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The fibrous scaffolds for bone tissue engineering that mimic the extracellular matrix with bioactive and bactericidal properties could provide adequate conditions for regeneration of damaged bone. Electrospun ultrathin fiber covered with nano-hydroxyapatite is a favorable fibrous scaffold design. We developed a fast and reproducible strategy to produce polyvinylidene fluoride (PVDF)/nano-hydroxyapatite (nHAp) nanofibrous scaffolds with bactericidal and bioactive properties. Fibrous PVDF scaffolds were obtained first by the electrospinning method. Then, their surfaces were modified using oxygen plasma treatment followed by electrodeposition of nHAp. This process formed nanofibrous and superhydrophilic PVDF fibers (133.6 nm, fiber average diameter) covered with homogeneous nHAp (202.6 nm, average particle diameter) crystals. Energy-dispersive X-ray spectrometry demonstrated the presence of calcium phosphate, indicating a Ca/P molar ratio of approximately 1.64. X-ray diffraction, Fourier transform infrared spectroscopy, and Raman spectroscopy spectra identified β-phase of nHAp. Thermal analysis indicated a slight reduction in stability after nHAp electrodeposition. Bactericidal assays showed that nHAp exhibited 99.8% efficiency against Pseudomonas aeruginosa bacteria. The PVDF/Plasma and PVDF/nHAp groups had the highest cell viability, total protein, and alkaline phosphatase activity by 7 days after exposure of the scaffolds to MG63 cell culture. Therefore, the developed scaffolds are an exciting alternative for application in bone regeneration.
Functional impairment is a defining feature of psychotic disorders. A range of factors has been shown to influence functioning, including negative symptoms, cognitive performance and cognitive reserve (CR). However, it is not clear how these variables may affect functioning in first-episode psychosis (FEP) patients. This 2-year follow-up study aimed to explore the possible mediating effects of CR on the relationship between cognitive performance or specific clinical symptoms and functional outcome.
A prospective study of non-affective FEP patients was performed (211 at baseline and 139 at follow-up). CR was entered in a path analysis model as potential mediators between cognitive domains or clinical symptoms and functioning.
At baseline, the relationship between clinical variables or cognitive performance and functioning was not mediated by CR. At follow-up, the effect of attention (p = 0.003) and negative symptoms (p = 0.012) assessed at baseline on functioning was partially mediated by CR (p = 0.032 and 0.016), whereas the relationship between verbal memory (p = 0.057) and functioning was mediated by CR (p = 0.014). Verbal memory and positive and total subscales of PANSS assessed at follow-up were partially mediated by CR and the effect of working memory on functioning was totally mediated by CR.
Our results showed the influence of CR in mediating the relationship between cognitive domains or clinical symptoms and functioning in FEP. In particular, CR partially mediated the relationship between some cognitive domains or clinical symptoms and functioning at follow-up. Therefore, CR could improve our understanding of the long-term functioning of patients with a non-affective FEP.
Invasive species are widely recognized as a major threat to global diversity and an important factor associated with global change. Species distribution models (SDMs) have been widely applied to determine the range that invasive species could potentially occupy, but most examples focus on predictive variables at a single spatial scale. In this study, we simultaneously considered a broad range of variables related to climate, topography, land cover, land use, and propagule pressure to predict what areas in the southeastern United States are more susceptible to invasion by 45 invasive terrestrial plant species. Using expert-verified occurrence points from EDDMapS, we modeled invasion susceptibility at 30-m resolution for each species using a maximum entropy (MaxEnt) modeling approach. We then analyzed how environmental predictors affected susceptibility to invasion at different spatial scales. Climatic and land-use variables, especially minimum temperature of coldest month and distance to developed areas, were good predictors of landscape susceptibility to invasion. For most of the species tested, human-disturbed systems such as developed areas and barren lands were more prone to be invaded than areas that experienced minimal human interference. As expected, we found that landscape heterogeneity and the presence of corridors for propagule dispersal significantly increased landscape susceptibility to invasion for most species. However, we also found a number of species for which the susceptibility to invasion increased in landscapes with large core areas and/or less-aggregated patches. These exceptions suggest that even though we found the expected general patterns for susceptibility to invasion among most species, the influence of landscape composition and configuration on invasion risk is species specific.
To assess the presence of nutrition declarations and nutritional quality in pre-packaged food products sold in Guatemala.
We photographed nutrition labels of pre-packaged foods. We extracted information about declaration of energy, total/saturated/trans-fats, total/added sugars and Na content (critical nutrients). We classified all products according to their degree of processing (NOVA classification) and nutritional quality (PAHO and WHO-Europe nutrient profile models).
Pre-packaged foods for sale in seven supermarkets in Guatemala City.
This study did not involve human subjects.
