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Objectives/Goals: Hearing loss (HL) can result from environmental and genetic factors. Some genetic variants may be more prevalent in populations living in geographic or cultural isolation. This study explores the genetic variants associated with HL in Puerto Rico and correlates these with auditory and balance disorders to uncover novel variants. Methods/Study Population: After obtaining individual informed consent and assent for a minor when applicable, we will collect clinical audiological data and biological samples (n = 600) from families across Puerto Rico with a history of severe to profound HL. Genomic DNA will be extracted, and exome and mitochondrial genome sequencing will be conducted to identify causal variants in genes associated with HL. The study will assess the prevalence of both novel and reported variants in genes associated with HL and investigate founder variants in the Puerto Rican population. Involvement of genes so far not associated with HL will also be considered when a genetic diagnosis cannot be established. Auditory phenotypes will be correlated with genetic findings, allowing for a comprehensive analysis of genetic contributions to HL in this population. Results/Anticipated Results: This research will advance understanding of the genetic causes of HL in Puerto Rico, leading to more accurate diagnoses, personalized treatment options, and the discovery of novel genes associated with HL. It will also serve as an evidence-based reference to analyze the adequacy of current neonatal hearing screening protocols in PR. Recruitment and sample collection have begun, and we expect our findings to uncover population-specific variants. These results will provide a foundation for further genetic studies aiming at identifying the causes of HL in Puerto Ricans regardless of age of onset. Discussion/Significance of Impact: This study will enhance our understanding of hereditary HL and serve as a basis for developing population-specific diagnostic tools and interventions, particularly in the Puerto Rican population. The research will support future genetic studies and address health disparities in HL in the island.
Diabetes Mellitus (DM) represents a significant public health concern with a global impact(1,2). According to the International Diabetes Federation, in 2021 the global prevalence of this pathology was 10.5% and 12.7% in Chile(3). Of these cases, 90% are cases of type 2 Diabetes Mellitus (DM2). One of the risk factors for its management and prognosis, once diagnosed, is a sedentary lifestyle(3). A sedentary lifestyle rate of 86.7% has been reported in Chile(4). However, to our knowledge, there is no data on sedentary lifestyles in the diabetic population of the commune of Copiapó. Therefore, this study aimed to describe and compare the level of sedentary lifestyle in women and men with DM2 in the Family Health Centres (CESFAM) of Copiapó (Chile).
A cross-sectional study was conducted using data obtained from participants in the CODIACO cohort. Twenty-five individuals, comprising both sexes and aged between 30 and 65 years, diagnosed with DM2 and users of the CESFAMs of Copiapó, were included. These individuals also had mobile devices capable of installing the accelerometry application ‘Physics Toolbox Sensor Suite’. Pregnant and lactating women, patients with diabetic neuropathy or nephropathy, cancer, and severe inflammatory or infectious diseases were excluded. They were asked to activate and deactivate the application for 7 to 12 days, at waking and bedtime, respectively. Physical activity and sedentarism were determined when the accelerometer was over or below 0.6 mm/sec2 respectively from the total daily activity (%). WhatsApp transmitted the information recorded to estimate each participant’s sedentary lifestyle level. A Student’s t-test for independent samples was employed to compare the percentage of sedentary behaviour between women and men. The results were expressed as the mean and standard deviation. A P-value of less than 0.05 was considered statistically significant. The CODIACO study was approved by the Scientific Research Ethics Committee of the Universidad de Atacama. The project was funded by FONDECYT N° 11180794.
The number of women in the sample was 19 (76%) and the number of men was 6 (24%). The values of sedentary lifestyle for women were 85.32±9.5%, which was similar to those found in men, 82.5±10.31%. Although women show a higher tendency to increase sedentary lifestyle behaviour, The T-test did not determine differences between sexes (p>0.05), maybe, due to the high number of women compared with men in the sample.
