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Most of the existing prediction models for COVID-19 lack validation, are inadequately reported or are at high risk of bias, a reason which has led to discourage their use. Few existing models have the potential to be extensively used by healthcare providers in low-resource settings since many require laboratory and imaging predictors. Therefore, we sought to develop and validate a multivariable prediction model of death in Mexican patients with COVID-19, by using demographic and patient history predictors. We conducted a national retrospective cohort study in two different sets of patients from the Mexican COVID-19 Epidemiologic Surveillance Study. Patients with a positive reverse transcription-polymerase chain reaction for SARS-CoV-2 and complete unduplicated data were eligible. In total, 83 779 patients were included to develop the scoring system through a multivariable Cox regression model; 100 000, to validate the model. Eight predictors (age, sex, diabetes, chronic obstructive pulmonary disease, immunosuppression, hypertension, obesity and chronic kidney disease) were included in the scoring system called PH-Covid19 (range of values: −2 to 25 points). The predictive model has a discrimination of death of 0.8 (95% confidence interval (CI) 0.796–0.804). The PH-Covid19 scoring system was developed and validated in Mexican patients to aid clinicians to stratify patients with COVID-19 at risk of fatal outcomes, allowing for better and efficient use of resources.
The aim of this study was to investigate the effects of Cactus (Opuntia spp) levels in total mixed ration silages based on Cactus and Gliricidia (Gliricidia sepium (Jacq.) Steud) on the fermentation profile, microbial populations, aerobic stability and taxonomic diversity. The completely randomized design was used in a 4 × 4 factorial design with four replications, being four rations with different levels of Cactus (15, 30, 45, 60% based on the dry matter) and four opening periods (0, 15, 30 and 60 days of fermentation). An interaction effect (P < 0.050) was observed among the diets and opening times for mould and yeast populations. An interaction effect for the levels of acetic acid was observed, where the diets 15, 30, 45 and 60% showed higher values at 60 days (0.44, 0.41, 0.35 and 0.40 g/kg DM, respectively). A significant difference was observed for the richness and diversity index (Chao1 and Shannon). The most abundant bacterial phyla were Proteobacteria and Firmicutes and the genera Lactobacillus and Weissella. Cactus can be added in total mixed ration silages up to the level of 60% in a way that it positively affects the qualitative indicators of the silages, modulating the taxonomic communities and allowing the predominance of important groups for preservation of the ensiled mass.
During the COVID-19 pandemic, the antimicrobial stewardship module in our electronic medical record was reconfigured for the management of COVID-19 patients. This change allowed our subspecialist providers to review charts quickly to optimize potential therapy and management during the patient surge.
Tuberculosis (TB) in children is a critical public health issue. In Bohol, Philippines, we found a high tuberculin skin test (TST)-positive prevalence (weighted prevalence = 6.4%) among 5476 children (<15 years) from 184 villages, with geographically isolated communities having prevalence as high as 29%. Therefore, we conducted a geospatial and hot spot analysis to examine the association between villages with high TST-positive prevalence (⩾6.5%) and access to medical care (distance (in kilometres and minutes of travel time) to the municipal Rural Health Units (RHU)), access to healthcare resources (distance to Provincial Health Office (PHO)) and socioeconomic determinants of health. Hot spot analysis revealed significant clusters of TST-positive prevalence in villages farthest from the PHO. Based on univariate analysis, the following variables associated with high prevalence were included in the multivariate model: minutes of travel time to the PHO, distance to the PHO, island villages and total deprivation based on socioeconomic indicators. In the final model, only distance to PHO in minutes was significant (P = 0.005). When evaluated further, greater than 1-hour drive significantly increased risk for TST-positivity (P = 0.003). Distance to healthcare resources likely increases the risk of TB transmission within the community. Expanding TB control efforts to geographically isolated areas is critical.
The Diabetes Mellitus is a chronic disease whose treatment requires strict clinical care and continuing education such as medication, nutrition and physical activity. Education is a decisive factor in preventing complications that may arise from the failure of therapy. Therefore, the therapeutic adherence must include a psycho-social approach.