We assessed 3459 pre-packaged foods, including 80 % ultra-processed, 7 % processed and 13 % unprocessed/minimally processed foods or culinary ingredients. Nutritional information was available in 3021 products (87·3 %). Energy content was declared in 87·0 %; total fats in 86·1 %; saturated fats in 81·5 %; trans-fats in 48·9 %; total sugars in 70·3 %; added sugars in 0·5 % and Na/salt in 85·5 % of products. Insufficient nutrient information made impossible to assess nutritional quality in 36·6 and 17·1 % of products with the PAHO and WHO-Europe models, respectively. Using PAHO and WHO nutrient profiles, we found that 66·2 and 50 % of food products did not meet the model’s nutritional criteria.
A high proportion of pre-packaged foods with nutritional information available in Guatemalan supermarkets do not meet the nutritional criteria recommended by WHO and PAHO. Furthermore, a high proportion of products did not declare critical nutrients and many did not even provide any nutritional information. National regulations should consider making critical nutrient declarations (including trans-fats and sugars) mandatory for all products.
Previous literature supports antipsychotics’ (AP) efficacy in acute first-episode psychosis (FEP) in terms of symptomatology and functioning but also a cognitive detrimental effect. However, regarding functional recovery in stabilised patients, these effects are not clear. Therefore, the main aim of this study is to investigate dopaminergic/anticholinergic burden of (AP) on psychosocial functioning in FEP. We also examined whether cognitive impairment may mediate these effects on functioning.
A total of 157 FEP participants were assessed at study entry, and at 2 months and 2 years after remission of the acute episode. The primary outcomes were social functioning as measured by the functioning assessment short test (FAST). Cognitive domains were assessed as potential mediators. Dopaminergic and anticholinergic AP burden on 2-year psychosocial functioning [measured with chlorpromazine (CPZ) and drug burden index] were independent variables. Secondary outcomes were clinical and socio-demographic variables.
Mediation analysis found a statistical but not meaningful contribution of dopaminergic receptor blockade burden to worse functioning mediated by cognition (for every 600 CPZ equivalent points, 2-year FAST score increased 1.38 points). Regarding verbal memory and attention, there was an indirect effect of CPZ burden on FAST (b = 0.0045, 95% CI 0.0011–0.0091) and (b = 0.0026, 95% CI 0.0001–0.0006) respectively. However, only verbal memory post hoc analyses showed a significant indirect effect (b = 0.009, 95% CI 0.033–0.0151) adding premorbid IQ as covariate. We did not find significant results for anticholinergic burden.
CPZ dose effect over functioning is mediated by verbal memory but this association appears barely relevant.
In this work, filament based on ɛ-polycaprolactone (PCL) and containing the bioactive ceramics nanohydroxyapatite (nHap) and Laponite® (Lap) was prepared by the extrusion process. To obtain the material, a mass ratio of 89:10:1 (PCL:nHap:Lap) was used, and structural and morphological characterization was realized. In addition, cytotoxicity (using Allium cepa bulbs) and viability tests on L929 cells also were performed. The results showed that filament (diameter of 1.79 ± 0.17 mm) presented a good dispersion of nHap and Lap into polymeric matrices. Fourier transform infrared spectroscopy identified typical bands at 1720, 1091, and 1045 cm−1 addressed to PCL and nHAp, In addition, Lap was identified through dispersive energy system and X-ray diffraction analyses. All filaments did not exhibit cytotoxic effects.
Ever since Hippocrates that it is acknowledged that post-partum represents a period of vulnerability for a number of psychiatric conditions in women, including postpartum psychosis.
In this poster, following a discussion of a clinical case of postpartum psychosis, we make a revision of the issue, with historical background, discussion of classification and nosologic status within international classification systems, epidemiology, risk factors, clinical presentation, treatment and prognosis.
The method used consisted in revision of literature, research of scientific articles on medline, consultation of gynecology clinical file and inpatient obstetrics and psychiatry clinical files.
From our research, we emphasize that postpartum psychosis is accountable for a small fraction of psychiatric morbidity in post-partum, occurring more frequently in primiparas, and women with similar psychiatric antecedents. Even thought there may be different clinical presentations, affective symptoms, state of conscience fluctuations and mood congruent delusions are typical. Several studies suggest that most cases are associated to bipolar disease.
Postpartum psychosis is a medical emergence. Fast identification and evaluation are crucial to implement multidisciplinary obstetrics and psychiatric care, involving family and providing adequate social support.
Alert for the efficiency of the clozapina, in high doses, in refractory mania to pharmacological treatment.
Review of literature relevant after the description of a clinical case example.
