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OBJECTIVE: To identify neonatal characteristics and 2-year neurodevelopmental outcomes associated with positive screening for risk of autism. STUDY DESIGN: Nine university-affiliated neonatal intensive care units (NICUs) enrolled infants born at <30 weeks of gestation. Infants underwent the NICU Network Neurobehavioral Scale examination before discharge and the Bayley Scales of Infant and Toddler Development, Third Edition, the Child Behavior Checklist, and the Modified Checklist for Autism in Toddlers, revised with follow-up (M-CHAT-R/F) at 2 years of corrected age. Generalized estimating equations examined associations between M-CHAT-R/F, neurobehavioral test results, and neonatal medical morbidities. RESULTS: At 2 years of corrected age, data were available for 466 of 744 enrolled infants without cerebral palsy. Infants with hypoaroused NICU Network Neurobehavioral Scale profiles were more likely to screen M-CHAT-R/F-positive (OR 2.76, 95% CI 1.38-5.54). Infants with ≥2 medical morbidities also were more likely to screen positive (OR 2.65, 95% CI 1.27-5.54). Children with positive M-CHAT-R/F scores had lower Bayley Scales of Infant and Toddler Development, Third Edition, Cognitive (t [451] = 5.43, P < .001, d = 0.82), Language (t [53.49] = 7.82, P < .001, d = 1.18), and Motor (t [451] = 7.98, P < .001, d = 1.21) composite scores and significantly greater Child Behavior Checklist Internalizing (t [457] -6.19, P < .001, d = -0.93) and Externalizing (t [57.87] = -5.62, P < .001, d = -0.84) scores. CONCLUSIONS: Positive M-CHAT-R/F screens at 2 years of corrected age were associated with neonatal medical morbidities and neurobehavioral examinations as well as toddler developmental and behavioral outcomes. These findings demonstrate the potential utility of the M-CHAT-R/F as a global developmental screener in infants born very preterm, regardless of whether there is a later autism diagnosis.

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An outbreak of coronavirus disease began in a large penitentiary complex in Brazil on April 1, 2020. By June 12, there were 1,057 confirmed cases among inmates and staff. Nine patients were hospitalized, and 3 died. Mean serial interval was ≈2.5 days; reproduction number range was 1.0-2.3.

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INTRODUCTION: Metabolic syndrome (MetS) is an emergent problem among patients with epilepsy. Here, we evaluate and compare the diagnostic yield and accuracy of different MetS criteria among adult patients with epilepsy to further explore the best strategy for diagnosis of MetS among patients with epilepsy. MATERIALS AND METHODS: Ninety-five epileptic adults from a tertiary epilepsy reference center were prospectively recruited over 22 weeks in a cross-sectional study. MetS was defined according to five international criteria used for the diagnosis of the condition [ATP3, American Association of Clinical Endocrinologists (AACE), International Diabetes Federation (IDF), AHA/NHLBI, and harmonized criteria]. Sensitivity, specificity, positive and negative predictive values (NPVs), and area under the receiver operating characteristic curve (ROC) curve were estimated for each criterion. RESULTS: In our sample, adult patients with epilepsy showed a high prevalence of obesity, hypertension, and diabetes. However, the prevalence of MetS was significantly different according to each criterion used, ranging from 33.7%, as defined by AACE, to 49.4%, as defined by the harmonized criteria (p < 0.005). IDF criteria showed the highest sensitivity [S = 95.5% (95% CI 84.5-99.4), p < 0.05] and AACE criteria showed the lowest sensitivity and NPV [S = 68.2% (95% CI 52.4-81.4), p < 0.05; NPV = 75.8% (95% CI 62.3-86.1), p < 0.05]. ROC curve for all criteria studied showed that area under curve (AUC) for IDF criterion was 0.966, and it was not different from AUC of harmonized criterion (p = 0.092) that was used as reference. On the other hand, the use of the other three criteria for MetS resulted in significantly lower performance, with AUC for AHA/NHLBI = 0.920 (p = 0.0147), NCEP/ATP3 = 0.898 (p = 0.0067), AACE = 0.830 (p = 0.00059). CONCLUSION: Our findings suggest that MetS might be highly prevalent among adult patients with epilepsy. Despite significant variations in the yield of different criteria, the harmonized definition produced the highest prevalence rates and perhaps should be preferred. Correct evaluation of these patients might improve the rates of detection of MetS and foster primary prevention of cardiovascular events in this population.

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We investigated the effect of chronic medical conditions including obesity on self-reported disability and mobility in Mexican Americans aged 75 or over using data from the Hispanic Established Population for the Epidemiological Study of the Elderly (Hispanic EPESE) Wave 5 (2004-2005). Disability was assessed with a modified version of the Katz activities of daily living (ADL) scale and mobility was assessed with the Rosow Breslau scale of gross mobility function. The percentage of participants needing assistance with ADLs were as follows: 26.7% for transferring from a bed to chair, 26.6% for walking across a small room, 17.9% for dressing, 16.3% for using a toilet, 14.3% for grooming, and 8.2% for eating. Fifty percent reported limitation in the ability to walk ½ a mile and walking up and down stairs. Multivariate logistic regression analysis after controlling for all covariates showed that arthritis, diabetes, stroke, and obesity were significantly associated with any ADL limitation, walking up and down stairs, and walking 1/2 mile. Prevention of obesity and chronic medical conditions will help increase functional independence in this population.

