Psicoterapia contemporánea: dilemas y perspectivas

Hablar de una psicoterapia contemporánea nos conduce necesariamente a abordajes en clave de complejidad que favorezcan miradas más abiertas, con más posibilidades, en su constitución, su ámbito de conocimiento, el ejercicio profesional y la formación de psicoterapeutas. Y pensarla desde una perspectiva interdisciplinar es fundamental para la comprensión, el análisis y las posibilidades de tratamiento de los problemas psicológicos que aquejan a las sociedades contemporáneas. Este es el planteamiento central que se desarrolla en esta obra conformada por ocho ensayos, en los cuales se abordan temas como la formación de los psicoterapeutas, la historia de este campo profesional, la influencia del entorno y de la familia en el consultante, así como la importancia del diálogo con otras disciplinas para el perfeccionamiento de este campo de generación e innovación en psicoterapia. Por ello, se recomienda la lectura de este volumen, el primero de la colección Psicoterapia y Diálogo Interdisciplinario, a estudiantes, docentes y profesionales en el campo de la psicoterapia y la salud mental, ya que este ejercicio profesional cobra cada día mayor relevancia para el entendimiento y abordaje de la complejidad de la vida humana hacia la promoción del bienestar.ITESO. A.C

Combination of KIR2DS4 and FcγRIIa polymorphisms predicts the response to cetuximab in KRAS mutant metastatic colorectal cancer

Cetuximab is a standard-of-care treatment for RAS wild-type metastatic colorectal cancer (mCRC) but not for those harbor a KRAS mutation since MAPK pathway is constitutively activated. Nevertheless, cetuximab also exerts its effect by its immunomodulatory activity despite the presence of RAS mutation. The aim of this study was to determine the impact of polymorphism FcγRIIIa V158F and killer immunoglobulin-like receptor (KIR) genes on the outcome of mCRC patients with KRAS mutations treated with cetuximab. This multicenter Phase II clinical trial included 70 mCRC patients with KRAS mutated. We found KIR2DS4 gene was significantly associated with OS (HR 2.27; 95% CI, 1.08–4.77; P = 0.03). In non-functional receptor homozygotes the median OS was 2.6 months longer than in carriers of one copy of full receptor. Multivariate analysis confirmed KIR2DS4 as a favorable prognostic marker for OS (HR 6.71) in mCRC patients with KRAS mutation treated with cetuximab. These data support the potential therapeutic of cetuximab in KRAS mutated mCRC carrying non-functional receptor KIR2DS4 since these patients significantly prolong their OS even after heavily treatment. KIR2DS4 typing could be used as predictive marker for identifying RAS mutated patients that could benefit from combination approaches of anti-EGFR monoclonal antibodies and other immunotherapies to overcome the resistance mediated by mutation in RAS.This clinical trial was approved and supported by Merck S.L., an affiliate of Merck KGaA, Darmstadt. Germany [research project number 2010-023580-18, date: 05-06-2014

Comparación de la castración quirúrgica al nacimiento versus inmunocastration sobre las características de la canal y carne en machos Holstein

El objetivo fue comparar el efecto de la castración quirúrgica al nacimiento vs immunocastración, sobre las características de la canal y carne en machos Holstein en engorda; se utilizaron 720 machos Holstein aproximadamente de 7 a 8 meses de edad con peso inicial de 240.82 kg. Se formaron 2 tratamientos con 4 corrales de 90 animales en cada uno: toros castrados quirúrgicamente que fueron castrados 24 h después del nacimiento y toros inmunocastrados vacunados con Bopriva aplicando cuatro dosis, al día 1, 21, 101 y 181 de engorda. Se tomaron pesos individuales en cada vacunación. Los animales se sacrificaron a los 242 días de engorda. A partir de la segunda vacunación se observaron diferencias (P0.05) entre tratamientos mientras que los valores de b*, C* y H* fueron más altos (P<0.05) en los animales inmunocastrados. Para fines de producción, el sacrificar los machos Holstein al nacimiento, se obtienen animales más pesados y con mejores características en la canal; sin embargo es importante evaluar el impacto del bienestar animal por la castración al nacimiento