The level of sedentary lifestyle in patients diagnosed with DM2 in the CESFAM of Copiapó is high and is in line with that observed in the general population in Chile. Furthermore, no differences are observed between men and women. Further studies are required to confirm this result and to investigate its cause to generate strategies to help reduce sedentary lifestyles in this population.
Understanding sex differences among persons with moderate-to-severe traumatic brain injury (TBI) is critical to addressing the unique needs of both males and females from acute care through to rehabilitation. Epidemiological studies suggest that 7 of every 10 persons with moderate-to-severe TBI are male, with females representing about 30%–33%.
Objective:
To examine the proportion of female and male individuals included in randomized controlled trials (RCTs) of interventions for moderate-to-severe TBI.
Methods:
A systematic review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines up to and including December 2022 using MEDLINE, PubMed, Scopus, CINAHL, EMBASE and PsycINFO databases. Studies were included if they met the following criteria: (1) human participants with a mean age ≥18 years, (2) ≥50% of the sample had moderate-to-severe TBI and (3) the study design was a RCT. Data extracted included author, year, country, sample size, number of female/male participants and time post-injury.
Results:
595 RCTs met the criteria for inclusion, published between 1978 and 2022, totaling 86,662 participants. The average proportion of female participants was 23.14%, and the percentage increased a small but significant amount over time. There was a significantly lower percentage of female participants in RCTs initiated in the acute phase (≤ 1 month) when compared with RCTs conducted in the chronic phase (≥ 6 months) post-injury (p < 0.001).
Conclusions:
Female participants are underrepresented in RCTs of moderate-to-severe TBI. Addressing this underrepresentation is critical to establish effective treatments for all persons with TBI.
This study aims to outline Clostridioides difficile infection (CDI) trends and outcomes in Mexican healthcare facilities during the COVID-19 pandemic.
Design:
Observational study of case series.
Setting:
Sixteen public hospitals and private academic healthcare institutions across eight states in Mexico from January 2016 to December 2022.
Patients:
CDI patients.
Methods:
Demographic, clinical, and laboratory data of CDI patients were obtained from clinical records. Cases were classified as community or healthcare-associated infections, with incidence rates calculated as cases per 10,000 patient days. Risk factors for 30-day all-cause mortality were analyzed by multivariate logistic regression.
Results:
We identified 2,356 CDI cases: 2,118 (90%) were healthcare-associated, and 232 (10%) were community-associated. Common comorbidities included hypertension, diabetes, and cancer. Previous high use of proton-pump inhibitors, steroids, and antibiotics was observed. Recurrent infection occurred in 112 (5%) patients, and 30-day mortality in 371 (16%). Risk factors associated with death were a high Charlson score, prior use of steroids, concomitant use of antibiotics, leukopenia, leukocytosis, elevated serum creatine, hypoalbuminemia, septic shock or abdominal sepsis, and SARS-CoV-2 coinfection. The healthcare-associated CDI incidence remained stable at 4.78 cases per 10,000 patient days during the pre-and pandemic periods. However, the incidence was higher in public hospitals.
Conclusions:
Our study underscores the need for routine epidemiology surveillance and standardized CDI classification protocols in Mexican institutions. Though CDI rates in our country align with those in some European countries, disparities between public and private healthcare sectors emphasize the importance of targeted interventions.
Archaeologists in North America and elsewhere are increasingly examining long-term Indigenous presence across multiple colonial systems, despite lingering conceptual and methodological challenges. We examine this issue in California, where archaeologists and others have traditionally overlooked Native persistence in the years between the official closing of the region's Franciscan missions in the 1830s and the onset of US settler colonialism in the late 1840s. In particular, we advocate for the judicious use of the documentary record to ask new questions of Indigenous life during this short but critical period, when many Native Californians were freed from the missions and sought new lives in their homelands or in emerging urban areas. We offer examples from our individual and collective research—undertaken in collaboration with the Muwekma Ohlone Tribe—regarding long-term Native persistence in the San Francisco Bay Area to demonstrate how archival evidence can illuminate four interrelated areas of daily life that could be investigated archaeologically, including resistance, freedom, servitude, and personal adornment. By using the written record to regain a sense of subjective time, these topics and others could stimulate new, interdisciplinary, and collaborative research that more firmly accounts for Indigenous people's enduring presence across successive waves of Euro-American colonialism.
