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Animal-derived dietary protein ingestion and physical activity stimulate myofibrillar protein synthesis rates in older adults. We determined whether a non-animal-derived diet can support daily myofibrillar protein synthesis rates to the same extent as an omnivorous diet. Nineteen healthy older adults (aged 66 (sem 1) years; BMI 24 (sem 1) kg/m2; twelve males, seven females) participated in a randomised, parallel-group, controlled trial during which they consumed a 3-d isoenergetic high-protein (1·8 g/kg body mass per d) diet, where the protein was provided from predominantly (71 %) animal (OMNI; n 9; six males, three females) or exclusively vegan (VEG; n 10; six males, four females; mycoprotein providing 57 % of daily protein intake) sources. During the dietary control period, participants conducted a daily bout of unilateral resistance-type leg extension exercise. Before the dietary control period, participants ingested 400 ml of deuterated water, with 50-ml doses consumed daily thereafter. Saliva samples were collected throughout to determine body water 2H enrichments, and muscle samples were collected from rested and exercised muscle to determine daily myofibrillar protein synthesis rates. Deuterated water dosing resulted in body water 2H enrichments of approximately 0·78 (sem 0·03) %. Daily myofibrillar protein synthesis rates were 13 (sem 8) (P = 0·169) and 12 (sem 4) % (P = 0·016) greater in the exercised compared with rested leg (1·59 (sem 0·12) v. 1·77 (sem 0·12) and 1·76 (sem 0·14) v. 1·93 (sem 0·12) %/d) in OMNI and VEG groups, respectively. Daily myofibrillar protein synthesis rates did not differ between OMNI and VEG in either rested or exercised muscle (P > 0·05). Over the course of a 3-d intervention, omnivorous- or vegan-derived dietary protein sources can support equivalent rested and exercised daily myofibrillar protein synthesis rates in healthy older adults consuming a high-protein diet.
Mycoprotein consumption has been shown to improve acute postprandial glycaemic control and decrease circulating cholesterol concentrations. We investigated the impact of incorporating mycoprotein into the diet on insulin sensitivity (IS), glycaemic control and plasma lipoprotein composition. Twenty healthy adults participated in a randomised, parallel-group trial in which they consumed a 7 d fully controlled diet where lunch and dinner contained either meat/fish (control group, CON) or mycoprotein (MYC) as the primary source of dietary protein. Oral glucose tolerance tests were performed pre- and post-intervention, and 24 h continuous blood glucose monitoring was applied throughout. Fasting plasma samples were obtained pre- and post-intervention and were analysed using quantitative, targeted NMR-based metabonomics. There were no changes within or between groups in blood glucose or serum insulin responses, nor in IS or 24 h glycaemic profiles. No differences between groups were found for 171 of the 224 metabonomic targets. Forty-five lipid concentrations of different lipoprotein fractions (VLDL, LDL, intermediate-density lipoprotein and HDL) remained unchanged in CON but showed a coordinated decrease (7–27 %; all P < 0·05) in MYC. Total plasma cholesterol, free cholesterol, LDL-cholesterol, HDL2-cholesterol, DHA and n-3 fatty acids decreased to a larger degree in MYC (14–19 %) compared with CON (3–11 %; P < 0·05). Substituting meat/fish for mycoprotein twice daily for 1 week did not modulate whole-body IS or glycaemic control but resulted in changes to plasma lipid composition, the latter primarily consisting of a coordinated reduction in circulating cholesterol-containing lipoproteins.
The co-infection between visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) has increased in several countries in the world. The current serological tests are not suitable since they present low sensitivity to detect the most of VL/HIV cases, and a more precise diagnosis should be performed. In this context, in the present study, an immunoproteomics approach was performed using Leishmania infantum antigenic extracts and VL, HIV and VL/HIV patients sera, besides healthy subjects samples; aiming to identify antigenic markers for these clinical conditions. Results showed that 43 spots were recognized by antibodies in VL and VL/HIV sera, and 26 proteins were identified by mass spectrometry. Between them, β-tubulin was expressed, purified and tested in ELISA experiments as a proof of concept for validation of our immunoproteomics findings and results showed high sensitivity and specificity values to detect VL and VL/HIV patients. In conclusion, the identified proteins in the present work could be considered as candidates for future studies aiming to improvement of the diagnosis of VL and VL/HIV co-infection.
