ABSTRACT Luis Tavares revolutionized cardiac surgery, always bringing the most modern instruments and equipment from his travels to England - surgical forceps, scissors, scalpels, etc. He always insisted that he was not just a thoracic surgeon, for his work extended over a wide field and created three important cardiac surgery centers which promoted a great development of cardiology. He carried out the first open heart surgery (atrial septal defect) employing extracorporeal circulation and closure of a ventricular septal defect with deep surface hypothermia of north and northeast Brazil. He promoted an intense scientific exchange program between Recife and England, resulting in significant advances in medicine, and participated directly in the creation of HEMOPE), leading to radical changes and improvements in blood therapy in the whole country. The PROCAPE, inaugurated in 2006, was the result of the cardiac center created by him in early 1970 at Hospital Oswaldo Cruz and can be considered the second largest public-university cardiology center in Brazil. He is thus widely regarded as an outstanding name in medicine in the 20th century and one of the fathers of modern cardiac surgery in Brazil. forceps scissors scalpels etc surgeon atrial Brazil HEMOPE, HEMOPE , HEMOPE) country PROCAPE 2006 197 publicuniversity public university th 200 19 20 1 2

ABSTRACT Bycatch species are as important as target species in the challenge of comprehensive fishery management. This is especially the case for vulnerable species such as elasmobranchs in offshore areas of the Colombian Pacific Ocean (CPO), for which information is scarce and long-term databases are used. Therefore, this study aimed to characterize the bycatch in tuna purse-seine fishery with an elasmobranch species approach using fishery data from 2000 to 2019. A total of 59 bycatch species were identified, including 27 bony fishes, 22 elasmobranchs, two mollusks, four sea turtles, and four dolphins. The total bycatch percentage was 20.8%, with elasmobranchs accounting for less than 5%. Fish aggregating devices (FADs) and class 6 vessels recorded the highest percentage of bycatch. Bony fish bycatch was mainly obtained from the border of Ecuador until 4° N across the CPO. Elasmobranchs were captured throughout the CPO, showing differences by vessel class and fishing method. The silky shark Carcharhinus falciformis was the most caught species. Elasmobranch spatial abundance and capture hotspots showed the highest values towards the northern coast, in offshore areas of Gorgona Island, southwards in offshore areas, and around Malpelo Island. FADs captured the highest number of bycatch species compared with other fishing methods, such as Tuna Associated with Dolphins (DEL), Natural Floating Objects (NAT), and Tuna not Associated (NoAs). Management recommendations for bycatch species in this fishery are provided in the CPO. management CPO , (CPO) longterm long term used Therefore purseseine purse seine 200 2019 5 identified 2 fishes mollusks turtles dolphins 208 20 8 20.8% 5% (FADs 4 method coast Island methods DEL, DEL (DEL) NAT, NAT (NAT) NoAs. NoAs . (NoAs) (CPO 201 20.8 (DEL (NAT (NoAs 20.

Resumen Objetivo: Determinar las características sociodemográficas, clínicas y de procedimiento asociadas a complicaciones en pacientes diabéticos con enfermedad coronaria severa, sometidos a revascularización quirúrgica. Métodos: Estudio de cohortes retrospectivo en pacientes mayores de 18 años con diagnóstico de diabetes mellitus y enfermedad coronaria multivaso, sometidos a revascularización quirúrgica, en el que se evaluaron las características individuales, clínicas y de procedimiento asociadas a complicaciones posquirúrgicas. Se realizó un análisis bivariado y multivariado mediante regresión logística binaria. Resultados: Los factores asociados a complicaciones fueron edad, índice de masa corporal, fracción de eyección del ventrículo izquierdo, clase funcional de la Asociación del Corazón de Nueva York (NYHA, su sigla en inglés por New York Heart Association) preintervención y antecedente de consumo de alcohol y tabaco; de estos, la edad es la variable que persiste con significancia estadística tras el modelo de regresión logística binaria. Conclusión: La incidencia de complicaciones posoperatorias en pacientes diabéticos sometidos a revascularización quirúrgica es comparable con la observada en estudios previos, y el factor asociado encontrado para este grupo de pacientes es la edad. El modelo podría explicar el 23 % del desarrollo de complicaciones en la cohorte estudiada.