Description of a clinical case: Woman 30 years, ethnicity african, with bipolar disease type 1, with 12 years of evolution, and 11 treatments with around 1 year duration. Specifics took place with medication, such as intolerance to mood stabilizers, including lithium and valproate. Last inpatient care, with 5 months, it was for outbreak manic characterized by huge dysphoria and easy irritability with aggressiveness. There were administered antipsychotics, in high doses, and attempted electroconvulsive therapy, without success. Clinical remission has been achieved by the gradual increase of clozapina, in accordance with the patient tolerance, until 1400 mg daily without occurrence of agranulocytosis. The only intercurrence was a epileptic seizure, controlled with phenytoin.
Refractory mania is treated with clozapina in high doses, which must be administered according to the patient tolerance and clinical improvement. The risk of agranulocytosis (1-3%) is low, and is the only formal indication to suspend the treatment. The extensive metabolizers do not respond to conventional doses of psychotropic substances, they need larger doses and are more frequent in african people.
To alert to manic like symptoms in frontotemporal dementia (FTD).
Review of literature relevant in medline database.
Frontotemporal dementia (FTD) is a behavioural syndrome caused by generation of the frontal and anterior temporal lobes.
Bipolar disorder in dementia and the temporal relation between the two conditions have rarely been studied. There is a increased probability of developing a manic episode in patients with dementia.
Those with temporal FTD have impairments in emotional processing and hypomania like behavior. Moria (childish excitement or tendency to joke) or frivolous excitement are common presenting symptoms, and is difficult to distinguish to features in bipolar disease.
The correlation between mania like symptoms and FTD can be make with the help of informations of the family and computed tomography imaging. Those with temporal involvement are particularly at risk of developing deficits in emotional processing secondary to atrophy in the amygdale, anterior temporal cortex, and adjacent orbitofrontal cortex.
Early temporal involvement in FTD is associated with frivolous behavior and right temporal involvement is associated with emotional disturbances.
Moria or frivolous behavior are common presenting symptoms of FTD and the differential diagnosis is made with the help of informant's reports and computed tomography imaging.
To alert to apathy as a sub-syndrome in the spectrum dementia-depression.
Review of literature relevant in medline database.
The modern concept of apathy implies a reduced volition. Apathy may occur in depression and dementia and the differential diagnosis is difficult. Symptoms of apathy may constitute a sub-syndrome in the spectrum depression-dementia, that are characterized by lack of interest, psychomotor retardation, loss of energy and loss of appetite. Apathy may occur in dementia without depression and is significantly associated with more severe cognitive deficits. In dementia, depression may primarily result from a combination of symptoms of anxiety and apathy. Most patients with dementia and apathy had concomitant depression, but less depressed patients had concomitant apathy. The key to diagnosis may be the mood symptoms: dysthymia could be a negative emotional reaction to the progressive cognitive decline in dementia, whereas major depression could more strongly related to biological factors.
The nosological position of apathy remains obscure, with some studies suggesting that apathy and depression are independent constructs, and other studies showing a significant overlap between apathy and depression. The major interest to the type of syndrome has therapeutics implications.
The Order Suberitida is defined as a group of marine sponges without an obvious cortex, a skeleton devoid of microscleres, and with a deletion of a small loop of 15 base pairs in the secondary structure of the 28S rDNA as a molecular synapomorphy. Suberitida comprises three families and 26 genera distributed worldwide, but mostly in temperate and polar waters. Twenty species were reported along the entire Brazilian coast, and although the north-eastern coast of Brazil seems to harbour a rich sponge fauna, our current knowledge is concentrated along the south-eastern Atlantic coast. A survey was implemented along the northern coast of Brazil, and the collection allowed the identification of six species belonging to the Order Suberitida. Two of them are considered new to science: Suberites purpura sp. nov., Hymeniacidon upaonassu sp. nov., and four, Halichondria (Halichondria) marianae Santos, Nascimento & Pinheiro, 2018, Halichondria (H.) melanadocia de Laubenfels, 1936, Suberites aurantiacus (Duchassaing & Michelotti, 1864), and Terpios fugax Duchassaing & Michelotti, 1864, are re-described. Taxonomic comparisons are made for Tropical Western Atlantic species and type species of the four genera. Finally, an identification key for the Western Atlantic Suberites species is provided.
Knowing the impact that religious beliefs can have on the etiology, diagnosis and course of psychiatric disorders will help psychiatrists better understand their patients, assessing when the religious or spiritual beliefs are used to cope with mental illness and when they may be exacerbating this disease.
Alert to the importance of religion in clinical practice.
Relevant literature review.
Several studies have demonstrated the influence of spirituality on physical, mental and health. In 1988, the World Health Organization (WHO) has given rise to the interest in further investigations in this area, with the inclusion of a spiritual aspect of the multidimensional concept of health. The spiritual well-being can be considered a protective factor for psychiatric disorders.
