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The Paleolithic diet (PaleoDiet) is an allegedly healthy dietary pattern inspired by the consumption of wild foods and animals assumed to be consumed in the Paleolithic era. Despite gaining popularity in the media, different operational definitions of this Paleolithic nutritional intake have been used in research. Our hypothesis is that specific components used to define the PaleoDiet may modulate the association of this diet with several health outcomes. We comprehensively reviewed currently applied PaleoDiet scores and suggested a new score based on the food composition of current PaleoDiet definitions and the theoretical food content of a staple dietary pattern in the Paleolithic age. In a PubMed search up to December 2019, fourteen different PaleoDiet definitions were found. We observed some common components of the PaleoDiet among these definitions although we also found high heterogeneity in the list of specific foods that should be encouraged or banned within the PaleoDiet. Most studies suggest that the PaleoDiet may have beneficial effects in the prevention of cardiometabolic diseases (type 2 diabetes, overweight/obesity, CVD and hyperlipidaemias) but the level of evidence is still weak because of the limited number of studies with a large sample size, hard outcomes instead of surrogate outcomes and long-term follow-up. Finally, we propose a new PaleoDiet score composed of eleven food items, based on a high consumption of fruits, nuts, vegetables, fish, eggs and unprocessed meats (lean meats); and a minimum content of dairy products, grains and cereals, and legumes and practical absence of processed (or ultra-processed) foods or culinary ingredients.
The hazardous environmental conditions hurricanes create might increase injury incidence almost 7 times. Therefore, a cohort study was performed at the Puerto Rico Trauma Hospital to compare morbidity and mortality patterns of patients after Hurricane Maria with a control period.
Admissions from September 20, 2017, through January 20, 2018, constituted the post-Maria period (473 patients); the corresponding months of the previous year comprised the pre-Maria period (439 patients). Comparisons were done using Pearson’s chi-square or Mann-Whitney U-tests, as appropriate. A logistic regression was performed to assess the association between mortality and the study period.
Postlandfall admissions among patients aged 40-64 y increased by 6.6%, while among subjects between ages 18 and 39 y dropped by 7.0% (P = 0.03). Falls, gunshots, and burns were the injury mechanisms that varied the most across the exposure period. The median Injury Severity Score (13 vs 12; P = 0.05) and the frequency of Glasgow Coma Scale scores ≤8 (17.1% vs 10.9%; P = 0.03) were higher among poststorm patients. Moreover, a 2-fold (odds ratio = 1.93; 95% CI: 1.07-3.47) increase in mortality was observed after Maria, when adjusting for covariates.
Following a hurricane, trauma centers might expect an older population, with more severe injuries and a 2-fold increased mortality risk.
Les signes neurologiques mineurs (SNM) sont des marqueurs aujourd’hui bien reconnus dans la schizophrénie, présents à un moindre degré chez les apparentés. Leur signification et leur spécificité reste néanmoins incertaines. Des aspects méthodologiques pourraient expliquer certaines de ces incertitudes (échelles variables selon les publications, méthodes de cotation sensible ou non au changement, types de signes pris en comptes etc) . Les corrélats des SNM peuvent apporter des éléments de réponses sur leur origine et leur signification. Nous avons ainsi montré que la SNM sont associés à une moindre performance cognitive, à plus d’erreurs dans les tâches oculomotrices, notamment dans des tâches de saccades adaptatives , ainsi à une altération du circuit préfronto cérébelleux , suggérant un dysfonctionnement cérébelleux.
Par ailleurs, nous avons également montré que les patients ayant des SNM ont une altération de la morphologie corticale, avec une moindre gyrification corticale, témoignant de l’origine développementale des SNM .
Enfin, nous avons montré récemment que les SNM sont plus marqués chez les sujets présentant un début des troubles précoces, avant l’adolescence (avant 15 ans), comparés à ceux présentant un trouble débutant à l’âge adulte, suggérant à nouveau que les SNM sont les marqueurs d’une forme à charge développementale plus importante.
L’association des SNM avec un âge de début précoce et des anomalies structurales touchant en particulier les circuits cérébelleux, suggère que les SNM pourraient permettre d’identifier un sous-type de schizophrénie précoce, et interroge sur un continuum avec les troubles du spectre autistique.