Abstract Objective: To determine the sociodemographic, clinical and procedural characteristics associated with complications in diabetic patients with severe coronary disease treated by coronary artery bypass surgery. Methods: A retrospective cohort study in patients over 18 years old with a diagnosis of diabetes mellitus and multivessel coronary disease, undergoing surgical revascularization, where individual, clinical and procedural characteristics associated with surgical complications were evaluated. A bivariate and multivariate analysis was performed using binary logistic regression. Results: The factors associated with complications that were found were: age, body mass index, left ventricular ejection fraction, pre intervention New York Heart Association (NYHA) functional class, alcohol and tobacco history. Of these, age was the only variable that persists with statistical significance after the logistic regression model. Conclusion: The incidence of postoperative complications in diabetic patients undergoing surgical revascularization is comparable to that observed in previous studies. The associated factor found for this group of patients is the age.

RESUMEN Introducción: Existen diferentes sistemas de graduación para interpretar la biopsia de glándula salival menor (BGSM) en pacientes con síntomas secos. En la actualidad la metodología recomendada (Focus Score [FS]), aunque no se emplea de forma rutinaria, conlleva discrepancias diagnósticas. Objetivo: Determinar la concordancia de la lectura histopatológica de BGSM entre las técnicas FS y Chisholm Mason (CM) para el diagnóstico de sialoadenitis linfocítica focal en el hospital de San José, entre enero de 2017 y junio de 2018. Métodos: Estudio de concordancia. Se incluyeron BGSM de pacientes con síntomas secos. Se excluyó material no apto para el estudio, o con menos de 4 lóbulos o menos de 8 mm de área. Se clasificaron utilizando las técnicas FS y CM por 2 evaluadores independientes. Se evaluó el acuerdo interobservador, intraobsevador y global entre las pruebas mediante el coeficiente de Kappa de Cohen. Resultados: Se evaluaron 130 biopsias. Los valores K intraobservador entre FS y CM fueron 0,42 para el observador 1 y 0,23 para el observador 2. Los valores K del acuerdo interobservador fueron 0,47 para FS y 0,65 para CM. La concordancia entre los 2 sistemas de puntuación fue K de 0,13. Conclusiones: Se evidencia una probable sobreestimación de focos con CM, que resalta sus debilidades, y mayor precisión con FS. Por ende, la concordancia entre las 2 pruebas es débil. Es necesario un mayor esfuerzo para el uso del método estandarizado de lectura de BGSM con el FS para una correcta interpretación y beneficio en la clasificación de pacientes con síndrome seco.

ABSTRACT Introduction: There are different grading systems for interpreting the minor salivary gland biopsy (MSGB) in patients with dry symptoms (Sicca). The recommended methodology is currently the Focus Score (FS), which, although not performed routinely, results in diagnostic discrepancies. Objective: To determine the concordance of the histopathological reading of MSGB between the FS and Chisholm Mason (CM) techniques for diagnosis of focal lymphocytic sialadenitis at the San José Hospital between January 2017 and June 2018. Methods: Concordance study. MSGB of patients with sicca symptoms were included. Material not suitable for study and / or with less than 4 lobules and / or less than 8 mm of surface area was excluded. They were classified, using the FS and CM techniques, by two independent evaluators. The inter-observer, intra-observer, and overall agreement between the tests were evaluated using Cohen's Kappa coefficient. Results: A total of 130 biopsies were evaluated. The intra-observer K values between FS and CM were 0.42 for observer 1, and 0.23 for observer 2. The K values of the inter-observer agreement were 0.47 for FS, and 0.65 for CM. The concordance between the two scoring systems was K = 0.13. Conclusions: There is evidence of a probable over-estimation of foci with CM, highlighting its weaknesses and greater precision with FS technique, resulting in the weak concordance between the two tests. A greater effort is necessary for the use of the standardised MSGB FS reading method for a correct interpretation and benefit in the classification of patients with dry syndrome.

