Choirosen7131

RESULTS This study assessed 70 consecutive patients and 28,939 ablation tags. Ablation time and force time integral (FTI) were significantly larger in the STAG group. Mean contact force, change of catheter tip temperature, and impedance were not significantly different between STAGs and NTAGs. The minimum ablation time and FTI to make durable scar lesions were 17.6, 13.6, and 11.0 s and 226.1, 187.4, and 161.4 g at 25, 35, and 50 W, respectively. CONCLUSIONS Minimum ablation time and FTI values are critical parameters that determine durable atrial scar creation and their minimum values vary with the ablation power setting. Cardiac resynchronization therapy (CRT) is becoming increasingly controversial in patients without typical left bundle branch block (LBBB). Yet, several recent studies displayed that a distinct subpopulation of patients with non-LBBB does benefit from CRT. Patients with non-LBBB should, therefore, not as a group be withheld from a potentially very beneficial therapy. Unfortunately, current clinical practice lacks validated selection criteria that may identify possible CRT responders in the non-LBBB subgroup. Consequently, clinical decision making in these patients is often challenging. A few studies, strongly differing in design, have proposed additive selection criteria for improved response prediction in patients with non-LBBB. There is accumulating evidence that more sophisticated echocardiographic dyssynchrony markers, taking into account the underlying electrical substrate responsive to CRT, can aid in the selection of patients with a non-LBBB who may benefit more favorably from CRT. Furthermore, it is important that cardiologists are aware of the shortcomings of current electrocardiographic selection criteria for CRT. Whereas these criteria provide an evidence-based approach for selecting patients for CRT, they do not necessarily guarantee the most optimal strategy for patient selection. Parameters obtained with vectorcardiography, such as QRS area, show potential to overcome the shortcomings of conventional electrocardiographic selection criteria and may improve response prediction regardless of QRS morphology. OBJECTIVE To analyse the use, indications and potential risks of tricyclic antidepressants (TCAs), using a technological system of clinical alerts at the time of prescription. METHODS Observational, descriptive, retrospective study on a population covered by a Colombian health insurance plan with an average of 2,333,582 members/month. The information was generated in the PBM (Pharmacy Benefit Management) MC21 Colombia technological platform. RESULTS Of the total members, 368,298 (16%) patients/month on average were prescribed medicines; 3,640 (1%) were prescribed TCAs 2,573 amitriptyline (70%) and 1.062 imipramine (29%); 817 (22.5%) were over 65 years of age. The median daily dose of amitriptyline and imipramine was 25 mg. A total of 17,153 alerts were reported 8,685 (51%) for drug-drug interactions, 7,354 (43%) for drug-age interactions and 543 (3%) for duplicate therapy. CONCLUSIONS Risks were identified in the prescription of tricyclic antidepressants, especially in the over-65 population, where these drugs are used in particular for the management of neuropathic pain. The clinical alert system at the time of medicinal product formulation can make an important contribution to the prevention of potential adverse events associated with the use of medicinal products. INTRODUCTION Obsessive-compulsive disorder is defined by the presence of obsessions and compulsions that cause marked anxiety or distress and has been associated with a disruption in cortico-striato-thalamo-cortical circuitry. After treatment, around 50% of patients continue to experience incapacitating symptoms. Deep-brain stimulation has been shown to be an effective therapeutic alternative to regular treatment. METHODS Case report. CASE PRESENTATION A 54-year-old woman with a diagnosis of treatment-resistant obsessive-compulsive disorder was treated with deep-brain stimulation of the anterior limb of the internal capsule. Molecular imaging before and after the procedure was obtained and correlated with clinical features. CONCLUSIONS Deep-brain stimulation may be a therapeutic alternative to regular care in treatment-resistant obsessive-compulsive disorder and can be correlated to functional changes in suspected anatomical structures. INTRODUCTION Depression is the most common psychiatric comorbidity in people with epilepsy. It worsens the prognosis and quality of life of these patients. Despite this, depression is poorly diagnosed and when the treatment is given, it is frequently suboptimal. OBJECTIVE To perform a narrative review of the medical literature, seeking to collect useful information regarding the relationship between epilepsy and depression. selleck RESULTS Narrative reviews, systematic reviews, meta-analyses, clinical trials, and follow-up studies were identified in English and Spanish with no time limit, including epidemiological, clinical, associated factors, etiological explanations, diagnostic and therapeutic approaches to comorbid depression in epilepsy. CONCLUSION The relationship between epilepsy and depression is complex. The available scientific evidence suggests the possibility of a bidirectional relationship that could be explained from common aetiopathogenic mechanisms. Despite the high prevalence of depression in epileptic patients, this mental disorder continues to be poorly identified by clinicians. To improve this, we have easy-to-apply instruments that routinely screen this patient population and contribute substantially to making the problem more visible and seek to improve the quality of life for this