To study the degree of adherence to the pharmacologic treatment and dietary habits in patients with type I and type II diabetes mellitus and to evaluate the influence of the level of education, sex and type of diabetes.
A cross-sectional study was conducted of the descriptive-correlational type. The sample consisted of 100 diabetic type I and type II individuals and was obtained by convenience at the health center of S. Martinho do Bispo, in Coimbra - Portugal, during the period from May till June 2009.
Results and conclusions
The results indicate a high adherence to therapy, reflected trhough the diet and also the pharmacological treatment. However, the higher adherence found was related to prescription of medication. The demographic variables such as sex and level of education of patients, seem to positively influence the adherence to treatment.
To know prevalence of depression in Spanish nursing home(NH) by analysing the clinical profile of residents from RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH).
A multicentral, transversal, observational study was carried out in April 2005. 71 geriatrician from 54 NH representing the Spanish state participated. Depression was analysed in patient´s history and determined by NPI of Cummings, NH version.
1037 residents were randomized, 1020 were used by clinical data analysis. 941 were used to determine depression prevalence. Median age 83,4yo, 66.6% were women, 70.9% with basic educational level, 57.4% widows, 25.7% single, 41.5% had some degree of functional deterioration, 22.1% had delirium. In 26.4% were documented Stroke(17,9% TIA). 61.7% had dementia.
Depression appears in 31.4% of elderly institutionalized with the only diagnosis of depression or independent of others. There were no significant differences in age groups. However, was most frequent in women. 95.7% of patients with diagnosis of dementia had at least one drug for depression. Most used anti-depressants were trazadone (23%), citalopram (20.9%), sertraline (15.8%), fluoxetine (10.1%). No tricyclical anti-depressant reached 1% of consumption.
Depression affects practically one in three institutionalized elderly in Spain
Institutionalized elderly with depression are largely treated with ISRS. It is believed that the use of trazadone is linked with the effects on sleep and anxiety.
The high prevalence of depression, its overlapping with other processes and the comorbility of residents requires a careful search and approach in NH which implies a challenge for professionals in order to treat it.
To describe validation process of the new apathy scale for institutionalized dementia patients (APADEM-NH).
100 elderly, institutionalized patients with diagnosis of probable Alzheimer Disease (AD) (57%), possible AD (13%), AD with cerebral vascular disease (CVD) (17%), Lewy Bodies Dementia (11%) and Parkinson associated to dementia (PDD) (2%). All stages of the disease severity according to the Global Deterioration Scale (GDS) and Clinical Dementia Rating (CDR) were assessed. The Apathy Inventory (AI), Neuropsychiatric Inventory (NPI), Cornell scale for depression, and the tested scale were applied. Re-test and inter-rater reliability was carried out in 50 patients. The feasibility and acceptability, reliability, validity, and measurement precision were analyzed.
APADEM-NH final version consists of 26 items and 3 dimensions: Deficit of Thinking and Self-Generated behaviors (DT): 13 items, Emotional Blunting (EB): 7 items, and Cognitive Inertia (CI): 6 items. Mean application time was 9.56 minutes and 74% of applications were fully computable. All subscales showed floor and ceiling effect lower than 15%. Internal consistency was excellent for each dimension (Cronbach’s α DT = 0.88, α EB = 0.83, α CI= 0.88);Test-retest reliability for the items was kW=0,48-0,92; Inter-rater reliability reached kW values 0.84-1.00; The APADEM-NH total score showed a low/moderate correlation with apathy scales (Spearman ρ, AI =0.33; NPI-Apathy= 0,31), no correlation with depression scales (NPI-Dementia = -0.003; Cornell= 0,10), and high internal validity (ρ =0.69 0.80).
APADEM-NH is a brief, psychometrically acceptable, and valid scale to assess apathy in patients from mild to severe dementia and discerning between apathy and depression.
Pregnancy and postpartum both imply high risk for developing psychiatric disorders in women.
To study the relationship between life events (LE) and social support degree (SS) during pregnancy and depressive symptoms in early postpartum period.