Cognitive strategies have received considerable attention in the field of pain management, together with more traditional approaches based on physical interventions and behavior modification. Distraction is a technique that lately has been often studied.
Distraction is based on an individual's limited attention capacity; it diminishes attention aimed to a painful stimulus with a subsequent pain reduction (Wismeijer & Vingerhoets, 2005).
To study the effect of VR as a distraction technique in an experimental pain task.
37 healthy participants were induced pain through two consecutive immersions using the cold-pressor test. All participants went through two experimental conditions: VR and black screen. The order of conditions was counterbalanced and a design of repetitive measures was used.
A virtual environment “Surreal World” was developed based on distraction techniques designed to surprise participants. The effect of VR as a distraction technique was evaluated using objective measures of pain (threshold, tolerance, pain intensity and time estimation) and other cognitive measures (self-efficacy and catastrophic thinking in vivo).
VR significantly decreased tolerance and pain intensity, influenced participants to underestimate the length of immersion. A higher self-efficacy in VR and a lower rumination and helplessness were registered in the pain experience. Thus, VR may help improve the efficacy of cognitive strategies.
The study shows the relevance of VR as an adjunctive method in the treatment of acute pain and allows studying its efficacy in patients with chronic pain.
To study the incidence of Attention Deficit and Hiperactivity Disorder (ADHD) in a patients sample in treatment for cocaine addiction, and the characteristics of this group.
We have recruited 43 subjects in treatment to cocaine abuse (DSM-IV-TR : F14) in Adicction Provincial Center in Grandada.
We have registered sociodemográfical and clinical data, habits of abuse, the Cocaine Effects Expectancy Questionnaire, two scales autoadministered for ADHD's diagnosis: in the infancy, Wender Utah Rating Scale (WURS) and in the adult (scale of the list of ADHD's symptoms in DSM-IV).
The sample was divided in two groups according to the presence of ADHD in adult age.
In 60,5% of the sample there was history of ADHD in the infancy, with persistence 80,8% (48,8% of the sample) in the adult age.
Patients with ADHD were smokers in 95,5%. 71,4% was consuming alcohol (average 12,6 gr/week), 23,8% was consuming cocaine always together with alcohol.
61,9% of the ADHD group was consuming another illegal drug (cannabis), opposite to 31,8% in control group. (p=0,048).
The first consumption in ADHD group is earlier (17 years vs. 22 years; p=0,001) and most frequent consumption too (22,4 years vs. 27,6 years; p=0,006).
Cocaine doses used is higher in ADHD group (1,39 gr vs 1,07 gr n.s.)
There is a high comorbidity in cocaine abuse with ADHD. This group has different characteristics, as the age of beginning of the abuse or of the higher abuse.
Polyfarmacy is frequent in patients with dual diagnosis.
To quantify the number and describe the treatments prescribed in a cohort of outpatients with dual diagnosis.
Material and methods
A descriptive and transversal study was performed. Patients with dual diagnosis treated at an Outpatient Drug Treatment Center from January 2005 to December 2009 were included. Data from demographic, clinical and therapeutical variables were gathered once. The instruments used for the diagnosis were EuropASI y SCID-I. The number and type of prescript drugs were related with protocol variables.
The study sample included 80 patients (71,6% men, average age 37,2 ± 9). Psychotic disorders (46.8%) and cocaine dependence/abuse (34.6%) were the most frequent comorbid psychiatric illnesses found. 40.8% of patients were polydrug users. The mean of prescript drugs was 3,06 ± 1,4 and only 14% of patients were on monotherapy. The frequency of drugs prescribed was: 68,4% antidepressant, 63,3% antipsychotic, 55,7% antiepileptic and 36,7% anxiolytic drugs. Older patients ( > 45years) took a major number of prescripted drugs (3,88 ± 1,1). Patients with psychotic disorders took the 43.9% of drugs prescripted (p = 0,042). Patients with benzodiazepine abuse took higher number of prescription drugs (5 ± 1,4;p = 0,003) compared with patients with other dependence or abuse.