Bipolar disorder is a chronic, recurrent and debilitating mood disorder with a major impact on several aspects of everyday life. Although pharmacotherapy plays a central role in bipolar disorder treatment, psychosocial interventions are essential to a more complete and successful treatment.
To present a psychoeducation program for bipolar patients runned in a Portuguese psychiatric hospital - Hospital de Magalhães Lemos, Oporto. To review the impact of psychoeducative measures on bipolar patients.
A psychoeducative program for bipolar patients was developed and adapted, based on the Barcelona Bipolar Disorders Program"s experience. The psychoeducative program was applied to bipolar patients as an adjuvant of maintenance treatment.
Fifteen sessions were runned during 15 weeks. Twelve patients were recruited to integrate the psychoeducative group. The sessions addressed several topics including information about the illness, early detection of prodromal symptoms and symptoms management, stress management and the importance of maintaining routines.
The best treatment available for patients with bipolar disorder includes, along with the pharmacological treatment, psychosocial interventions aimed to target issues as early identification of prodromal symptoms, coping skills, medication adherence and understanding of the disorder. This broader approach of bipolar disorder treatment has proved to be efficient in reducing relapse rates, and improving patients’ feelings of self-efficacy and quality of life.
Frailty is a state of increased vulnerability that entails a high risk of adverse outcomes. While traditional approaches define frailty as an exclusively physical condition, there is an increasing number of authors that include psychological and social components in the conceptualization of the syndrome.
Assuming a multidimensional approach to frailty, this study aims to examine which domain (physical, psychological or social) is the most significant predictor of disability and quality of life.
A longitudinal study was designed recruiting 95 community-dwelling elderly. Frailty domains were assessed at baseline with the Tilburg Frailty Indicator. Disability in basic and instrumental activities of daily living/ADL and IADL were measured with the Barthel Index and with the Lawton and Brody Scale. Quality of life was evaluated with EUROHIS-QOL-8 and WHOQOL-OLD.
The mean age of the participants was 78.5±6.2 years, and most were women (67.4%). After controlling for life-course determinants and comorbidity, physical frailty contributed to the prediction of most of the adverse outcomes: ADL disability (3.3%), IADL disability (2.2%), global quality of life (EUROHIS-QOL-8: 4.7%; WHOQOL-OLD: 2.9%) and quality of life facets: sensory abilities (4.5%), social participation (5.6%), death and dying (3.0%) and family/family life (2.8%). Psychological frailty predicted past, present and future activities (7.2%) and intimacy (4.0%), whereas the effect of social frailty was not significant when compared with the other domains.
The results of the present study highlight the relevance of physical factors, but also the importance at least of the psychological components, in the definition of frailty.
The Sexology Outpatient Clinic of São João Hospital Center is specialized in the attendance of users with problems or dysfunctions related to sexuality, such as male sexual dysfunctions.
46 year old man, single, with late onset of sexual activity which relates with his fears (partner becoming pregnant and sexually transmitted diseases) and his markedly obsessive personality.
He describes previous occasional or short-term relationships and premature ejaculation on his first sexual experiences. During a phase without relationships, he began to discover his sexuality through masturbation, which tended to occur very frequently. He reported to especially appreciate the instant that precedes ejaculation, which led him to constantly try to delay the moment of ejaculation. Finding himself in a stable relationship, he reports that he cannot ejaculate during intercourse, achieving it only through masturbation, despite he could obtain sexual pleasure and have a sustained erection. At this point, the couple decided to have sex therapy.
Premature ejaculation is a psychosexual disturbance defined as a persistent or recurrent ejaculation with minimal sexual stimulation before, on or shortly after penetration and before the person wishes it to occur. The main option for treating premature ejaculation are behavioral therapies such as the stop-start technique. In this case, the patient used this technique autonomously, by the means of masturbation, to delay his ejaculation, leading him to the point of being unable to ejaculate during intercourse.
Living Kidney transplantation leads to better outcomes for the transplant recipient and is associated with low morbility and mortality to receptors and donors.
This study aims to describe the narratives, motivations and distinctive characteristics of kidney donors, and changes in psychopathology and life quality.