A cross-sectional study of 309 consecutive Spanish women, evaluated the second day postpartum. They were all over 18 years old and have signed the informed consent. We excluded: illiteracy, cognitive impairment or severe medical illness, psychiatric disorders during pregnancy and decease of the newborn. We collected socio-demographic and obstetrical data, as well as family and personal psychiatric history, the Edinburgh Postnatal Depression Scale (EPDS), LE (Saint Paul Ramsey) and SS (DUKE-UNK).
Mean age (SD) was 31.6 (4.7). Most of women were married, had intermediated or high level of education. Sixty-one percent were primiparous. Twenty-six percent had family history and 22% had personal psychiatric history. Mean (SD) of LE was 0.95 (0.89) and of SS was 53.1 (7.6). The prevalence of depressive symptoms according to EPDS scores was 18%. This subgroup of depressed women had more psychiatric family history (p=0.046), less LE (p< 0.001) and more SS during pregnancy (p=0.048). Logistic regression analysis showed that SS was the only significant variable (OR=1.085; 95%CI=0.997-0.994; p=0.001). LE did not achieve statistical significance (OR=1.085; 95%CI=0.997-1.180; p=0.059).
Low social support degree during pregnancy is associated with depressive symptoms during immediate postpartum.
This study has been done in part with grants Instituto Carlos III: G03/184, FIS: PI04178; 05/2565.
Determine the presence of neuropsychiatric symptoms (NPS), using the NPI-NH(Neuropsychiatric Inventory Nursing Home(NH) Version),in order to provide a multidimensional profile in behavioural symptoms in residents and to calculate its prevalence in Spanish NH.
From randomized population of RESYDEM study (Identification of patients with cognitive deterioration and dementia in NH) a multi-central, cross-sectional and observational study was carried out. 71 geriatrician from 54 NH representative the Spanish state participated.NPS was determinated by NPI Cummings NH version. This version includes upsets in sleep and feeding patterns.
992 residents were examined (Median age 83.4yo, 66.6% women, 91.8% received at least one type of treatment, 61.7% with dementia). 523 (52.7%) presented at least one type of NPS. In order of greatest frequency, the following were noted: alterations in sleep patterns (41.7%), depression/disphoria (31.4%), anxiety (31.2%), agitation/aggressiveness (29.6%), apathy/indifference (25.8%), delirious ideas (23.7%), irritability (22.4%), feeding/appetite upsets (18.5%), anomalous motor behaviour (15.3%), hallucinations (13.8%), desinhibition (11.1%), euphoria (4.4%).
35.9% of residents received benzodiapines, 26.7% antidepressants. Atypical neuroleptics were used in 15.8%, in contrast with 7.4% of the use of classic ones.
NPS ´s reached a high prevalence in NH and it is usual that more than one co-exists in the patients.
Alterations in sleep patterns, depression, anxiety, agitation/aggressiveness affect approximately one in three residents.
It is useful and recommendable to evaluate the 12 behavioural areas from the NH version of the NPI scale. This instrument was chosen as a sifting measure to establish neuropyschiatric symptomology in residences.
Several studies associated Major Depressive Disorder (MDD) with an increased production of pro-inflammatory cytokines, such as interleukin 6 (IL-6). Serum IL-6 levels were found to be significantly increased in subjects with MDD and with Treatment Resistant Depression (TRD). Moreover, ketamine, a drug with fast-acting antidepressant properties, has proven to reduce IL-6 levels in rat prefrontal cortex and hippocampus. However, despite the clear influence of IL-6 in the pathophysiology of depression and in antidepressant response, studies evaluating the impact of IL-6 functional genetic polymorphisms on treatment response phenotypes are scarce.
We aim to evaluate the role of IL6-174G>C, IL6-6331T>C and IL6R D358A A>C functional polymorphisms in antidepressant treatment phenotypes, specifically remission, relapse and TRD.
We genotyped the referred polymorphisms in a subset of 80 MDD patients followed at Hospital Magalhães Lemos, Portugal, within a period of 18 months.
We found that patients carrying IL6-174 GG genotype are more prone to develop TRD (OR=4.125; 95%CI: [1.151-14.786]; p=0.038). We also observed that patients carrying IL6-6331 TC genotype have a higher risk of relapse (OR=3.988; 95%CI: [1.176-13.516]; p=0.022), and present a lower time to relapse, TC: 26 weeks vs. TT: 45 weeks (p=0.041, Log-rank test). No association was found between IL6R D358A genetic polymorphism and any of treatment phenotypes.