Why don&#x0027;t we treat chronic hepatitis C in HIV patients? Results from a cohort of HIV-HCV coinfected patients from the southeast of Spain

Purpose of the study: To know the different reasons why we decide not to treat or to delay the antiviral treatment against HCV in HIV coinfected patients. Methods: Prospective cohort of HIV and HCV coinfected patients, followed in the Infectious Diseases Department of the Santa Lucia Universitary Hospital (Cartagena, Spain) between 1/12/2011 and 28/02/2012 in which we made transitory elastography. We evaluated the main reasons that moved us to decide not to treat or to delay the antiviral treatment against HCV: social-familiar-laboral reasons; neuro-psychiatric severe diseases; patient decision; low grade hepatic fibrosis; previous failure to pegylated interferon (IFN) and ribavirin (RBV) in no-1 genotype patients; delay in the approval of the triple therapy with INF-RBV and a protease inhibitor (boceprevir or telaprevir) by the Regional Sanitary Authority; active alcohol abuse; active diseases that contraindicate the antiviral treatment, incomplete study of HCV (VL of HCV, genotype, ILB28, abdominal ecography); previous intolerance against IFN-RBV and severe thrombocytopenia (&#60;50&#x00D7;109/L). Summary of results: The cohort included 109 patients, being 27 of them females (25%) and 82 males (75%), with a median of age of 45.8 years (SD: 6.2). In 98 patients (90%) we decided not to treat or to delay the antiviral treatment against HCV for one or more of the following reasons: 37 (34%) presented low grade hepatic fibrosis (&#60;9.5 kpascal or F0-F2); 19 (17%) had neuro-psychiatric diseases; 18 (16.5%) were waiting for the approval of triple therapy by the Regional Sanitary Authority; 10 (9.2%) did not want to be treated; 10 (9.2%) had failure to IFN-RBV in no-1 genotype; 6 (5.5%) had social-familiar-laboral reasons; 6 (5.5%) presented active severe diseases; 4 (3.7%) were waiting to complete HCV study; 3 (2.8%) presented active alcohol abuse; 3 (2.8%) had previous intolerance against IFN-RBV treatment and 2 (2%) had severe thrombocytopenia. Conclusions: In our cohort of HIV-HCV coinfected patients it was decided to delay or not to treat chronic hepatitis C in a significant proportion of subjects. The low grade of hepatic fibrosis measured with transitory elastography was the main reason for delaying the HCV antiviral treatment. The neuro-psychiatric disease was the main clinical reason to not treat HCV. The delay of the approval of triple therapy treatment by the Regional Sanitary Authority was the most relevant non- clinical reason in our prospective study

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p&lt;0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p&lt;0\ub70001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding: No funding

Diminishing benefits of urban living for children and adolescents’ growth and development

Optimal growth and development in childhood and adolescence is crucial for lifelong health and well-being1–6. Here we used data from 2,325 population-based studies, with measurements of height and weight from 71 million participants, to report the height and body-mass index (BMI) of children and adolescents aged 5–19 years on the basis of rural and urban place of residence in 200 countries and territories from 1990 to 2020. In 1990, children and adolescents residing in cities were taller than their rural counterparts in all but a few high-income&nbsp;countries. By 2020, the urban height advantage became smaller in most countries, and in many high-income western countries it reversed into a small urban-based disadvantage. The exception was for boys in most countries in sub-Saharan Africa and in some countries in Oceania, south Asia and the region of central Asia, Middle East and north Africa. In these countries, successive cohorts of boys from rural places either did not gain height or possibly became shorter, and hence fell further behind their urban peers. The difference between the age-standardized mean BMI of children in urban and rural areas was &lt;1.1 kg m–2 in the vast majority of&nbsp;countries. Within this small range, BMI increased slightly more in cities than in rural areas, except in south Asia, sub-Saharan Africa and some countries in central and eastern Europe. Our results show that in much of the world, the growth and developmental advantages of living in cities have diminished in the twenty-first century, whereas in much of sub-Saharan Africa they have amplified