Relative to the numerous studies focused on mammalian schistosomes, fewer include avian schistosomatids particularly in the southern hemisphere. This is changing and current research emerging from the Neotropics shows a remarkable diversity of endemic taxa. To contribute to this effort, nine ducks (Spatula cyanoptera, S.versicolor, Netta peposaca), 12 swans (Cygnus melancoryphus) and 1,400 Physa spp. snails from Chile and Argentina were collected for adults and larval schistosomatids, respectively. Isolated schistosomatids were preserved for morphological and molecular analyses (28S and COI genes). Four different schistosomatid taxa were retrieved from birds: Trichobilharzia sp. in N. peposaca and S. cyanoptera that formed a clade; S.cyanoptera and S. versicolor hosted Trichobilharzia querquedulae; Cygnus melancoryphus hosted the nasal schistosomatid, Nasusbilharzia melancorhypha; and one visceral, Schistosomatidae gen. sp., which formed a clade with furcocercariae from Argentina and Chile from previous work. Of the physid snails, only one from Argentina had schistosomatid furcocercariae that based on molecular analyses grouped with T. querquedulae. This study represents the first description of adult schistosomatids from Chile as well as the elucidation of the life cycles of N.melancorhypha and T. querquedulae in Chile and Neotropics, respectively. Without well-preserved adults, the putative new genus Schistosomatidae gen. sp. could not be described, but its life cycle involves Chilina spp. and C. melancoryphus. Scanning electron microscopy of T. querquedulae revealed additional, undescribed morphological traits, highlighting its diagnostic importance. Authors stress the need for additional surveys of avian schistosomatids from the Neotropics to better understand their evolutionary history.
This work provides insights into the deterioration of cacti seeds of Escontria chiotilla (F.A.C. Weber ex K. Schum) and Stenocereus pruinosus (Otto ex Pfeiff.) Buxbaum stored ex situ at 25 °C, under dry and dark conditions or buried in situ conditions in a xerophytic shrubland. Viability, germination speed, electrolyte leakage and indicators of the redox balance including glutathione content, glutathione half-cell reduction potential (EGSSG/2GSH) and malondialdehyde (MDA), oxidized protein content, together with water-soluble antioxidant enzyme activity were assessed. Over a period of two years of storage, viability was maintained when seeds were stored ex situ at 7–9% water content compared to seeds buried in the soil. A second burial experiment showed that seeds of E. chiotilla maintained viability during a year of storage that included a rainy season followed by a dry season. Thereafter, they died rapidly during the second rainy season. In contrast, those of S. pruinosus started to lose viability after 6 months of burial at the end of the rainy season and were mostly dead at the end of the dry season. This difference in persistence between species was related to a difference in the glutathione content and antioxidant enzyme activities. In both storage experiments, the loss of viability of both species was associated to a EGSSG/2GSH shift to a more oxidative state during burial. Yet, contents in MDA and oxidized soluble proteins were not related to redox imbalance and loss of viability, indicating that these compounds are not good markers of oxidative stress in cacti seeds during storage.
The prevalence of medical illnesses is high among patients with psychiatric disorders. The current study aimed to investigate multi-comorbidity in patients with psychiatric disorders in comparison to the general population. Secondary aims were to investigate factors associated with metabolic syndrome and treatment appropriateness of mental disorders.
Methods
The sample included 54,826 subjects (64.73% females; 34.15% males; 1.11% nonbinary gender) from 40 countries (COMET-G study). The analysis was based on the registration of previous history that could serve as a fair approximation for the lifetime prevalence of various medical conditions.