Resumen Introducción. El objetivo de este estudio fue evaluar si la laparotomía de control de daños con ligadura y reconstrucción intestinal diferida, en pacientes con peritonitis secundaria a compromiso de víscera hueca, reduce el número de ostomías. Métodos. Se incluyeron todos los pacientes menores de 18 años de edad que ingresaron a la clínica con sospecha de peritonitis de origen no traumático y que se sometieron a laparotomía entre enero del 2003 y diciembre del 2018. Se evaluaron las características sociodemográficas, comorbilidades, escalas de gravedad fisiológica, técnicas de reconstrucción intestinal y resultados clínicos. Resultados. Se incluyeron 306 pacientes, distribuidos en tres grupos: 1) 120 (39,2 %) sometidos a resección y anastomosis, 2) 87 (28,4 %) sometidos a ostomía y 3) 99 (32,3 %) sometidos inicialmente a ligadura intestinal. Los pacientes sometidos a ligadura intestinal presentaron mayor compromiso fisiológico al ingreso a la unidad de cuidado intensivo, con puntuación APACHE 11: 14 (rango intercuartílico, RIC=10-18) en el grupo 1, 13 (RIC=11-18) en el grupo 2, y 18 (RIC=14-24) en el grupo 3 (p<0,01). Sin embargo, más de la mitad se reconstruyeron en la siguiente laparotomía: anastomosis mecánica (16/99; 16,1 %), anastomosis manual (49/99; 49,5 %), ostomía (34/99; 34,3 %). Además, estos pacientes sometidos a ligadura intestinal tuvieron un número significativamente mayor de nuevas laparotomías, y de días de asistencia respiratoria mecánica, de estancia en la unidad de cuidado intensivo y de estancia hospitalaria. No hubo diferencias estadísticamente significativas en la mortalidad entre los subgrupos: (grupo 1=19 (15,8 %), grupo 2=16 (18,4 %), grupo 3=19 (19,2 %) (p=o,79). Conclusión. En este estudio, se logró evitar la ostomía como técnica de reconstrucción definitiva en más de la mitad de los pacientes con peritonitis que se sometieron a laparotomía de control de daños con ligadura intestinal.

Abstract Introduction. The objective of this study was to evaluate if the damage control laparotomy with ligation and delayed intestinal reconstruction (DR), in patients with peritonitis secondary to compromised hollow viscera, reduces the number of ostomies. Methods. All patients under 18 years of age who entered the clinic with suspected non-traumatic peritonitis and who underwent laparotomy between January 2003 and December 2018 were included. Sociodemographic characteristics, comorbidities, severity scales physiological, intestinal reconstruction techniques and clinical results were evaluated. Results. A total of 306 patients were included, divided into three groups: 1) 120 (39.2 %) underwent resection and anastomosis, 2) 87 (28.4 %) underwent ostomy, and 3) 99 (32.3 %) underwent initial to intestinal ligation. Patients undergoing intestinal ligation presented greater physiological compromise upon admission to the intensive care unit, with an APACHE II score: 14 (interquartile range, IQR= 10-18) in group 1, 13 (IQR = 11-18) in the group 2, and 18 (IQR = 14-24) in group 3 (p<0.01). However, more than half were reconstructed in the following laparotomy: mechanical anastomosis (16/99; 16.1 %), manual anastomosis (49/99; 49.5 %), ostomy (34/99; 34.3 %). Also, they had a significantly greater number of new laparotomies, and of days of mechanical respiratory assistance, of stay in the intensive care unit and of hospital stay. There were no statistically significant differences in mortality between the subgroups: group 1= 19 (15.8 %), group 2= 16 (18.4 %), group 3= 19 (19.2 %) (p= 0.79). Conclusion. In this study, it was possible to avoid the ostomy as the definitive reconstruction technique in more than half of the patients with peritonitis who underwent damage control laparotomy with intestinal ligation.