population. BACKGROUND Bipolar disorder (BD) is reported to be the mental disorder with the highest rate of comorbidity with substance use disorders (SUD). More than half of patients with BD have been found to have disorders associated with alcohol use. METHODS A secondary analysis was performed in a population sample of Colombian adults. The aim was to identify bipolar-alcohol comorbidity and factors related to the use of alcohol in people with BD. The diagnosis of BD among participants was made with the "Composite International Diagnostic Interview" (CIDI-CAPI) and the pattern of alcohol consumption in the last year was evaluated with the AUDIT C screening tool. RESULTS It was found that all patients with BD had some type of problematic alcohol consumption pattern. Women with BD were at greater risk of having a dependence-type pattern, using nicotine and marijuana and, among those living in urban areas, had higher rates of suicidal ideation, although that risk was lower if they were in a stable relationship. DISCUSSION Some of the related factors we identified are new with respect to previous publications and others have already been described in similar studies. CONCLUSIONS Given the importance of such factors in the management of this population and their prognosis, these findings highlight the need to determine consumption patterns of alcohol and other substances in patients with BD. INTRODUCTION The DSM-5 diagnostic criteria for non-suicidal self-injury (NSSI) needs to be validated in non-European populations. The aims of this study were to determine how common NSSI was in a sample of self-harming Mexican adolescents and examine the associated variables. METHODS We examined the medical records of 585 adolescents with a history of self-injurious behaviour who attended a public hospital in Mexico City from 2005 to 2012. A group of experts established the diagnosis according to the DSM-5. The clinical and demographic characteristics of patients with and without NSSI were compared. RESULTS NSSI was diagnosed in 351 patients (60%) with evidence of self-harm. The main reasons for not being diagnosed were a previous suicide attempt (criterion A, 158 subjects [26.87%]) and another diagnosis that better explained the self-injurious behaviour (criterion F, 60 subjects [10.25%]). The NSSI group had a higher proportion of males (26.5% vs 16.2%) and patients with behavioural disorders (28.5% vs 13.7%). These patients were also found to seek psychiatric support in relation to their self-harm more frequently (31.9% vs 14.1%). The associated clinical characteristics included behavioural disorder (OR=2.51; 95% CI, 1.62-3.90), personality disorders (OR=0.56; 95% CI, 0.33-0.97), hospital admission (OR=0.23; 95% CI, 0.16-0.33), depressive symptoms (OR=0.60; 95% CI, 0.42-0.85), anxiety symptoms (OR=2.08; 95% CI, 1.31-3.31) and self-harming to influence others (OR=2.19; 95% CI, 1.54-3.11). CONCLUSIONS More than half of the adolescents in the clinical sample with self-injury met DSM-5 criteria for NSSI. There are clinical and demographic characteristics which may be associated with this diagnosis. OBJECTIVE To determine the healthy life years (HLY) lost as a result of mental disorders and nervous system diseases in Medellin from 2006 to 2012. METHODS Descriptive study using a secondary information source according to the Global Burden of Disease (GBD) framework. To calculate the years of potential life lost (YPLL), we used vital statistics data; to calculate disability-adjusted life years (DALY), we used morbidity data from individual records managed by health service providers, outpatient clinics and other research studies. HLY are the sum of YPLL and DALY. RESULTS In Medellin, from 2006 to 2012, out of 1,242,407 HLY related to mental disorders and nervous system diseases, the vast majority (99.39%) were due to disability. Most HLY were found in females (70.22%) and 81% were found in people aged 15 to 59. The disorders representing the greatest burden were unipolar depressive disorder (81%), Alzheimer's disease and other types of dementia (4.82%), schizophrenia (3.5%) and drug use disorders (2.78%). CONCLUSIONS Our results indicate a significant increase in the disease burden due to mental disorders and nervous system diseases. Public policy decision-makers in the city of Medellin should take note, as health problems of this type can result in a substantial rise in healthcare costs. BACKGROUND The family has been seen over the years and in the historical evolution of humans as the essential unit of which societies are formed and structured. It is considered the original cell of life in society and the cradle of education that favours the learning and potential development of its members. Domestic violence encompasses verbal abuse, physical or emotional abuse, intimidation, sexual abuse or financial control. We studied domestic violence in the Bolivarian population, looking at couple relationships and the repercussions on the family members in terms of the education and performance of the children in their care. METHODS Surveys were applied in the cantons of San Miguel, San José de Chimbo and Guaranda. RESULTS It was found that disputes in families are caused mainly by financial situations (19%) and jealousy (24%), and that they are witnessed by the children, with shouting being the predominant form. From the point of view of the children, fear (29%) is the outstanding feeling for those who have witnessed family fights. CONCLUSIONS Shouting is the predominant form of arguments between couples, with finances, jealousy and alcohol consumption being the most common causes of family disputes. In children who witness these forms of behaviour, a feeling of fear or dread predominates.