The IL6-174G>C and IL6-6331T>C polymorphisms influence antidepressant treatment response in our subset of MDD patients. These polymorphisms may possibly contribute to the elevated IL-6 levels found in patients with TRD. This research was partially supported by an AstraZeneca Grant
Recent studies suggested that immune activation and cytokines might be involved in depression. The proinflammatory cytokine interleukin-18 (IL-18) is less reported in depression but is still relevant since it is expressed in the brain and serum levels of IL-18 have been found to be increased in patients with moderate to severe depression. Therefore, it seems reasonable that IL-18 promoter SNPs may have an effect in antidepressant response phenotypes.
We aim to evaluate the role of IL18-607C>A and IL18-137G>Cpromoter polymorphisms in antidepressant treatment phenotypes, specifically remission, relapse and treatment resistant depression (TRD).
We genotyped the referredpolymorphisms in a subset of 80 MDD patients followed at Hospital Magalhães Lemos, Portugal, within a period of 27 months.
We found that patients carrying IL18-607CA or AA genotypes are more prone to relapse after AD treatment (OR=4.145; 95%CI: [1.038-16.555]; p=0.043) and present a lower time to relapse than patients carrying CC genotype (69 vs 115 weeks, p=0.019, Log-rank test). We also observed that patients carrying IL18-137GC or CC genotypes have a higher risk of relapse (OR=3.988; 95%CI: [1.176-13.516]; p=0.022) and display relapse earlier than the ones carrying GG genotype (64 vs 112 weeks, p=0.006, Log-rank test). No association was found between the evaluated genetic polymorphisms and remission or TRD.
The IL18-607A>C and IL18-137G>Cpolymorphisms seems to influence relapse after antidepressant treatment in our subset of depressed patients. These polymorphisms may possibly contribute to the elevated IL-18 levels found in patients with moderate to severe depression.
Cognitive impairment is a core feature of schizophrenia, associated with significant social and functional impairment. Schizophrenia has also been associated with inflammation and immune changes. Recently it has been showed that IL-6, a pro-inflammatory cytokine, was associated with cognitive impairment.
The aim of this study was to assess the associations between a pro-inflammatory cytokines (IL-6) and an anti-inflammatory cytokine (IL-4) with social cognition in a sample of stable patients with schizophrenia.
Social cognition was assessed using the Face Emotion Identification Task (FEIT) and the Hinting Task in 29 stable outpatients with schizophrenia. Blood was collected and cytokines (IL-4, IL-6) assays were realized (CBA method).
IL-6 levels showed a significant inverse correlation with FEIT global score (p = 0.019, rho = -0.475) and a trend of significant inverse correlation with the Hinting Task (p = 0.079, rho = -0.332). However, IL-4 levels showed no significant association with the FEIT or the Hinting task (rho = 0.079 and 0,121; respectively).
Elevated IL-6 levels seem to play a role in social cognitive impairment in stable patients with schizophrenia. These results should be interpreted with caution due to the limited number of participants in the study.
S100B is a calcium-binding protein produced by the astrocytes that has been used as a biomarker of brain inflammation. S100B has been involved in the schizophrenia pathophysiology, being considered a marker of state and prognosis.
Studying the relationship between serum S100B levels and psychopathology in first-episode psychosis (FEP).
At admission and discharge, serum S100B levels were measured in 20 never-medicated FEP in-patients and 20 healthy controls. Psychopathology was assessed with the PANSS (Positive and Negative Syndrome Scale). The total, positive, negative and general psychopathology scores were assessed. Results are presented as mean±sd. and S100B levels in pg./ml.
At admission, patients had significantly higher serum S100B concentrations than healthy subjects (39.2±6.4 vs. 33.3±0.98, p<0.02). S100B levels increased from admission to discharge (39.2±6.4 vs. 40.0±6.8, p=0.285) but they do not reach statistical significance. There were no correlations between PANSS (total, positive, negative and general) scores and S100B at admission and discharge. Individual item by item PANSS correlations with S100B elicited a positive correlation with P5 (grandiosity) (r=0.486, p=0.030) and G5 (mannerisms/posturing) (r=0.514; p=0.02) at discharge. There also was a positive trend with G7 (motor retardation) (r=0.409; p=0.073) at discharge.