Patients with dual diagnosis take high quantity of drugs. Older patients, diagnosis of psychosis and benzodiacepine abuse were related with polydrug prescription. Quantification of medication is recommended for treatment optimisation and avoiding yatrogenic.
Attention plays an important rol in pain perception. Focusing attention in pain intensifies the painful experience whereas distraction may decrease its subjective sensation (Eccleston & Crombez, 1999).The purpose of the two studies is to establish the efficacy of distraction by means of VR in the control and reduction of pain using the cold-pressor test. In both studies threshold, tolerance, perceived pain intensity and time estimation were measured.
37 healthy participants were induced pain in two consecutive immersions using the cold-pressor test. The experiment was counterbalanced and all participants went through two experimental conditions: VR (stereoscopic screen) and black screen. A virtual environment “Surreal World” was designed based on distraction of attention techniques. Results showed that VR significantly increased threshold and tolerance, diminished pain intensity and perception of time.
35 healthy participants underwent two consecutive immersions using cold pressor: VR (using the updated version of Surreal World and 3D laptops) and black screen. VR significantly increased the threshold and tolerance, whereas variations in the estimation of time were barely significant.
Differences in the results of the two studies could be accounted for by the immersive effect of the stereoscopic screen. Findings are discussed in relation to previous studies on VR and pain. Results support VR as an adjunctive method in pain treatment and allow proving its efficacy in patients with chronic pain.
Mentally ill patients have rates of medical comorbidity and mortality higher than the rest of the population. They require adequate medical care that isn't usually.
Emphasis on physical health problems affecting the mentally ill patients, analyze situations that may motivate and possible solutions.
Bibliographical review in the literature and pub med using key words: “medical comorbidity, severe mental illness, psychopharmacological treatments”
Mentally ill patients have greater medical comorbidity and higher mortality rate than the general population. in patients with schizophrenia life expectancy is 20% lower and mortality risk of 1.5–3 times higher than the rest of population. Affective disorders are associated with a standardized mortality ratio for medical reasons also high. Studies show that excess mortality in patients with severe mental illness is 60% due to natural causes and 40% to unnatural causes (28% suicide and 12% accidents). This increased mortality is mainly due to cardio-respiratory and infectious disease. Low socioeconomic class, lack of social care, poor medical care, bad habits (poor diet, sedentary, toxics) and adverse effects of psychopharmacological treatments are the main factors. Despite this, detection and treatment of physical illness is low. It is estimated that between 30% and 47% of these patients are untreated.
Improved medical care of these patients would improve their performance and quality of life. A system for each type of mental health to screening, assessment, diagnosis and treatment of somatic diseases, and a protocol for referral to appropiate medical/surgical centers are required.
The World Health Organization Disability Assessment Schedule II (WHODAS II) was developed for assessing disability. This study provides data on the validity and utility of the Spanish version of the WHODAS II in a large sample of patients with schizophrenia.
The sample included 352 patients with a schizophrenia spectrum disorder. They completed a comprehensive assessment battery including measures of psychopathology, functionality and quality-of-life. A sub-sample of 36 patients was retested after six months to assess its temporal stability.
Participation in society (6.3%) and Life activities (4.0%) were the domains with the highest percentage of missing data. The internal consistency (Cronbach's alpha) of the total scale was 0.94, and the test-retest stability reached an intraclass correlation coefficient of 0.92. It became apparent that the six primary factor model represents a better fit with reality than other competing models. Relationships between the WHODAS and measures of symptomatology, social and work-related functionality, and quality-of-life were in the expected direction and the scale was ultimately found to be able to differentiate among patients with different degrees of disease severity and different work status.
Assessment of disability using appropriate tools is a crucial aspect in the context of mental health and, in this regard, the Spanish version of the WHODAS II shows ample evidence of validity in patients with schizophrenia. The most important contribution of this study is that it is the first analysing the Spanish version of the WHODAS II (36-item version) in a large sample of patients with schizophrenia.
Until now, no reliable biological markers of risk and relapse in cocaine-dependent patients have been identified. The yawn-inducing Apomorphine test has been proposed as a marker for predicting relapse during cocaine withdrawal.
Studying the Apomorphine complete Test as a predictor of relapse in intranasal cocaine dependet-patients during abstinence.