Results
About 24.5% reported a history of somatic and 26.14% of mental disorders. Mental disorders were by far the most prevalent group of medical conditions. Comorbidity of any somatic with any mental disorder was reported by 8.21%. One-third to almost two-thirds of somatic patients were also suffering from a mental disorder depending on the severity and multicomorbidity. Bipolar and psychotic patients and to a lesser extent depressives, manifested an earlier (15–20 years) manifestation of somatic multicomorbidity, severe disability, and probably earlier death. The overwhelming majority of patients with mental disorders were not receiving treatment or were being treated in a way that was not recommended. Antipsychotics and antidepressants were not related to the development of metabolic syndrome.
Conclusions
The finding that one-third to almost two-thirds of somatic patients also suffered from a mental disorder strongly suggests that psychiatry is the field with the most trans-specialty and interdisciplinary value and application points to the importance of teaching psychiatry and mental health in medical schools and also to the need for more technocratically oriented training of psychiatric residents.
Ultra-processed plant-based foods, such as plant-based burgers, have gained in popularity. Particularly in the out-of-home (OOH) environment, evidence regarding their nutritional profile and environmental sustainability is still evolving. Plant-based burgers available at selected OOH sites were randomly sampled in Amsterdam, Copenhagen, Lisbon and London. Plant-based burgers (patty, bread and condiment) (n 41) were lab analysed for their energy, macronutrients, amino acids and minerals content per 100 g and serving and were compared with reference values. For the plant-based burgers, the median values per 100 g were 234 kcal, 20·8 g carbohydrates, 3·5 g dietary fibre and 12·0 g fat, including 0·08 g TFS and 2·2 g SFA. Protein content was 8·9 g/100 g, with low protein quality according to amino acid composition. Median Na content was 389 mg/100 g, equivalent to 1 g salt. Compared with references, the median serving provided 31% of energy intake based on a 2000 kcal per day and contributed to carbohydrates (17–28%), dietary fibre (42%), protein (40%), total fat (48%), SFA (26%) and Na (54%). One serving provided 15–23% of the reference values for Ca, K and Mg, while higher contributions were found for Zn, Mn, P and Fe (30–67%). The ultra-processed plant-based burgers provide protein, dietary fibre and essential minerals and contain relatively high levels of energy, Na and total fats. The amino acid composition indicated low protein quality. The multifaceted nutritional profile of plant-based burgers highlights the need for manufacturers to implement improvements to better support healthy dietary habits, including reducing energy, Na and total fats.
Hypertension remains a public health issue in Cameroon, though lifestyle and dietetic measures are the main approaches for the prevention and management of hypertension. The present study aimed at evaluating the impact of a Dietary Approaches to Stop Hypertension (DASH) diet using local foodstuffs on the status of hypertensive patients at the Ngaoundere Regional Hospital. A case–control study was carried out with 160 hypertensive patients divided into two groups, a test and a control group. A food questionnaire was used to evaluate the food habits of patients and design the sheet of the DASH diet to provide a maximum of 2000 kcal/d. The DASH diet was administered to the test group (eighty-eight patients), while the control group (seventy-two patients) consumed their normal diet. Both groups were followed up for 8 weeks. The systolic and diastolic blood pressures (SBP, DBP), body mass index (BMI), triglycerides, HDL-c, LDL-c and total-cholesterol levels of patients of the two groups were measured before and after the intervention. The results indicate that the DASH diet improves all the markers of hypertension in the test group with significant decreases in BMI, SBP, DBP, LDL-c and total-cholesterol. Patients of the control group had fourteen and seven times more risk of having increased systolic and diastolic pressures, respectively, and are thus exposed to hypertension complications. The DASH diet established in this study is therefore effective for the management of hypertension.