Abstract Objective: Endovascular therapy offers reduction in costs, morbidity and mortality. Drug eluting stent (DES) Zilver PTX has up to 89.9% patency rates. Our objective is to determinate patency and presence of complications at 6 months with the DES Zilver PTX in comparison to open bypass using ePTFE in the infrainguinal segment. Methods: This is a retrospective study with two groups of 15 patients each, with a mean age of 66 years old, with a diagnosis of symptomatic peripheral arterial disease (PAD). The control group was treated with open revascularization using ePTFE graft, whereas the study group was treated with the DES Zilver PTX. Both groups were evaluated immediately, at 3 and 6 months. Results: In comparison, both methods were effective to treat PAD. DES Zilver PTX reduced hospitalization length and had a higher tendency to increase functional class. Primary patency was 87% vs 93% and secondary patency was 93% vesus 100% for open revascularization and DES respectively. Conclusions: Both methods are effective to treat PAD in the infrainguinal segment. Our results tend to favor DES over open revascularization with synthetic graft.

Resumen Objetivo: La terapia endovascular ofrece menor costo y reducción en la morbimortalidad. El uso del stent medicado Zilver PTX muestra resultados prometedores con permeabilidad del 89.9% a un año. El objetivo es analizar la permeabilidad a 6 meses y la presencia de complicaciones con el uso del stent medicado Zilver PTX en comparación a la derivación femoropoplítea sintética. Métodos: Estudio retrospectivo que abarca dos grupos de 15 pacientes cada uno, con una edad promedio de 66 años, todos presentan diagnóstico de enfermedad arterial periférica (EAP) sintomática. El grupo control fue sometido a revascularización con injerto sintético, mientras el grupo de estudio fue tratado con stent medicado Zilver PTX. Ambos grupos fueron vigilados por un periodo de 6 meses. Resultados: En comparación, ambos métodos son eficaces en el tratamiento de la EAP del sector femoropoplíteo. Para el grupo tratado con stent medicado, se encontró disminución en días de estancia intrahospitalaria y tendencia a incrementar la clase funcional. La permeabilidad primaria fue del 87 vs. el 93% en la derivación abierta y grupo manejado con stent medicado Zilver PTX, respectivamente. Como permeabilidad secundaria se encontró 93% vs. 100%. Conclusiones: Ambos métodos son eficaces para tratar la enfermedad femoropoplítea. Nuestros resultados favorecen el uso de stent medicado en comparación a derivación con injerto sintético.

Abstract The current population decline of amphibians, mainly due to habitat destruction and alteration by humans, is alarming. From March to May 2017, we searched for amphibians in terrestrial and arboreal bromeliads (>20cm in height) in 16ha of pine-oak forest. Out of 3 467 bromeliads, only two specimens had amphibians, indicating a devastating population decline.

Resumen El actual declive de anfibios, principalmente por la destrucción y alteración del hábitat, por actividades antropogénicas es alarmante. De marzo a mayo del 2017, buscamos anfibios en bromelias terestres y arbóreas (>20cm de altura en 16ha de bosque de pino-encino. De 3 467 bromelias, solo dos especímenes tenían anfibios, indicando un declive devastador de la población.