39 (35 men) cocaine addicts were recruited and included in an addiction program involving 2 weeks in-patient setting and a 23 follow-up weeks. Dependence was diagnosed according to DSM-IV-TR criteria and other axis I comorbid main diagnosis were excluded.
We performed the Apomorphine complete Test (including an Apomorphine Test plus a Placebo Test) at the beginning (day 1) and end (day 11 or 12) of a detoxification program. Patient received 0′005 mg/kg of apomorphine and 0′005 mg/kg of placebo subcutaneously each test.
The patients who relapse prematurely (before 4 weeks), yawn more 11′42 (0–31) in the Apomorphine complete Test realized the first day of the detoxification compared with patients that relapse no prematurely (after 4 weeks of follow-up), 6′83 (0–20), Z -2′14 p < 0′03. A model can establish, with a point of court of 7 yawns in the first Apomorphine complete Test that has a sensibility of 61 ′ 9% and a specificity of 70 ′ 6%.
There an increased number of yawns in relapse-patients The Apomorphine complete Test could be proposed as a biological marker of early relapse.
Involuntary admissions continue to be a controversial topic in psychiatry. However, it is well known that psychosocial rehabilitation treatment is more successful when the patient is involved in it improving awareness and adherence to treatment.
This study examined admissions patterns, including voluntary, involuntary, and partly voluntary admissions to a subacute psychiatric hospital.
This is a transversal study. All patients admitted for a medium-term psychiatric treatment since 01/06/2014 to 30/11/2015 were included. Patients's basic sociodemographic and clinical data were collected and compiled in a database. Descriptive statistics were performed using SPSS Software.
A total of 88 patients (52% men; mean age: 48.6 years) composed the sample. In 58% of cases, schizophrenia and schizoaffective disorder were the diagnoses motivating the admission. Among 88 patients, 44 (50%) had voluntary admissions, 16 (18.2%) had involuntary admissions, 27 (30.7%) had partly voluntary admissions and just one patient (1.1%) had partly involuntary admissions. Seventy-one (80.1%) patients had voluntary admissions at discharge, and only one of them escape from hospital and did not finish the treatment.
In the short term involuntary hospitalization has benefits, however also can have adverse long-term consequences for the patient-therapist allegiance, breaking the psychotherapeutic relationship and making the patient abandon treatment. It's important to reassess the condition of admission and work with the patient the need to engage in treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Psychiatric disorders, particularly mood disorders, have a profound effect on the use of and adherence to highly active antiretroviral therapy (HAART) among patients with human immunodeficiency virus (HIV) infection.
HIV infection and mood disorders have features in common, and each is a significant risk factor for the other.
The objective is to highlight the clinicians on the importance of screening and treating affective disorders among patients with HIV infection.
Two cases of HIV infected patients with comorbid mood disorder and torpid evolutions by poor adherence to treatment are reported.
A brief literature review on this subject is done.
Major depression has been shown to alter the function of killer lymphocytes in HIV-infected patients and may be associated with the progression of HIV disease.
HIV-positive patients with mental disorders are less likely to receive and adherence to antiretroviral therapy.
First case-report: a man 52 years old, HIV-positive since 1985 with a comorbid bipolar disorder, with recurrent depressions and poor adherence to both treatment with a rapidly exitus laetalis.
Second case-report: man 45 years old, HIV-positive since 1992 with a comorbid depressive disorder, non-adhered to both therapy and HIV-associated dementia.
Depressive disorders are common in HIV infection. Antiretroviral regimens for HIV-infected patients require strict adherence. Untreated depression has been associated with medication nonadherence. Understanding the contribution of depression and its subsequent treatment on antiretroviral therapy adherence might direct clinicians toward earlier identification and more aggressive treatment among this population.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Several studies report that Clozapine is more effective in reducing symptoms of schizophrenia, producing clinically meaningful improvements and postponing relapse than other antipsychotic strategies.
To analyze the prescription of Clozapine in a sample of 88 inpatients admitted to a subacute psychiatric hospitalization unit.
This is a transversal study. All patients admitted for a medium-term psychiatric treatment since 01/06/2014 to 30/11/2015 were included. Data about socio-demographical status and clinical situation were obtained and compiled in a database. This study compares patients receiving clozapine treatment with those who receive other psychopharmacologic treatment. Statistics were performed using SPSS Software.