There are many stressors that lead to burn out and decrease the quality of life of health professionals as a whole and it occurs also to trainee psychiatrists.
Training programs rarely include specific interest in the personal self of students even if they begin to deal with severe human suffering.
Authors present a model of experiential group training in psychiatry that is centred on the person/trainee at the very most.
Objectives
The aim is to focus on unsolved emotional needs of students to allow them to achieve the capacity of relationship with patients. It is not a mere application of empathy but a truth overcoming, for trainees, of major risks of collusion due to reflection of individual conflicts into the patients and/or due to the encounter with strong emotion during clinical training.
Methods
The model is Experiential because it is the space for personal expression and it is Strategic because it is born inside the strategic group training in psychotherapy (Battuello et al. Psichiatria e Psicoterapia 2022; 41, 2, 65-82).
The conductor of the group carries on her/his skin the experience of own training group, to be brought into the trainees’ one.
This is an original approach because the epistemology of the model came directly from the experience.
The group is led by a psychotherapist that plays an active part inside the process instead of being only a facilitator.
The main focus is to allow students to express themselves that includes various steps such as: tuning with their own experiences/emotions, freedom of expressing them to the group, active listening to the other and response to the same other even when feelings don’t resonate but instead are divergent.
This phase is related to the conductor’s participation that is totally immersed into the group bringing personal feelings, stories and emotions to create an undifferentiated space, free from hierarchical roles.
During a second period, students can access a more mature relational capacity that carries the group to a phase of individuation of the self that also engages professional issues.
Results
Students in the group question themselves: it is the root of every health professional that has to explore and overcome personal relational issues. Only after the expressiveness phase, as authors name this part of the training, an individuation phase is truly possible that leads to the definition of the professional.
Conclusions
The training group is necessary for students to explore the wider range of emotions, expressing personal ones, accepting others’, experiencing the tolerance to their frustration, and emerging as professional, that is, in few words, professional of the relationship, the key and the basement of the psychiatrist.
The training in mental health should include, at first, the taking care of the person/student as it is proposed by authors inside the group model.
This paper describes the methodology used to analyse oscillations of foils of a wide range of aspect ratios, 0.5 ≤ AR ≤ 4, and Reynolds numbers, 104 ≤ Re ≤ 105, for energy harvesting purposes. The foils were fixed at their trailing edge, and their dynamical behaviour was captured as the wind speed was varied. The foil response was then analysed as a function of velocity, Reynolds number, oscillation amplitude and frequency. Additionally, the forces and moments acting on the foils were measured, utilising an aerodynamic scale, designed and built in-house. An empirical power generation equation was derived to determine the foil characteristics for maximum energy harvesting production. The results show that a flexible foil with AR = 3 with oscillations in the large-amplitude regime is the most effective for energy harvesting.
Background: People with parkinsonian syndromes (PPS) in advanced stages deal with a wide range of highly impactful motor and non-motor problems, including dementia, hallucinations, falls, and dysautonomia. Care planning becomes difficult and unpredictable. In addition, while healthcare providers focus on reducing symptom burden, PPS and carepartners deal with difficult emotions such as demoralization and grief. At those stages, multidisciplinary care becomes imperative. In October 2022 we launched Advanced Care Team for Parkinson’s (ACT-PD), a clinical research program whose goals include advanced care planning, symptoms management and emotional support. Methods: Our primary outcomes are changes in quality of life (QoL-AD), carepartner burden (ZBI-12) and patient satisfaction. The team involves neurology, palliative nursing, social-work, psychology, and spiritual care. Every three months, participants meet the team in person or virtually. In two hours, they address tailored concerns, complemented with phone calls as required. Accordingly, participants complete assessments. Results: In its first 4 months, ACT-PD included 40 PPS and 40 carepartners. Preliminary results show that the first visit with ACT-PD resulted in a 30% reduction in carepartner burden and 28% of improvement in patients’ QoL. Conclusions: Even in early phases, this novel patient and carepartner-centered approach improves QoL and reduces carepartner burden in PPS in advanced disease stages.
