 86% to 97% in the improved ones.

This study aimed atexploring the psychometric properties of the Brief Assessment Scale for Depression (BAS-DEP) and the Even Briefer Assessment Scale for Depression (EBAS-DEP) scales as screening instruments in a sample of 104 elderly participants, 41 men and 63 women, residing in two Colombian cities. The BAS-DEP included 21 items assessing depressive mood, worry, suicidal ideation and somatic complaints. Meanwhile, the EBAS-DEP was derived by means of extracting 8 ítems of the BAS-DEP, and its performance was regarded as equivalent by the authors of the original study (Allen, et al., 1994).Reliability, validity,sensitivity and specificity were assessedand a receiver operating characteristics curve (ROC) was obtained. Rasch analyses of adjustment, difficulty, and performance were executed and an item map was obtained.The BAS-DEP showed an appropriate level of reliability (.82).Nonetheless, such value was low for the EBAS-DEP (.56).Low reliability of the EBAS-DEP could be explained in terms of its briefness.Nevertheless, its performance in terms of sensitivity and specificity was appropriate. Factor solutions derived from the analyses revealed that most of the items in the BAS-DEP and EBAS-DEP scales contributed in explaining the total variance.When the Yesavage GDS scale was used as an external criterion of validity, coefficients of sensitivity and specificity above .70 were obtained in addition to cut-off scores of 5/6 for the BAS-DEP and 2/3 for the EBAS-DEP.ROC statistics showed that both scales are similarly efficient to detect depression in the sample.These findings are similar to those reported in studies conducted in Australia, England, Germany, and China. This study has been the first to assess the psychometric properties of the Spanish versions of these scales.Further independent studies will enrich the evidence base in favor of the usefulness and validity of these instruments.

Background: Post design and material has very important effects on dentinal stress distribution since the post placement can create stresses that lead to root fracture. Materials and Methods: In this study we use finite element analysis (FEA) to evaluate stress distribution on endodontically treated maxillary central incisors that have been restored with different prefabricated posts. Six models were generated from the image of anatomical plate: Four metallic posts (ParaPost XH, ParaPost XT, ParaPost XP, and Flexi-Flange) and one fiberglass post (ParaPost Fiber Lux). The sixth model was a control-a sound maxillary central incisor. We used CAD software and exported the models to ANSYS 9.0. All the materials and structures were considered elastic, isotropic, homogeneous, and linear except the fiberglass post which was considered orthotropic. The values for the mechanical properties were obtained by a review of the literature and the model was meshed with 8-node tetrahedral elements. A load of 2N was applied to the lingual surface at an angle of 135°. Results: The stress results were recorded by shear stress and von Mises criteria; it was observed that there was no difference for stress distribution among the titanium posts in the radicular portions and into posts. There was higher stress concentration on the coronary portion with the titanium posts than with the glass fiber post. It seems that the metallic posts′ external configuration does not influence the stress distribution. Conclusion: Fiber posts show more homogeneous stress distribution than metallic posts. The post material seems to be more relevant for the stress distribution in endodontically treated teeth than the posts′ external configuration.

JUSTIFICATIVA E OBJETIVOS: A anestesia e a cirurgia freqüentemente causam perturbações térmicas significativas. A hipotermia durante a anestesia é o distúrbio térmico peri-operatório mais comum. O presente relato evidenciou um mecanismo não usual de alteração do controle térmico corporal, neste caso, associado à utilização da morfina no espaço subaracnóideo. O objetivo deste relato foi descrever este efeito incomum. RELATO DO CASO: Paciente do sexo feminino, 44 anos, estado físico ASA I, sem doenças prévias conhecidas, foi admitida para histerectomia abdominal por quadro de miomatose uterina. Foi realizada raquianestesia com 20 mg de bupivacaína hiperbárica e 100 µg de morfina. Durante o procedimento não apresentou qualquer intercorrência. Na sala de recuperação pós-anestésica (SRPA), 3h30 minutos após a realização do bloqueio, a paciente apresentou quadro de sudorese profusa do tronco levando, inclusive, ao descolamento de eletrodos e de fitas adesivas, leve sonolência e diminuição da temperatura timpânica para 35,2 ºC. Nos 60 minutos subseqüentes manteve temperatura abaixo de 36 ºC e com 90 minutos após o evento já apresentava temperatura de 36,2 ºC e remissão completa dos sintomas. CONCLUSÕES: Além dos clássicos mecanismos de perda excessiva de calor durante o bloqueio do neuro-eixo, podem ocorrer perturbações diretas nos centros hipotalâmicos de controle da temperatura corporal, neste caso, associado ao uso de morfina por via subaracnóidea.