Eighty-eight patients (52% men; mean age: 48.6 years) composed the sample. In 58% of cases, schizophrenia and schizoaffective disorder were the diagnoses motivating the admission. Within the 51 patients with Schizophrenia o Schizoaffective Disorder, 16 of them (31.4%) received Clozapine. Comparing clozapine group vs non-clozapine group, there were no significant differences between the groups in terms of sex, civil state or working state. Instead, Clozapine group patients were older, had a major number of previous hospitalization admissions and had a larger trajectory of their disorder.
Patients requiring treatment with Clozapine had a major number of hospital admissions and had more often committed suicide attempts, suggesting a more severe course of the disorder. They were older than the non-clozapine group. Clozapine is delayed in its use among resistant-treatment patients. It is worth highlighting that only 16 cases of Schizophrenia inpatients received Clozapina. It could mean that Clozapine is underprescribed.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Psychiatric comorbidities are shown to be very prevalent in patients diagnosed with Autism Spectrum Disorder (ASD), up high to 53% for mood, 50% anxiety and 43% for ADHD disorders in an European cohort of adults with HFA. Using a new approach, our study proposes to explore aspects of comorbidities in the largest French cohort of HFA adults (C0733/InfoR) by implying qualitative and quantitative clinical tools.
To explore: (1) the prevalence rates of psychiatric comorbidities; (2) the interplay between comorbidities and the ASD symptoms.
Diagnosis was made according to DSM 5 criteria. Dimensional evaluation used Social Responsiveness Scale (SRS), Systemizing Quotient (SQ) and Empathy Quotient (EQ). We used T-test, Mann–Whitney test and linear regression models.
We included 103 patients (mean age 29.3, sex ratio M/F: 3.4:1). Lifetime prevalence rates of 53.5% for depressive disorder 73.5% for anxiety disorders and 37.5% for ADHD were found. Subjects with psychotic co-morbid symptoms had a more severe social deficit (SRS score 66.2 vs 77.9 P < 0.05); patients with ADHD, lower cognition (mean IQ total 107.7 vs 99.0 P < 0.05). SQs (P < 0.05) were significantly higher in patients with co-morbid psychosis, dysthymia, suicide attempts, and depressive disorders and directly correlated with age (β = 0.35, P < 0.05). SQ and EQ were inversely correlated.
The results reproduce the high prevalence of comorbidities in other studies and explore its association with social functioning and cognition. Identification of associated psychiatric conditions in subjects with HFA is therefore a crucial clinical issue potentially guiding the treatment.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Genetic variability in organisms with sexual reproduction is produced by a complex mechanism of cell division of the germ line cells known as meiosis. During meiosis, homologous chromosomes pair and exchange genetic material (meiotic recombination), process that is essential to complete the meiotic division and to produce variability. Homologous chromosome pairing is mediated by the synaptonemal complex (SC). The SC is a proteinaceous structure composed of two lateral elements (LEs) and a central region (CR). Any defect in SC structure impairs meiotic recombination leading to blockage of the cell division process and infertility1. The SC has been observed since the introduction of the electron microscope (EM) in the biological field and it has been reported to be present in almost all the organisms with sexual reproduction, conserving a very similar structure and organisation along the different species2,3. The classic approach to study the SC structure is to chemically fixate the sexual tissues (gonads), dehydrate and embedded them in plastic resins that provide a support for sample sectioning and observation under the EM. However, chemical fixation followed by dehydration is well known to produce artefacts in the structure of many biological samples. Recently, we have combined fluorescence activated cell sorting of cells with SCs with high-pressure freezing and freeze- substitution and have found that the structure of the CR looks different from that observed in chemically fixated samples. These data have prompted us to analyse the organization of the CR components under cryo-processing.