FEP in-patients have significantly increased serum levels of S100B proteins, suggesting an activation of glial cells that may be associated with a neurodegenerative/inflammatory process. Apart from the study of total scale scores, the analysis of individual item is also recommended. The long-term treatment effect (one year or more) may be relevant to see their relationship to S100B levels.
Recently, a renaissance of interest in ‘negative symptoms’ as emotional withdrawal or blunted affect, has occurred. Some investigators believe that these symptoms are important indicators of outcome, of response to treatment and of a distinct underlying pathologic process.
Research on the negative-symptom syndrome in schizophrenia has been handicapped until recently.
This research aims at studying whether acute phase proteins, precisely, Alpha1-glycoprotein, can be considered as a marker of negativesymptom in Schizophrenia.
29 chronic schizophrenics were assessed by the Positive and Negative Syndrome Scale (PANSS). A routine blood test including Alpha1-glycoprotein levels was carried out.
Alpha1-glycoprotein shows a positive correlation, according to Pearson correlation coefficient, with the Negative Scale at an almost significant level (p=.05), and at a significant level in the following items, Blunted affect (p=.03), Passive/apathetic Social Withdrawal (p=.01) of the Negative spectrum and Poor Attention (p=.02) of the General Psychopathology Scale.
There is a significant correlation with two Negative variables and an almost significant one, spite of the small sample, with the Negative Scale. Further studies with bigger samples are needed in order to consider alpha1-glycoprotein as a schizophrenia negative psychopathology marker.
Circadianity is a characteristic of several human biological variables, such as testosterone, melatonin and cortisol. There is little information whether or not S100B serum protein presents a circadian rhythm.
Material and methods:
44 healthy subjects (24 female and 20 male, age 39.7 ± 9.4) participated in the study. Blood was sampled in July at 09:00, 12:00 and 24:00 h. Blood was centrifuged and serum was aliquot in Eppendorf tubes and frozen at −70° C. Serum S100B was measured by ELISA.
Serum S100B concentrations at 09:00 (56.3 ± 18.1 pg/ml), 12:00 (53.8 ± 23.1 pg/ml) and 24:00 h. (55.3 ± 20.3 pg/ml) were not significantly different.
Our results point to the absence of a circadian rhythm of S100B serum protein concentrations. the lack of the disadvantage may allow researchers on this area to sample subjects at any time of the day.
Currently, studies taking into account the incidence of burnout in Nurses Rehabilitation Specialists (NRS) are scarce, a fact which reinforces the need for further investigations in order to be able to understand the real impact of this syndrome in this professional category. This study aimed to determine the occurrence of burnout in NSR and determine whether there is any relationship between the different domains of burnout and sociodemographic aspects, and psychosocial work.
We conducted a cross-sectional, quantitative and analytical, which was attended by 117 NSR carrying out functions in various health institutions Portuguese's, aged between 27 and 57 years. To measure the variables used the following instruments: Scale MBI-GS, General Labor Satisfaction Scale, Scale My Health Locus of Control Scale and Levenson's Global Self-Esteem Scale for adults.
With regard to levels of burnout in NSR conclude that men have higher rates in the dimensions “physical and emotional exhaustion” and “cynicism” compared to women with an average ranking of 11,89 vs 11,57 and 9,56 vs 9,48, respectively; the dimension “professional effectiveness” are women who are more prone to burnout, with an average ranking of 31,20 vs 30,11. The data reveal that there are significant influences of variable working “time professional in the art.” Are obtained also for any significant influences of the psychosocial variables: locus control and self-esteem.
The evidence found in this study invite us to prepare and reflect on new strategies of intervention training and information aimed at promoting labor welfare of these subjects.
The objective of the present study was to examine the short-term effectiveness of a 11-week chess training course for children with ADHD. This is a naturalistic, descriptive clinical intervention study.