We report direct numerical simulations of the flow around a spanwise-flexible wing in forward flight. The simulations were performed at $Re=1000$ for wings of aspect ratio 2 and 4 undergoing a heaving and pitching motion at Strouhal number $St_c\approx 0.5$. We have varied the effective stiffness of the wing $\varPi _1$ while keeping the effective inertia constant, $\varPi _0=0.1$. It has been found that there is an optimal aerodynamic performance of the wing linked to a damped resonance phenomenon, that occurs when the imposed frequency of oscillation approaches the first natural frequency of the structure in the fluid, $\omega _{n,f}/\omega \approx 1$. In that situation, the time-averaged thrust is maximum, increasing by factor 2 with respect to the rigid case with an increase in propulsive efficiency of approximately 15 %. This enhanced aerodynamic performance results from the combination of larger effective angles of attack of the outboard wing sections and a delayed development of the leading edge vortex. With increasing flexibility beyond the resonant frequency, the aerodynamic performance drops significantly, in terms of both thrust production and propulsive efficiency. The cause of this drop lies in the increasing phase lag between the deflection of the wing and the heaving/pitching motion, which results in weaker leading edge vortices, negative effective angles of attack in the outboard sections of the wing, and drag generation in the first half of the stroke. Our results also show that flexible wings with the same $\omega _{n,f}/\omega$ but different aspect ratio have the same aerodynamic performance, emphasizing the importance of the structural properties of the wing for its aerodynamic performance.
To examine the parental food consumption and diet quality and its associations with children’s consumption in families at high risk for developing type 2 diabetes mellitus across Europe. Also, to compare food frequency consumption among parents and children from high-risk families to the European Dietary guidelines/recommendations.
Design:
Cross-sectional study using Feel4diabetes FFQ.
Setting:
Families completed FFQ and anthropometric measures were obtained. Linear regression analyses were applied to investigate the relations between parental food consumption and diet quality and their children’s food consumption after consideration of potential confounders.
Participants:
2095 European families (74·6 % mothers, 50·9 % girls). The participants included parent and one child, aged 6–8 years.
Results:
Parental food consumption was significantly associated with children’s intake from the same food groups among boys and girls. Most parents and children showed under-consumption of healthy foods according to the European Dietary Guidelines. Parental diet quality was positively associated with children’s intake of ‘fruit’ (boys: β = 0·233, P < 0·001; girls: β = 0·134, P < 0·05) and ‘vegetables’ (boys: β = 0·177, P < 0·01; girls: β = 0·234, P < 0·001) and inversely associated with their ‘snacks’ consumption (boys: β = –0·143, P < 0·05; girls: β = –0·186, P < 0·01).
Conclusion:
The present study suggests an association between parental food consumption and diet quality and children’s food intake. More in-depth studies and lifestyle interventions that include both parents and children are therefore recommended for future research.
Intercropping maize (Zea mays L.) with cover crops (Crotalaria spectabilis and Urochloa ruziziensis) is a sustainable cultivation strategy that can generate ecological benefits combined with grain yield (GY). However, cover crops may require nitrogen (N) fertilization management to be adjusted to obtain a high GY in intercropping systems. This study was carried out over 2 years in southeastern Brazil using randomized complete block design in a split-plot scheme. The plots were composed of three cropping systems: sole maize, maize + U. ruziziensis and maize + C. spectabilis. The subplots consisted of four N levels: 0, 70, 140 and 210 kg/ha. The GY of the maize + U. ruziziensis may be reduced by 13% compared to the sole maize. The GY of the sole maize increased up to 11.3 Mg/ha for 95 kg/ha of N in the first year and 6.7 Mg/ha for 169 kg/ha of N in the second year. The GY of the maize + U. ruziziensis intercropping system showed linear increments of 120 kg/ha for every 10 kg/ha of N applied. In the maize + C. spectabilis intercropping, GY increased up to 9.8 Mg/ha for 201 kg/ha of N in the first year, without any variation during the second year. The land equivalent ratio (LER) of intercropping was increased by more than 35% compared to that of sole maize, and N fertilization increased the LER of the sole maize and maize + U. ruziziensis intercropping. Maize intercropping had higher LER values with greater demand for nitrogen to obtain similar yields compared to sole maize cropping.