We evaluated all kidney donors candidates in Hospital São João Centre, between January 2004 and September 2012, using a semistructured questionnaire.
A total of 62 donors candidates were evaluated, all were receptors family, most were non-practicing catholic and few participated in voluntary activities or were blood donors. The decision was spontaneous, the main aim was to improve the health of the family and the negative consequences were devalued. about the candidates in which the donation happened (30.6%), the majority would repeat the decision, they felt more valued and there self-esteem was higher. They took more responsibility for the health of the receptor and they thought that after transplantation the kidney belonged to both. In general, the donation strengthened the relationship with the receptor and didn’t affect donor's life quality.
The decision to donate is more dependent on the relationship with the recipient than altruism feelings. After the donation, donors will experience a period of renegotiation of identity (usually with increased self-esteem and enjoyment of life), redefinition of roles (changing activities, multiple roles and feelings of heroism) and changes in the relationship with the receptor (stronger, with feelings of debt and recognition).
Frailty is a geriatric syndrome that entails an increased risk of clinically significant adverse outcomes. There are different approaches regarding frailty’s clinical operationalization.
To compare how different frailty measures (the Frailty Phenotype/FP, Groningen Frailty Indicator/GFI and the Tilburg Frailty Indicator/TFI) predict short-term adverse outcomes.
A longitudinal study was designed recruiting 95 community-dwelling elderly. Participants were assessed at baseline for frailty, determinants of frailty and adverse outcomes, and 10 months later for the same outcomes (healthcare utilization, quality of life, disability in basic and instrumental activities of daily living/ADL and IADL).
The mean age of the participants was 78.5±6.2 years, and most were women (67.4%). Being classified as frail at baseline by each operationalization of frailty was associated with specific healthcare utilization indicators at follow-up: the FP with a greater utilization of informal care; GFI with increased contact with healthcare professionals; and TFI with more contact with a general practitioner. In general, after controlling for the effect of life-course determinants, comorbidity and the same adverse outcome at baseline, GFI predicted IADL disability and TFI predicted total quality of life and most of the quality of life domains. The effect of the FP on the outcomes was not significant, when compared with the other measures.
Frailty at baseline was associated with adverse outcomes at follow-up. In this study, multidimensional measures of frailty (GFI and TFI) were better predictors of the selected outcomes in a 10-month follow-up than an exclusively physical one (FP).
The underlying diagnoses in catatonic patients can be affective disorder, schizophrenia, schizoaffective disorder and a range of medical/neurological illnesses. Benzodiazepine and 6 to 12 sessions of electroconvulsive therapy (ECT) have been considered the first-line treatments for almost all types of catatonia.
To discuss when ECT should be started, its risks and lateral effects, pointing the maximum number of sessions and if there are patients that need a higher number of ECT than what is referred in literature.
A revision about catatonia etiology, diagnosis and treatment was done, based on two clinical cases.
The number of ECTs recommend in literature is 6 to 12, and although there isn’t a maximum number defined, the treatment should be reconsidered if there isn’t response after 6 sessions. The lateral effects of higher ECT number are not known to differ with ECT number. We present a case of a 63 years old woman with major depressive and catatonia whose symptoms only resolved after the 21 ECT, with a previous psychotic depression treated with 17 ECT. The second case is a 60 years old woman with the diagnosis of paranoid schizophrenia with catatonic symptoms that only recovered after 17 ECT. In both patients, the clinical improvements where noticed only after a higher number of sessions.
The maximum ECT number should be adapted to each patient and the clinical response obtained, always considering the possibility of exceeding the numbers recommended in literature.
The full etiology of transsexualism is still unknown. However many factors, like biological and environmental, are being suggested as possible explanations to the cause of this entity.
We intend to revisit the major etiological theories of transsexuality, based on the description of two cases occurring in first-degree relatives.
A mother and her daughter both diagnosed with Gender Identity Disorder are followed at Multidisciplinary Clinical Sexology Group in our facilities since 2011.
This case is related to a young girl who in her childhood felt and behaved himself as a boy by adopting male gender stereotypes. She has lived with distress during the development of female secondary sexual characteristics, and the age of 17, after identifying his problem decided to tell his mother. However our patient founded that her mother, with 38 years old, was already resigned by living with a sex gender that didn't recognize as her own. In the end they decided to confront the social and family environment, joining both in the process of sexual reassignment.