Sample and procedure: Parents of 44 children between 6 and 17 of age with a primary diagnosis of ADHD consented to take part into the present study. Parents completed the Spanish version of the Swanson, Nolan and Pelham Scale for parents (SNAP-IV) and the the Abbreviated Conners Rating Scales for parents (CPRS-HI) prior to 11-week chess training course. Statistical Analyses: We used a paired t test statistic to compare pre- to post- intervention outcomes, and Cohen-d calculations to measure the magnitude of the effect. Statistical significance was set at p< 0.05.
After 11 weeks of these pilot programme, more than 80% of children showed improvement in the severity of ADHD. T-test revealed that children with ADHD improved in both the SNAP-IV (t=6.23; d.f.=41; p< 0.001) and the CPRS-HI (5.39; d.f.=33; p< 0.001). Our results suggest a large effect in decreasing the severity of ADHD as measured by the SNAP-IV (d=0.96) and the CPRS-HI (d=0.92)
Schizophrenia is a chronic disease characterized by disturbances of thought, perception, volition, affectivity and cognition. An imbalance of the oxidant-antioxidant system is one of the proposed etiological factors. There are controversies regarding the effect of antipsychotics on the oxidant-antioxidant balance.
The aim of this research is to study the serum levels of the total antioxidant capacity (TAC) in paranoid schizophrenia patients treated with typical and/or atypical antipsychotics.
The sample is comprised by 38 patients admitted to the psychiatric ward of the University Hospital of the Canary Islands. All patients met DSM-IV criteria for paranoid schizophrenia. Some patients were treated only with atypical antipsychotics (N=21) while others were treated with a combination of atypical and typical antipsychotics (N=17).
The next table shows the comparison of serum TAC levels at admission (TAC-A) and discharge (TAC-D) at 12:00 and 00:00 h.
Patients treated with a combination of typical and atypical antipsychotics present at discharge (12:00 hours) significantly higher levels of TAC than patients treated only with typical antipsychotics. The remaining comparisons did not elicit significant results.
The results point out the fact that a combination of typical and atypical antipsychotics is more helpful in reducing the deficits of the antioxidant system than treatments based only on typical antipsychotics.
S100B protein is an astroglial protein that can be measured in peripheral tissues such as blood, urine or saliva. S100B serum concentrations have been proposed as a maker of brain dysfunction. Body Mass Index (BMI) has been reported as a confounding variable in S100B measures.
Material and methods:
44 healthy subjects (24 female and 20 male, age 39.7 ± 9.4) participated in the study. Blood was sampled in July at 09:00, 12:00 and 24:00 h. Blood was centrifuged and serum was aliquot in Eppendorf tubes and frozen at −70° C. Serum S100B was measured by ELISA. S100B serum data are reported as pg/ml.
There were no significant correlations between BMI and any of the three S100B measures (09:00 h. r = 0.150, p = 0.339, 12:00 h. r=0.041, p = 0.794, 24:00 h. r=0.192, p = 0.223).
Our results point to the fact that there are no relationships between BMI and S100B serum concentrations in healthy adult subjects.
Although asthma has been one of the most investigated topics in psychosomatics, studies and papers on psychopathology in asthma are fairly scarce and of diverse meaning. Furthermore, psychopathology acoording to sex in asthma is not a common research topic.
Aim This study aims at analyzing psychopathology sex differences in asthmatics.
The psychopathology profile in a sample of 84 adult asthmatics in a hospital outpatient facility, mean age 34.62 (s.d.12.78), 36 male / 48 female, is studied. The Symptom Checklist-90-R (SCL-90-R) Self-Report Questionnaire was administered.
The symptomatic profile is characterized by higher scores in women, with a main elevation in the dimensions of Somatization (1.92), Depression (1.66), Obsession-Compulsion (1.62) and Anxiety (1.44) whereas lower scores are recorded in men, with a profile dominated by Hostility (1.70), Anxiety (1.68), Interpersonal Sensitivity (1.58) and Depression (1.44). These scores mainly contribute to the psychopathology pattern according to sex.
The possible clinical implications of the observed psychopathology sex differences should be taken into account in the management of these patients.