Resumo Justificativa: O delírio pós-operatório é uma complicação séria em pacientes submetidos à cirurgia abdominal de grande porte. Ainda não está claro se as variáveis hemodinâmicas e de perfusão no período perioperatório afetam o risco de delírio pós-operatório. O objetivo deste estudo piloto foi avaliar a associação entre perfusão e hemodinâmica no perioperatório com o surgimento de delírio pós-operatório. Métodos: Estudo prospectivo de coorte de adultos com 60 anos ou mais, submetidos à cirurgia eletiva aberta do cólon. As variáveis multimodais de hemodinâmica e perfusão foram monitoradas, inclusive oxigenação venosa central (ScvO2), níveis de lactato e oxigenação cerebral não invasiva (rSO2), de acordo com um protocolo-padrão de anestesia. O teste exato de Fisher ou o teste t de Student foram usados para comparar os pacientes que desenvolveram delírio pós-operatório com aqueles que não desenvolveram p < 0,05. Resultados: Avaliamos 28 pacientes, 73 ± 7 anos, 60,7% do sexo feminino. Dois pacientes desenvolveram delírio pós-operatório (7,1%). Esses dois pacientes tinham menos anos de escolaridade do que aqueles sem delírio pós-operatório (p = 0,031). Nenhuma das variáveis de pressão arterial no perioperatório foi associada à incidência de delírio. Quanto aos parâmetros de perfusão, ScvO2 foi menor no grupo que apresentou delírio pós-operatório do que no grupo que não apresentou delírio, sem atingir significância estatística (65 ± 10% vs. 74 ± 5%; p = 0,08), mas o delta-ScvO2 (a diferença entre as médias no pós-operatório e intraoperatório) foi associado ao delírio (p = 0,043). As variáveis de lactato e rSO2 no pós-operatório não foram associadas ao delírio. Conclusões: Nosso estudo piloto sugere uma associação entre delta-ScvO2 e delírio e uma tendência à diminuição da ScvO2 no pós-operatório de pacientes com delírio. Estudos adicionais são necessários para elucidar essa associação.

Abstract Background: Post-operative delirium is a serious complication in patients undergoing major abdominal surgery. It remains unclear whether peri-operative hemodynamic and perfusion variables affect the risk for postoperative delirium. The objective of this pilot study was to evaluate the association between perfusion and hemodynamics peri-operative with the appearance of post-operative delirium. Methods: Prospective cohort study of adults 60 years or older undergoing elective open colon surgery. Multimodal hemodynamic and perfusion variables were monitored, including central venous oxygenation (ScvO2), lactate levels, and non-invasive cerebral oxygenation (rSO2), according to a standard anesthesia protocol. Fisher's exact test or Student's t-test were used to compare patients who developed post-operative delirium with those who did not (p < 0.05). Results: We studied 28 patients, age 73 ± 7 years, 60.7% female. Two patients developed post-operative delirium (7.1%). These two patients had fewer years of education than those without delirium (p = 0.031). None of the peri-operative blood pressure variables were associated with incidence of post-operative delirium. In terms of perfusion parameters, postoperative ScvO2 was lower in the delirium than the non-delirium group, without reaching statistical significance (65 ± 10% vs. 74 ± 5%; p = 0.08), but the delta-ScvO2 (the difference between means post-operative and intra-operative) was associated with post-operative delirium (p = 0.043). Post-operative lactate and rSO2 variables were not associated with delirium. Conclusions: Our pilot study suggests an association between delta ScvO2 and post-operative delirium, and a tendency to lower post-operative ScvO2 in patients who developed delirium. Further studies are necessary to elucidate this association.

Resumen Para optimizar el flujo vehicular en una intersección vial se diseñaron un al- goritmo de control adaptativo y una base de datos que apoya la depuración del rendimiento del controlador, ambos alojados en el sistema embebido Raspberry Pi B+. El desempeño del algoritmo fue evaluado con un instrumento virtual, que emuló una intersección semafórica de la ciudad de Cúcuta, esto es, los sensores magnetorresistivos, el proceso de encendido en las luces de los semáforos y el flujo vehicular. La manipulación de los tiempos de encendido en las luces de los semáforos, aumentó el flujo vehicular hasta 5.5 % y, disminuyó el tiempo máximo de espera del vehículo para avanzar hasta 28 segundos y el largo de fila hasta un 18 %. Con base en el caso de estudio, se puede inferir que es posible integrar el control adaptativo y los sistemas embebidos como herramientas de software y hardware para mejorar el funcionamiento en los sistemas de regulación vial.