The transsexualism is a complex phenomenon. The occurrence of two cases of transsexualism in a mother and daughter highlights the importance of consider and extend the knowledge about the biological aspects of gender identity disorder.
It is relevant to communicate the cases occurring within the same family to contribute to the etiology investigation in this area. In the literature the rare cases described of family transsexuals are among brothers, which makes this case between mother and daughter special.
Frail individuals are highly vulnerable to minor stressful events, presenting a higher risk for adverse health outcomes (e.g. falls, disability, hospitalization), which can lead to a decline in quality of life (QoL). In this context, an early screening of elderly frailty is of crucial importance.
To compare how the Frailty Phenotype (FP) and the Tilburg Frailty Indicator (TFI) predict QoL in a two-year follow-up.
A longitudinal study was designed recruiting 110 community-dwelling elderly (≥ 65 years). The presence of frailty was assessed at baseline (FP ≥ 3 and TFI ≥ 6), whereas QoL was measured two years later with two different scales: the WHOQOL-OLD and the EUROHIS-QOL-8. Hierarchical regressions were conducted.
The mean age of the participants at baseline was 77.7 ± 6.9 years, and most were women (75.5%). According to FP, 33.6% of the participants were classified as frail, while the TFI detected frailty in 50% of the elderly. After adjusting for age and gender, the TFI significantly predicted QoL (WHOQOL-OLD: β = −18.9, t(106) = −6.97, P < 0.001; EUROHIS-QOL-8: β = −6.1, t(106) = −6.71, P < 0.001), whereas the effect of the FP on the outcome measures was non-significant.
Frailty at baseline was associated with a lower QoL at follow-up. A multidimensional frailty operationalization (TFI) showed a stronger predictive validity than an exclusively physical one (FP). The option of which frailty measure to use in a clinical setting should take into account its ability to predict specific adverse outcomes, conducing to targeted and effective interventions.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
There is no suitable vaccine against human visceral leishmaniasis (VL) and available drugs are toxic and/or present high cost. In this context, diagnostic tools should be improved for clinical management and epidemiological evaluation of disease. However, the variable sensitivity and/or specificity of the used antigens are limitations, showing the necessity to identify new molecules to be tested in a more sensitive and specific serology. In the present study, an immunoproteomics approach was performed in Leishmania infantum promastigotes and amastigotes employing sera samples from VL patients. Aiming to avoid undesired cross-reactivity in the serological assays, sera from Chagas disease patients and healthy subjects living in the endemic region of disease were also used in immunoblottings. The most reactive spots for VL samples were selected, and 29 and 21 proteins were identified in the promastigote and amastigote extracts, respectively. Two of them, endonuclease III and GTP-binding protein, were cloned, expressed, purified and tested in ELISA experiments against a large serological panel, and results showed high sensitivity and specificity values for the diagnosis of disease. In conclusion, the identified proteins could be considered in future studies as candidate antigens for the serodiagnosis of human VL.
Background: Hereditary transthyretin-mediated (hATTR) amyloidosis is a multi-systemic, heterogenous, life-threatening disease. Patisiran resulted in significant improvement in neuropathy and QoL at 18-months compared to placebo, and was generally well-tolerated in the Phase 3 APOLLO study. Methods: Multi-center, OLE study to evaluate the efficacy and safety of long-term patisiran dosing for ≤ 5 years in hATTR amyloidosis patients with polyneuropathy who have completed the APOLLO study (NCT02510261). Endpoints include safety, tolerability and long-term efficacy of patisiran. Measures of clinical benefit are the same endpoints used in APOLLO including changes in mNIS+7 composite neuropathy impairment score and QoL (Norfolk QoL-DN) Results: As of December 2017, 184 of 186 (99%) patients who completed APOLLO and 25 patients from the Ph 2 OLE study enrolled in the Global OLE study. Baseline data for 211(APOLLO/placebo, n=49; APOLLO/patisiran, n=137 and patisiran Ph 2 OLE, n=25) patients included: median age 61 years (26-84); 74% males; 46% V30M. Interim safety data and 12-month efficacy results will be presented. Conclusions: The global OLE study includes a diverse population of hATTR amyloidosis patients. Interim data will include the long-term safety and maintenance of effect in patients continuing on patisiran, as well as the impact of treatment with patisiran on patients previously treated with placebo.