Although it is not possible to determine with accuracy, the mechanisms of interaction of spirituality on health, especially mental health, several studies suggest that exercise can influence the spiritual activities, psychodynamically, through positive emotions. Furthermore, these emotions may be important for mental health in terms of possible psychophysiological and psychoneuroimmunological mechanisms.
Anthropological sources suggest that beliefs in demons, black magic and evil spirits as cause of mental illness and distress are common. They may be less prevalent in western countries but even in Europe it's possible to see patients thought that their condition have been caused by evil and occult possession.
Clinicians should understand the negative and positive roles that religion plays in those with mental disorders and use this in clinical practice.
The presence of cognitive dysfunction in bipolar disorder is well established, but in the euthymic phase appear a few studies that point to the absence of cognitive deficits.
Alert to cases of euthymic bipolar disorder with no cognitive dysfunction.
Review of relevant literature and description of a clinical case with psychological tests that assess memory and executive functions.
Description of a clinical case: FP is a middle age woman, early retired, with a bipolar disorder type 2, which begins at age 30.
Her disease has several depressive episodes, and in the last 10 years, she spent most of the days lying in bed and repeatedly resorted to the emergency department for excessive voluntary drug intoxication or simply because she “wanted” to be hospitalized; her husband could not stand this situation. In September of 2009, in addition to the medical and psychological consultations, she starts attending group therapy; over the next 6 months her medication was changed and finally her disease goes into remission.
The psychological tests, made at euthymic phase, show’s no significant deficits in verbal memory and executive functions.
This patient has a disease with prolonged course and multiple hospitalizations and drug treatments, but don’t present relevant cognitive deficits, which may point to the fact that cognitive impairment is determined by biological factors.
Mental health service delivery in the general health care sector is restricted with regard to understanding the magnitude and impact of mental illness in the medically ill (co-morbidity), as well as the significance of current mental health service delivery. A new model in development in the framework of a Biomed2 grant is presented. It consists of case-finding through complexity of hospital care prediction (COMPRI) followed by an integral health service needs assessment (INTERMED). It might serve to develop a more structural relation with the general health care sector for the management of mentally co-morbid high utilizing patients.
The suicide of a patient in ongoing treatment is surely among the most traumatic events in the professional life of a psychiatrist.
Alert to the psychiatrist's reactions to patient suicide.
Review of literature relevant in medline database.
A substantial proportion, estimated to range from 15% to 68%, of psychiatrists has experienced a patient suicide. A significant proportion of psychiatrists show strong negative reactions, affecting professional and personal lives at levels of distress that are frequently comparable with those seen in clinical populations. Psychiatrists develop rather classic symptoms of anxiety, depression, or acute or posttraumatic stress symptoms, and their responses are typical: in the beginning occurs shock, disbelief, denial and depersonalization; and in the second phase takes place: grief, shame and guilt (“did I listen to him?”), anger (toward the patient who did not honor a therapeutic contract), relief (for example, after the suicide of a chronically suicidal patient), and the finding of omens that the psychiatrist considered signs of the coming suicide. But they are predictors of increased distress among psychiatrists who experienced a patient suicide, and the more consistent are age, experience, individual personality and psychiatric history. Recognition of all this combined with an avoidance of isolation is an effective coping mechanism that prevents the structuring of a pathological response to the patient's suicide.
Psychiatrist's reactions to patient suicide are specific but not noted; its recognition is important to help them find appropriate coping mechanisms.
Delirium involves an acute, transient disturbance in consciousness and cognition. When the delirium involves aggressive behavior it's termed excited delirium; when this is followed by sudden death, it's termed excited delirium syndrome. Typically, patients presented fever, a rapid pulse, agitation and anxiety, with increasing confusion, and a progressive deterioration over a course of weeks before dying.
Objectives and Aims
Alert to the poor prognosis of excited delirium syndrome.
Review of relevant literature after the description of a clinical case.
Description of a clinical case:
A.R. is a man of 69 years, without psychiatric background, under neoadjuvant chemotherapy for metastatic bone disease. He has multiple comorbidity: chronic obstructive pulmonary disease, hypertension, diabetes and stomach cancer treated 15 years ago.
Three days before the hospitalization the patient began incoherent speech, and physically he was dehydrated; it was requested observation liaison psychiatry for psychomotor agitation. in the course of the interview, the patient was aggressive, very anxious, with jealousy and paranoid delusions, visual and auditory hallucinations, disoriented and with dispersed attention. It's placed the hypothesis of delirium by multiple etiologies and he was medicated with neuroleptics. It was necessary increased doses and physical restraint to control of agitation, which was not complete and lasted two weeks; meanwhile, he developed a respiratory infection. the patient eventually died of cardiopulmonary arrest.
It's described a typical case of excited delirium syndrome in a patient with psychomotor agitation that was difficult to control and lasted weeks, which culminated in cardiopulmonary arrest.