Abstract In order to optimize the traffic flow on a road intersection, an adaptive control algorithm and a data base were designed; both components were hosted on a Raspberry Pi B+ embedded system. The data base helps to debug the performance of the controller. The efficiency of the algorithm was assessed using a virtual instrument, which emulated a traffic light intersection in the city of Cucuta, i. e., the magnetorresistive sensors, the activation process of the traffic lights and the traffic flow. By processing and updating the times assigned to the traffic lights, the traffic flow was increased up to 5.5 % and the maximum time a vehicle has to wait before passing through the traffic light was decreased up to 28 seconds. Aditionally the length of line was diminished up to 18 %. Based on this case study, it can be inferred that is possible to integrate the adaptive control and the embedded systems as software and hardware tools to improve the operation of traffic control systems.

Fitzroya cupressoides, commonly known as Alerce in South American Spanish, is a conifer species native to southern South America, where its wood is highly prized for its beauty and durability. This study evaluated the effect of hormonal components supplemented with culture media on the organogenic process of Fitzroya cupressoides and analyzed the in vitro regeneration process by histological studies. The Quorin-Lepoivre (QL) basic culture medium, supplemented with different concentrations of indole 3-butyric acid (IBA), 6-benzylaminopurine (BA) and 2,4-dichlorophenoxyacetic acid (2,4-D), was tested using nodal segments and acicular leaves. A completely randomized design with five balanced replications was used; the experimental unit was a glass jar containing an explant, while a petri dish containing four foliar explants was used for inducing callogenesis. The treatment factor had significant (P = 0.001) effects on the response variables number of shoots and caulinary elongation. Duncan's multiple range test confirmed that the treatments that had significant differences were 0.1 mg·L-1 of IBA and 1.5 mg·L-1 of BA for number of shoots per explant and 0.1 mg·L-1 IBA and 1.0 mg·L-1 of BA for caulinary elongation. Histological studies demonstrated the proliferation of meristematic structures from sub-epidermal tissue.

Fitzroya cupressoides (alerce) es una conífera endémica de Sudamérica austral cuya madera ostenta atributos de belleza y durabilidad. El presente estudio evaluó el efecto de componentes hormonales suplementado con medios de cultivo sobre la capacidad organogénica de Fitzroya cupressoides, y se analizó el proceso de regeneración in vitro mediante estudios histológicos. Se ensayó el medio de cultivo básico Quorin y Lepoivre (QL) suplementado con diferentes concentraciones de ácido indol 3-butírico (AIB), 6-bencilaminopurina (BAP) y ácido 2,4-diclorofenoxiacético (2,4-D) utilizando segmentos nodales y hojas aciculares. Se utilizó un diseño completamente al azar con cinco repeticiones balanceado; la unidad experimental fue un frasco de vidrio conteniendo un explante, y la inducción de callogénesis correspondió a una placa petri con cuatro explantes foliares. Hubo efectos significativos (P = 0.001) del tratamiento sobre las variables respuesta número de brotes y elongación caulinar. La prueba de rangos múltiples de Duncan confirmó que los tratamientos que observaron diferencias significativas fueron 0.1 mg·L-1 de AIB y 1.5 mg·L-1 de BAP para número de brotes por explante y 0.1 mg·L-1 AIB y 1.0 mg·L-1 de BAP para la elongación caulinar. El análisis histológico demostró la proliferación de estructuras meristemáticas a partir de tejido subepidérmico.

Se presenta el primer caso de linfoma intravascular de célula grande, una variante del linfoma de células B grandes difuso, diagnosticado en el Hospital Militar Central de Bogotá, en una mujer adulta mayor, quien consultó por un síndrome febril prolongado, pérdida de peso, síntomas constitucionales y quien veinte días antes del ingreso perdió fuerza progresiva, hasta la paraplejia. Se iniciaron estudios para descartar enfermedades neoplásicas, infecciosas y autoinmunes, pero falleció el día catorce de su hospitalización. El estudio post-mortem, realizado cinco horas después, mostró una lesión tumoral maligna de célula grande, limitada a los espacios vasculares de múltiples vísceras. Se planteó como diagnóstico una neoplasia de origen linfoide, que se confirmó posteriormente mediante pruebas inmunohistoquímicas.