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Analizar la patología médica de las mujeres en edad fértil que fueron atendidas en el Hospital General del Oeste de Caracas, Venezuela. Métodos: se realizó un estudio descriptivo, transversal, de pacientes con edades entre 14 y 44 años evaluadas desde 1º Octubre 2015 al 1º Mayo 2016. Tratamiento estadístico: Se realizó estadística descriptiva con medidas de tendencia central en las variables continuas y de proporción en las cualitativas. Resultados: Se evaluaron 910 pacientes con edad promedio de 25,63 ± 6,69 DS. El grupo entre 14 y 19 años fue el 33,40% y el 17,5% eran adolescentes. El promedio de edad de las embarazadas fue de 23,31 ± 6,08 DS, mientras que en las no gestantes 30,57 ± 7,97 DS. Según el Graffar modificado por Méndez Castellanos predominó la clasificación III en 57,06%. El promedio de la menarquia fue 12,7 ± 1,75 DS y de la sexarquia 16,54 ± 4,04 DS. La edad promedio del primer parto fue 18 ± 1,33 DS. El 73,62% no cumplía control ginecológico anual. Eran gestantes 78% y de ellas, el 80% eran sanas. Las patologías médicas del embarazo fueron preeclampsia 39%, anemia 35,93%, diabetes gestacional 12%, síndrome de HELLP 11%, hiperemesis gravídica 1,56%. Los diagnósticos médicos no relacionados con el embarazo fueron: asma 41,77%, HTA crónica 16,45%, ITU 12,65%, obesidad 7,59%, anemia 5,09%. La violencia doméstica se documentó en 3,4% y 20% ocurrió durante la gestación. En las no gestantes el diagnóstico médico predominó en 48% y los mas frecuentes fueron: anemia 34,84%, ITU 27,77%, HTA crónica 7,57%. Conclusión: La atención médica de la mujer en edad reproductiva debe ser adecuadamente abordada(AU)

To analyze the medical conditions in women of childbearing age who consulted at the Hospital General del Oeste, Caracas, Venezuela. Methods: This is an analitycal, transverse case design, of female patients in a non probabilistic sample, of intentional selection, that included 100% of patients aged 14 - 44 years, who consulted between October 1st 2015 and May 1st 2016- We included hospitalized and outpatients of internal medicine, as well as obstetrics and gynecology. A previous informed consent was obtained. The sample was divided in two groups, pregnant and not pregnant, classified as healthy and with any medical or gynecological pathology. The variables studied were: age, menarche, sexarche, parity, demographics, and final diagnoses, as well as associated complications. Results: We studied 910 patients, with an average age of 25,63 ± 6,69 DS. The group of 14 to 19 years was 3,40% and 17,5% of them were adolescents. The average age of the pregnant women was 23,31 ± 6,08 DS, and in the non-pregnant 30,57 ± 7,97 DS The Graffar score modified by Méndez Castellanos showed a class III in 57,06%. The average age of menarche was 12,7 ± 1,75 DS and of the first sexual intercourse 16,54 ± 4,04 DS. The average age of the first delivery 18 ± 1,33 DS. An important 73,62% did not have an annual gynecological consultation. The pregnant women were 78%. Among them, 80% were healthy. Their pathological conditions of pregnancy were: preeclampsia 39%, anemia 35,93%, gestational diabetes 12%, HELLP syndrome 11%, hyperemesis gravídarum 1,56%. The medical conditions not related to pregnancy were: asthma 41,77%, chronic hypertension 16,45%, UTI 12,65%, obesity 7,59%, anemia 5,09%. Doméstic violence was documented in 3,4%, and 20% ocurred during pregnancy. In non pregnant women there was 48% of medical conditions, being the most frequent anemia 34,84%, UTI 27,77%, chronic hypertension 7,57%, Conclusion: Women in childbearing age must be adequately approached and treated(AU)

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El objetivo de este estudio fue evaluar la utilidad de la escala para depresión de Hamilton (EDH) en la detección de trastornos depresivos en pacientes médicos hospitalizados. Los pacientes inicialmente fueron entrevistados con una guía estructural para la EDH y seguidamente una entrevista clínica. Un total de 57 pacientes fue evaluado, con una edad promedio de 45.1 años. 51.6% hombres y 43.9% mujeres. La concordancia absoluta entre la entrevista clínica y la EDH fue de 0.68, la prueba kappa fue de 0.31. Se concluye que la EDH es un instrumento poco útil en la detección de trastornos depresivos en pacientes hospitalizados con problemas médicos. Es probable que los síntomas somáticos comunes a la condición médica y a los trastornos depresivos expliquen este resultado...

The objective of this study was to evaluate the utility of Hamilton Depression Rating Scale (HDRS) for detecting depressive disorders in medical inpatients. Patients were interviewed, first using HDRS with a structured interview guide and last a clinical evaluation. Fifty-seven patients were evaluated, with age average of 45.1 years. 56.1% male and 43.9% female. The absolute concordance was 0.68, but kappa test was 0.31. We conclude that HDRS is not useful in medical inpatients. It is likely somatic symptoms common both medical condition and depressive disorders explain this results...

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