Background: Hereditary transthyretin-mediated (hATTR) amyloidosis a hereditary, multi-systemic and life-threatening disease resulting in neuropathy and cardiomyopathy. In the APOLLO study, patisiran, an investigational RNAi therapeutic targeting hepatic TTR production resulted in significant improvement in neuropathy and QoL compared to placebo and was generally well tolerated. Methods: APOLLO, a Phase 3 study of patisiran vs. placebo (NCT01960348) prespecified a cardiac subpopulation (n=126 of 225 total) that included patients with baseline left ventricular (LV) wall thickness ≥ 13mm and no medical history of aortic valve disease or hypertension. Cardiac measures included structure and function by electrocardiography, changes in NT-proBNP and 10-MWT gait speed. Results: At 18 months, patisiran treatment resulted in a mean reduction in LV wall thickness of 1 mm (p=0.017) compared to baseline, which was associated with significant improvements relative to placebo in LV end diastolic volume (+8.31 mL, p=0.036), global longitudinal strain (-1.37%, p=0.015) and NT-proBNP (55% reduction, p=7.7 x 10-8) (Figure 1). Gait speed was also improved relative to placebo (+0.35 m/sec, p=7.4 x 10-9). Rate of death or hospitalization was lower with patisiran. mNIS+7 results in the cardiac subpopulation will also be presented. Conclusions: These data suggest patisiran has the potential to halt or reverse cardiac manifestations of hATTR amyloidosis.
In the current study, phage-exposed mimotopes as targets against tegumentary leishmaniasis (TL) were selected by means of bio-panning cycles employing sera of TL patients and healthy subjects, besides the immune stimulation of peripheral blood mononuclear cells (PBMCs) collected from untreated and treated TL patients and healthy subjects. The clones were evaluated regarding their specific interferon-γ (IFN-γ) and interleukin-4 (IL-4) production in the in vitro cultures, and selectivity and specificity values were calculated, and those presenting the best results were selected for the in vivo experiments. Two clones, namely A4 and A8, were identified and used in immunization protocols from BALB/c mice to protect against Leishmania amazonensis infection. Results showed a polarized Th1 response generated after vaccination, being based on significantly higher levels of IFN-γ, IL-2, IL-12, tumour necrosis factor-α (TNF-α) and granulocyte-macrophage colony-stimulating factor (GM-CSF); which were associated with lower production of specific IL-4, IL-10 and immunoglobulin G1 (IgG1) antibodies. Vaccinated mice presented significant reductions in the parasite load in the infected tissue and distinct organs, when compared with controls. In conclusion, we presented a strategy to identify new mimotopes able to induce Th1 response in PBMCs from TL patients and healthy subjects, and that were successfully used to protect against L. amazonensis infection.
Keto analogues and amino acids (KAAA) supplementation can reduce blood ammonia concentrations in athletes undergoing high-intensity exercise under both ketogenic and thermoneutral conditions. This study evaluated the acute effects of KAAA supplementation on ammonia metabolism during extenuating endurance exercise in rats fed a ketogenic diet. In all, eighty male Fischer rats at 90 d of age were divided into eight groups, and some were trained using a swimming endurance protocol. A ketogenic diet supplemented with keto analogues was administered for 10 d. Administration of the ketogenic diet ended 3 d before the exhaustion test (extenuating endurance exercise). A ketogenic diet plus KAAA supplementation and extenuating endurance exercise (trained ketogenic diet supplemented with KAAA (TKKa)) increased blood ammonia concentrations by approximately 50 % compared with the control diet (trained control diet supplemented with KAAA (TCKa)) and similar training (effect size=1·33; statistical power=0·50). The KAAA supplementation reduced blood urea concentrations by 4 and 18 % in the control and ketogenic diet groups, respectively, compared with the groups fed the same diets without supplementation. The trained groups had 60 % lower blood urate concentrations after TCKa treatment than after TKKa treatment. Our results suggest that KAAA supplementation can reduce blood ammonia concentrations after extenuating endurance exercise in rats fed a balanced diet but not in rats fed a ketogenic diet.