This is the first case of intravascular large cell lymphoma diagnosed at the Hospital Militar de Bogota, in an adult female who presented with chronic fever, weight loss, constitutional symptoms and progressive motor deterioration for the previous 20 days to the point of paraplegia. A work up was carried out to rule out neoplastic diseases, infections or autoimmune diseases, but she died on the fourteen hospital day. The autopsy, performed 5 hours post mortem, showed an intravascular large cell malignancy, limited to the vascular spaces of multiple organs. The lymphomatous origin was confirmed posteriorly by immunochemical tests.

Apresenta-se o primeiro caso de linfoma intravascular de célula grande, uma variante do linfoma de células B grandes difuso, diagnosticado no Hospital Militar Central de Bogotá, numa mulher adulta maior, quem conferiu por uma síndrome febril prolongado, perda de peso, sintomas constitucionais e quem vinte dias antes do rendimento perdeu força progressiva, até a paraplegia. Iniciaram-se estudos para descartar doenças neoplásicas, infecciosas e auto-imunes, mas faleceu o dia quatorze de sua hospitalização. O estudo post-mortem, realizado cinco horas depois, mostrou uma lesão tumoral maligna de célula grande, limitada aos espaços vasculares de múltiples vísceras. Propôs-se como diagnóstico uma neoplasia de origem linfóide, que se confirmou posteriormente mediante provas inmunohistoquímicas.

Background and objective: The aim of this study was to design and validate a scale to detect major depressive disorders in elderly individuals in primary care (Detection of Depression in the Elderly Scale [DDES]). Methods: We performed an observational and cross-sectional study for the validation of a scale, administered by means of a personal interview, in 259 patients aged 65 years old or older. Available instruments were reviewed and the questions were designed. Subsequently, a first pilot study was performed. In a second pilot study the reproducibility of the instrument was analyzed. The gold standard was the result of a standardized psychiatric interview performed by psychiatrists (DSM-IV criteria and SCAN interviews). Results: The intraclass correlation coefficients corresponding to the test-retest and inter-rater reliability were 0.858 (95% confidence interval [CI], 0.634-0.946) and 0.908 (95% CI, 0.726-0.969) respectively. Two hundred sixteen subjects underwent an assessment, in which primary care and psychiatric evaluations were blinded. Major depression was diagnosed in 81 patients (37.5%; 95% CI, 31.1-44.4). The internal consistency of the DDES was good (Cronbach's alpha = 0.79). Exploratory factorial analysis revealed an 8-component structure (55.8% of explained variance). A cutoff score of 15 or more for the DDES showed sensitivity of 90.1% (95% CI, 80.95-95.33), specificity of 74.8% (95% CI, 66.48-81.71) and a likelihood ratio (+) of 3.58 (95% CI, 2.65-4.83). Conclusions: The DDES is a clinically useful instrument for the detection of major depression in elderly patients in primary care.

Fundamento y objetivo: Elaborar y validar una escala para detectar trastornos depresivos mayores (TDM) en ancianos que utilizan las consultas de atención primaria (Escala para la Detección de Depresión en Ancianos [EDDA]). Métodos: Estudio observacional transversal para validar una escala, administrada mediante entrevista personal, en 259 pacientes de 65 o más años. Tras revisar los instrumentos disponibles y elaborar los ítems, se realizó una primera prueba piloto o pretest. En una segunda prueba piloto se analizó la reproducibilidad del instrumento. El estándar de oro fue el resultado de una entrevista psiquiátrica estandarizada realizada por psiquiatras (criterios DSM-IV y entrevista SCAN). Resultados: Los coeficientes de correlación intraclase (CCI) correspondientes a la fiabilidad intra e interobservador fueron, respectivamente, de 0,858 (intervalo de confianza [IC] del 95%, 0,634-0,946) y 0,908 (IC del 95%, 0,726-0,969). El número de sujetos válidos para el estudio fue de 216 ancianos, en quienes se realizó, de forma ciega, una valoración en consultas de atención primaria y de psiquiatría. En éstas se objetivó la existencia de un TDM en 81 de ellos (37,5%; IC del 95%, 31,1-44,4). La EDDA mostró una elevada coherencia interna (* de Cronbach = 0,79). El análisis factorial determinó que existían 8 factores capaces de explicar el 55,8% de la varianza total. Para una puntuación mayor o igual a 15, la EDDA presenta una sensibilidad del 90,1% (IC del 95%, 80,95-95,33), una especificidad del 74,8% (IC del 95%, 66,48-81,71) y un cociente de probabilidad positivo de 3,58 (IC del 95%, 2,65-4,83). Conclusiones: La EDDA es un instrumento clínicamente útil para la detectar los TDM de los ancianos en la atención primaria.