A checklist of larval digeneans parasitising molluscs from inland waters of Argentina is presented here. Based on the bibliographical survey of 113 scientific articles and nine theses published between 1930 and 2021, 213 digeneans were found, which were distributed within 13 superfamilies and 35 families. The parasites were identified in 102 locations, encompassing eight of the sixteen biogeographical provinces in Argentina. Digeneans were found in 34 mollusc species (31 gastropods and three bivalves) belonging to 17 genera. The available data are presented for each digenean species, and included host information, localities, prevalence values, type of habitat, life cycle information (natural or experimental host), and information on material and genetic sequences deposited in repositories. Only 21.1% of individuals were identified to species level, and 8.5% to genus level. In addition, the genetic sequences of only 10 species (4.7%) were available at GenBank. This survey constitutes the first checklist of parasitic helminths in molluscs from inland waters of Argentina.
Patients with anti-N-methyl-d-aspartate (NMDA) receptor encephalitis (ANMDARE) show a wide range of behavioral abnormalities and are often mistaken for primary psychiatric presentations. We aimed to determine the behavioral hallmarks of ANMDARE with the use of systematic neuropsychiatric and cognitive assessments.
Methods
A prospective study was conducted, with 160 patients admitted to the National Institute of Neurology and Neurosurgery of Mexico, who fulfilled criteria for possible autoimmune encephalitis and/or red flags along a time window of seven years. Cerebrospinal fluid (CSF) antibodies against the NR1 subunit of the NMDAR were processed with rat brain immunohistochemistry and cell-based assays with NMDA expressing cells. Systematic cognitive, neuropsychiatric, and functional assessments were conducted before knowing NMDAR antibodies results. A multivariate analysis was used to compare patients with and without definite ANMDARE according to antibodies in CSF.
Results
After obtaining the CSF antibodies results in 160 consecutive cases, 100 patients were positive and classified as having definite ANMDARE. The most frequent neuropsychiatric patterns were psychosis (81%), delirium (75%), catatonia (69%), anxiety-depression (65%), and mania (27%). Cognition was significantly impaired. A total of 34% of the patients had a predominantly neuropsychiatric presentation without seizures. After multivariate analysis, the clinical hallmarks of ANMDARE consisted of a catatonia–delirium comorbidity, tonic-clonic seizures, and orolingual dyskinesia.
Conclusions
Our study supports the notion of a neurobehavioral phenotype of ANMDARE characterized by a fluctuating course with psychotic and affective symptoms, catatonic signs, and global cognitive dysfunction, often accompanied by seizures and dyskinesia. The catatonia–delirium comorbidity could be a distinctive neurobehavioral phenotype of ANMDARE.
In the 1930s the Bolivian and Mexican governments decreed the nationalization of their respective oil industries, thus starting a juncture of tensions in their relationship with the United States government and companies. In both cases foreign companies quit the respective host countries, but Bolivia was less successful than Mexico in maintaining its initial stand in face of the external pressure. Following a most-similar-system design strategy to compare both cases of asymmetrical confrontation, which share a similar set of conditions regarding simultaneity, starting causes of the conflict, actors involved and international context, we contend that the difference in the confrontation’s resolution is mainly attributable to differing domestic variables. Controlling for the similarity in external conditions, we show that the building and maintenance of a strong internal support coalition was critical for the capacity of the weakest part to advance its interest in an asymmetrical atmosphere.