Leprosy still represents a serious health problem in a number of countries, including Brazil. Although leprosy has been associated with poverty for a long time, it is still difficult to accurately define this relationship. Here, we evaluated in an endemic municipality the progress from 1995 to 2015 of epidemiological indicators to establish if there were any strong associations between social indicators and the occurrence of leprosy. An ecological study was conducted using the SINAN database (Brazilian leprosy-national notifiable diseases information system) in combination with georeferencing of leprosy cases. The georeferencing used the ArcGis programme and occurrence of cases was evaluated in relation to the Health Vulnerability Index (HVI), an indicator that categorises socio-economic and sanitation factors. The data identified a marked decrease in the overall prevalence of leprosy, a reduction in the new case-detection rate and a reduction in the number of cases with grade 2 disabilities (albeit with transient peaks in 2007 and 2015). Logistic regression analysis showed association of detection rates with elevated HVI. Thus, while the epidemiological indicators point to the elimination of leprosy, there is evidence of hidden cases and an association between higher rates of leprosy detection and greater social vulnerability remain.
Reducing the risk of human immunodeficiency virus type 1 (HIV-1) transmission is still a public health priority. The development of effective control strategies relies on the quantification of the effects of prophylactic and therapeutic measures in disease incidence. Although several assays can be used to estimate HIV incidence, these estimates are limited by the poor performance of these assays in distinguishing recent from long-standing infections. To address such limitation, we have developed an assay to titrate p24-specific IgG3 antibodies as a marker of recent infection. The assay is based on a recombinant p24 protein capable to detect total IgG antibodies in sera using a liquid micro array and enzyme-linked immunosorbent assay. Subsequently, the assay was optimised to detect and titrate anti-p24 IgG3 responses in a panel of sequential specimens from seroconverters over 24 months. The kinetics of p24-specific IgG3 titres revealed a transient peak in the 4 to 5-month period after seroconversion. It was followed by a sharp decline, allowing infections with less than 6 months to be distinguished from older ones. The developed assay exhibited a mean duration of recent infection of 144 days and a false-recent rate of ca. 14%. Our findings show that HIV-1 p24-specific IgG3 titres can be used as a tool to evaluate HIV incidence in serosurveys and to monitor the efficacy of vaccines and other transmission control strategies.
In this study, a Leishmania hypothetical protein, LiHyS, was evaluated regarding its antigenicity, immunogenicity and protective efficacy against visceral leishmaniasis (VL). Regarding antigenicity, immunoblottings and an enzyme-linked immunosorbent assay using human and canine sera showed high sensitivity and specificity values for the recombinant protein (rLiHyS) in the diagnosis of VL. When evaluating the immunogenicity of LiHyS, which is possibly located in the parasite's flagellar pocket, proliferative assays using peripheral blood mononuclear cells from healthy subjects or VL patients showed a high proliferative index in both individuals, when compared to the results obtained using rA2 or unstimulated cultures. Later, rLiHyS/saponin was inoculated in BALB/c mice, which were then challenged with Leishmania infantum promastigotes. The vaccine induced an interferon-γ, interleukin (IL)-12 and granulocyte-macrophage colony-stimulating factor production, which was maintained after infection and which was associated with high nitrite and IgG2a antibody levels, as well as low IL-4 and IL-10 production. Significant reductions in the parasite load in liver, spleen, bone marrow and draining lymph nodes were found in these animals. In this context, the present study shows that the rLiHyS has the capacity to be evaluated as a diagnostic marker or vaccine candidate against VL.
Thanks to their point-like structure and to their lack of significant proper motion, quasars represent the ideal objects for modeling quasi-inertial directions in space. For that reason the present primary conventional reference frame, the ICRF-2, is constructed from the set of the celestial coordinates of a sample of extragalactic objects, whose the very large majority are quasars. Thus any newly discovered quasar must be considered as a potential future ideal astrometric marker. Therefore compiling all the recorded quasars at a given epoch looks as a useful task. This constitutes the aim of the LQAC (Large Quasar Astrometric Catalogue). We present here the contents of the future release of this catalogue quoted as the LQAC-4, insisting on the related strategy of compilation. Preliminary results concerning the cross-identification with the Gaia DR1 catalogue are emphasized