Background and objective: The aim of this study was to design and validate a scale to detect major depressive disorders in elderly individuals in primary care (Detection of Depression in the Elderly Scale [DDES]). Methods: We performed an observational and cross-sectional study for the validation of a scale, administered by means of a personal interview, in 259 patients aged 65 years old or older. Available instruments were reviewed and the questions were designed. Subsequently, a first pilot study was performed. In a second pilot study the reproducibility of the instrument was analyzed. The gold standard was the result of a standardized psychiatric interview performed by psychiatrists (DSM-IV criteria and SCAN interviews). Results: The intraclass correlation coefficients corresponding to the test-retest and inter-rater reliability were 0.858 (95% confidence interval [CI], 0.634-0.946) and 0.908 (95% CI, 0.726-0.969) respectively. Two hundred sixteen subjects underwent an assessment, in which primary care and psychiatric evaluations were blinded. Major depression was diagnosed in 81 patients (37.5%; 95% CI, 31.1-44.4). The internal consistency of the DDES was good (Cronbach's alpha = 0.79). Exploratory factorial analysis revealed an 8-component structure (55.8% of explained variance). A cutoff score of 15 or more for the DDES showed sensitivity of 90.1% (95% CI, 80.95-95.33), specificity of 74.8% (95% CI, 66.48-81.71) and a likelihood ratio (+) of 3.58 (95% CI, 2.65-4.83). Conclusions: The DDES is a clinically useful instrument for the detection of major depression in elderly patients in primary care.

Fundamento y objetivo: Elaborar y validar una escala para detectar trastornos depresivos mayores (TDM) en ancianos que utilizan las consultas de atención primaria (Escala para la Detección de Depresión en Ancianos [EDDA]). Métodos: Estudio observacional transversal para validar una escala, administrada mediante entrevista personal, en 259 pacientes de 65 o más años. Tras revisar los instrumentos disponibles y elaborar los ítems, se realizó una primera prueba piloto o pretest. En una segunda prueba piloto se analizó la reproducibilidad del instrumento. El estándar de oro fue el resultado de una entrevista psiquiátrica estandarizada realizada por psiquiatras (criterios DSM-IV y entrevista SCAN). Resultados: Los coeficientes de correlación intraclase (CCI) correspondientes a la fiabilidad intra e interobservador fueron, respectivamente, de 0,858 (intervalo de confianza [IC] del 95%, 0,634-0,946) y 0,908 (IC del 95%, 0,726-0,969). El número de sujetos válidos para el estudio fue de 216 ancianos, en quienes se realizó, de forma ciega, una valoración en consultas de atención primaria y de psiquiatría. En éstas se objetivó la existencia de un TDM en 81 de ellos (37,5%; IC del 95%, 31,1-44,4). La EDDA mostró una elevada coherencia interna (* de Cronbach = 0,79). El análisis factorial determinó que existían 8 factores capaces de explicar el 55,8% de la varianza total. Para una puntuación mayor o igual a 15, la EDDA presenta una sensibilidad del 90,1% (IC del 95%, 80,95-95,33), una especificidad del 74,8% (IC del 95%, 66,48-81,71) y un cociente de probabilidad positivo de 3,58 (IC del 95%, 2,65-4,83). Conclusiones: La EDDA es un instrumento clínicamente útil para la detectar los TDM de los ancianos en la atención primaria.