Adipogenesis, myogenesis and fibrogenesis are related processes that can contribute to meat quality. Therefore, extending the knowledge of these processes would facilitate the identification of molecular markers that predict intramuscular fat accretion. The main purpose of this work, based on previous results, was to further study the expression of key genes related to adipogenic, myogenic, fibrogenic processes and some cytokines in Longissimus thoracis (LT) and Masseter (MS) muscles of Pirenaica and Holstein young bulls. Longissimus thoracis and MS muscles from Pirenaica (n = 4) and Spanish Holstein (n = 4) were sampled for proximate analysis, determination of adipocyte size distribution and expression of key candidate genes. Fat percentage was lower in LT than in MS muscle in Pirenaica young bulls (P = 0.023) and was higher in LT muscle in Holstein than in Pirenaica young bulls (P = 0.007). Gene expression analysis revealed that the mRNA level of myogenic differentiation 1 (MYOD) was higher in LT than in MS muscles in both groups of animals (P < 0.001) and that myostatin (MSTN) expression was also higher in LT than in MS muscle in Holstein bulls (P = 0.001). On the other hand, MSTN and PPARG showed higher expression in LT and MS in Pirenaica young bulls (P = 0.026), while the expression of fatty acid-binding protein 4 (FABP4) was higher in Holstein young bulls, also in both muscles (P < 0.001). The results suggested that the development of intramuscular adipose depot was directly related to the expression of adipogenic genes, such as FABP4, but inversely related to the expression of the cytokine MSTN and the myogenic gene MYOD, genes which showed a muscle-specific expression.
Wake modes of a three-dimensional blunt-based body near a wall are investigated at a Reynolds number
. The targeted modes are the static symmetry-breaking mode and two antisymmetric periodic modes. The static mode orientation is aligned with the horizontal major
-axis of the base and randomly switches between a positive
and a negative
state leading to long-time bistable dynamics of the turbulent wake. The modifications of these modes are studied when continuous blowing is applied at different locations through four slits along the base edges (denoted L for left, R for right, T for top and B for bottom) in either four single asymmetric configurations or two double symmetric configurations (denoted LR and TB). Two regimes, referred to as mass and momentum, are clearly identifiable for all configurations. The mass regime, which is fairly insensitive to blowing momentum and location, is characterized by the growth of the recirculating bubble as the total injected flow rate is increased, and is associated with a base drag reduction and interpreted as resulting from the equilibrium between mass fluxes feeding and emptying the recirculating region. A simple budget model is shown to be in agreement with entrainment velocities measured for isolated turbulent mixing layers. The strength of the static mode is reduced up to 20 % when the bubble length is maximum, whereas no change in the periodic mode frequencies is found. On the other hand, the momentum regime is characterized by the deflating of the recirculating bubble, leading to base drag increase, and it is interpreted by the free shear layer forcing, which increases the entrainment velocity, thus emptying the recirculating bubble. In this regime the static mode orientation is imposed by the blowing symmetry. Lateral L and R (respectively top/bottom T and B) blowing configurations select
states in the horizontal (respectively vertical) direction, while bistable dynamics persists for the symmetric LR and TB configurations. The shape of periodic modes follows the changes in wake static orientation. The transition between the two regimes is governed by both the total injected flow rate and the location of the injection.
Predation by Engytatus varians (Distant) adults on different development stages of the prey species Bactericera cockerelli (Sulcer) (egg, second, and third nymphal instars), Spodoptera exigua (Hübner) and Spodoptera frugiperda (J. E. Smith) (egg, first, and second larval instars) was evaluated using tomato (Solanum lycopersicum L.) leaflets or plants. These insects are the primary pest of several agriculturally important crops. The influence of E. varians age on the predation capacity was also analysed. Engytatus varians females consumed significantly more B. cockerelli eggs and nymphs than males. Additionally, female predators consumed significantly more second than third instar prey at two predator ages, while males consumed significantly more the second instar than third instar prey at all predator ages. In most of the cases, females also consumed significantly more S. exigua and S. frugiperda eggs than males; however, in terms of larvae consumption, this difference was observed only in some predator ages. Females consumed more the first than second instar S. exigua than males, whereas this behaviour was only observed in males when the predators were 15 and 17 days old. No significant differences were observed in the consumption of first and second instar of S. frugiperda for both sexes of the predators. Predator age did not cause any systematic effects on the predation rates of any prey species. Based on these results, we confirmed that E. varians has potential as a biological control agent for B. cockerelli and also for the Spodoptera species bioassayed.